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GUIDE Individuals have the alternative, and are not required, to make offered respite through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Providers requirements and information surrounding the payment for such services are defined in the Participation Arrangement.

The facilities payment is meant for service providers who want to develop brand-new dementia care programs and require resources to get started. GUIDE Individuals certified as a safeguard service provider based upon the proportion of their client population that is dually eligible for Medicare and Medicaid or receive the Part D low-income subsidy.

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To certify as a GUIDE safeguard provider, a brand-new program candidate need to have had a Medicare FFS beneficiary population comprised of a minimum of 36% recipients getting the Part D low-income subsidy 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 go through beneficiary cost-sharing.

When a lined up beneficiary is re-assessed and designated to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd efficiency year will be required to repay the whole worth of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Individuals that withdraw or are ended from the GUIDE Model are not needed to repay the facilities 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 preparation, and technology-based check-ins.

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The GUIDE Design is not a total-cost-of-care design, so GUIDE Individuals will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. Additional information, including a total list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS may add or get rid of codes with time to reflect modifications in PFS billing codes.

The care group may consist of the beneficiary's main care provider, and if not, the care team is needed to determine and share information with the beneficiary's medical care provider and experts and outline the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data connected to the performance measures that CMS uses to identify the GUIDE Participant's performance-based modification 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 bill for those services throughout the Design Efficiency Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Cost savings Program is allowed. The GUIDE Model is developed to be compatible with other CMS designs and programs that intend to improve care and reduce spending. CMS believes targeted assistance for individuals with dementia and their caregivers will assist improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary each month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Cost savings Program benchmark calculations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program during Performance Year 2024 and after that renews and begins a brand-new arrangement period as of January 1, 2025, that ACO would have their Shared Savings Program criteria 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 cost savings, nor benchmarking start in 2024 throughout of the GUIDE Design.

GUIDE Participants may participate in multiple CMS Development Center models or Medicare value-based care initiatives to accelerate innovation in care shipment, reduce the cost of care, and enhance population health. Individuals and beneficiaries are eligible to get involved 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 Reprieve Service claims in the REACH ACOs' total expense of care expenditures or computation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Participants likewise participating in ACO REACH ought to discontinue billing the Medicare Physician Charge Schedule Services consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both designs must follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Method Paper.

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The GUIDE Individual must not bill Medicare separately for the services supplied in the extensive evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the recipient is not eligible for the GUIDE Model, the GUIDE Individual can bill for a proper Medicare-covered professional service that corresponds to the services rendered.