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GUIDE Individuals have the alternative, and are not required, to make readily available break through an adult day center or a 24-hour center. Additional GUIDE Reprieve Services requirements and information surrounding the payment for such services are specified in the Participation Arrangement.

The infrastructure payment is intended for providers who wish to establish brand-new dementia care programs and require resources to start. GUIDE Individuals qualified as a safeguard company based upon the percentage of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To qualify as a GUIDE security net supplier, a new program applicant should have had a Medicare FFS recipient population consisted of at least 36% beneficiaries receiving the Part D low-income subsidy or 33.7% beneficiaries who are dually qualified for Medicare and Medicaid. Accepting the facilities payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE break services will undergo recipient cost-sharing.

When a lined up recipient is re-assessed and appointed to a new tier, the GUIDE Individual will be qualified to bill the G-code for the recognized client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd performance year will be needed to pay back the whole value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not required to pay back the infrastructure payment. The primary design payment under the GUIDE Design is a per-beneficiary, per-month care management payment called the Dementia Care Management Payment (DCMP). The DCMP will change fee-for-service payment for some existing Medicare Doctor Fee Set Up (PFS) services, consisting of chronic care management and principal care management, transitional care management, advance care planning, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care design, so GUIDE Participants will continue to costs under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might include or eliminate codes over time to show changes in PFS billing codes.

The care team may consist of the beneficiary's medical care service provider, and if not, the care group is needed to recognize and share details with the recipient's medical care provider and specialists and lay out the care coordination services required to manage the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data associated with the performance determines that CMS uses to figure out the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track need to be prepared to start providing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Design Efficiency Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is allowed. The GUIDE Model is created to be suitable with other CMS models and programs that intend to enhance care and decrease spending. CMS believes targeted support for people with dementia and their caretakers will assist enhance population-based care outcomes overall.

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As an example, if an ACO is participating in both the GUIDE Design and the Shared Cost Savings Program during Performance Year 2024 and then restores and starts a new agreement duration as of January 1, 2025, that ACO would have their Shared Savings Program benchmark based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Participants might participate in multiple CMS Development Center designs or Medicare value-based care initiatives to speed up innovation in care shipment, decrease the expense of care, and enhance population health. Participants and beneficiaries are eligible to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service declares in the REACH ACOs' total expense of care expenditures or calculation of shared savings/shared losses.

Overlapping individuals should follow GUIDE billing assistance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will include DCMP expenditures for functions of alignment computations. GUIDE Respite Service claims will not count towards ACO expenses, shared cost savings, or benchmarking in 2025 and for the duration of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH must cease billing the Medicare Physician Cost Schedule Services included under the DCMP (See Display 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals participating in both models need to follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare individually for the services provided in the extensive assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not eligible for the GUIDE Model, the GUIDE Participant can bill for an appropriate Medicare-covered expert service that represents the services rendered.