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

The infrastructure payment is planned for suppliers who wish to develop new dementia care programs and need resources to get going. GUIDE Individuals qualified as a safeguard company based upon the proportion of their patient population that is dually eligible for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard company, a new program applicant should have had a Medicare FFS beneficiary population comprised of at least 36% recipients getting the Part D low-income subsidy or 33.7% recipients 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 recipient cost-sharing.

When a lined up beneficiary is re-assessed and assigned to a brand-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 terminated before the start of the second efficiency year will be needed to repay the whole 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 needed to repay the infrastructure payment. The main model payment under the GUIDE Model 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 Schedule (PFS) services, consisting of 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 model, so GUIDE Participants will continue to bill under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Extra details, consisting of a complete list of duplicative codes, is available in the Demand for Applications (Table 8, pg. 35). CMS might add or get rid of codes gradually to reflect changes in PFS billing codes.

The care group might consist of the beneficiary's medical care supplier, and if not, the care team is needed to recognize and share information with the recipient's primary care service provider and professionals and detail the care coordination services required to handle the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data connected to the efficiency measures that CMS utilizes to figure out the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Individuals in the recognized program track must be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and expense for those services during the Design Performance Period.

Yes, GUIDE recipient and supplier overlap with the Shared Savings Program is allowed. The GUIDE Design is created to be suitable with other CMS designs and programs that intend to improve care and reduce costs. CMS believes targeted assistance for people with dementia and their caretakers will assist improve population-based care outcomes overall.

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As an example, if an ACO is participating in both the GUIDE Model and the Shared Savings Program during Efficiency Year 2024 and then restores and starts a new contract period as of January 1, 2025, that ACO would have their Shared Savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Break Service claims will not be counted toward ACO expenses, shared cost savings, nor benchmarking beginning in 2024 for the period of the GUIDE Design.

GUIDE Individuals might take part in multiple CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care shipment, reduce the expense of care, and improve 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 include the Dementia Care Management Payment (DCMP) or Break Service claims in the REACH ACOs' total cost of care expenditures or computation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing assistance as set forth below. GUIDE Break Service claims will not count towards ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH should discontinue billing the Medicare Doctor Cost Set up Providers included under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both designs must follow the GUIDE billing requirements in the GUIDE Involvement Agreement and GUIDE Payment Methodology Paper.

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The GUIDE Individual need to not bill Medicare separately for the services provided in the comprehensive evaluation. The extensive assessment (and any re-assessments) is covered by the DCMP. If CMS determines the beneficiary is not qualified for the GUIDE Model, the GUIDE Participant can bill for a proper Medicare-covered expert service that represents the services rendered.