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Nevertheless, GUIDE Participants have the alternative, and are not required, to provide reprieve through an adult day center or a 24-hour facility. Additional GUIDE Break Providers requirements and information surrounding the payment for such services are defined in the Involvement Agreement. GUIDE Individuals in the brand-new program track that are categorized as safety net service providers will be eligible to get a one-time infrastructure payment of $75,000 (geographically adjusted by the Geographic Adjustment Factor [GAF] to cover some of the upfront expenses of establishing a new dementia care program.

The infrastructure payment is intended for companies who want to establish new dementia care programs and need resources to begin. GUIDE Participants certified as a security net company based on the percentage of their client population that is dually qualified for Medicare and Medicaid or get the Part D low-income subsidy.

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To qualify as a GUIDE security web provider, a brand-new program applicant need to have had a Medicare FFS beneficiary population consisted of at least 36% recipients receiving the Part D low-income aid or 33.7% beneficiaries who are dually eligible for Medicare and Medicaid. Accepting the infrastructure payment was optional. Neither the Dementia Care Management Payment (DCMP) nor GUIDE reprieve services will be subject to beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and assigned to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the established patient payment rate connected with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second performance year will be required to pay back the entire value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not required to pay back the facilities payment. The primary model 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 Physician Cost Arrange (PFS) services, including persistent care management and primary 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 Individuals will continue to expense under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS may include or eliminate codes over time to show modifications in PFS billing codes.

The care group may consist of the recipient's main care service provider, and if not, the care team is required to identify and share info with the beneficiary's main care company and professionals and describe the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Individuals data associated with the efficiency measures that CMS uses to identify the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the recognized program track should be prepared to start providing services under the GUIDE Model on July 1, 2024, and expense for those services throughout the Model Efficiency Period.

Yes, GUIDE recipient and supplier overlap with the Shared Savings Program is allowed. The GUIDE Design is developed to be compatible with other CMS models and programs that intend to improve care and lower spending. CMS thinks targeted assistance for individuals with dementia and their caretakers will help improve population-based care outcomes overall.

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The Dementia Care Management Payment (DCMP), the per recipient each month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenses. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Cost savings Program standard estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Cost Savings Program during Efficiency Year 2024 and after that restores and begins a brand-new arrangement duration since January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. However, GUIDE Reprieve Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking start in 2024 throughout of the GUIDE Design.

GUIDE Individuals might take part in multiple CMS Innovation Center models or Medicare value-based care initiatives to accelerate innovation in care shipment, minimize the expense of care, and enhance population health. Individuals and beneficiaries are eligible to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' overall expense of care expenditures or estimation of shared savings/shared losses.

Overlapping individuals must follow GUIDE billing guidance as set forth below. GUIDE Respite Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals likewise participating in ACO REACH ought to terminate billing the Medicare Doctor Charge Schedule Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Individuals participating in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Individual should not bill Medicare separately for the services supplied in the comprehensive assessment. The comprehensive evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Model, the GUIDE Individual can bill for an appropriate Medicare-covered expert service that represents the services rendered.