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Nevertheless, GUIDE Participants have the option, and are not required, to provide respite through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Services requirements and details surrounding the payment for such services are defined in the Involvement Arrangement. GUIDE Participants in the brand-new program track that are categorized as safeguard suppliers will be eligible to get a one-time facilities payment of $75,000 (geographically adjusted by the Geographic Change Factor [GAF] to cover some of the upfront costs of establishing a new dementia care program.

The infrastructure payment is intended for providers who want to develop brand-new dementia care programs and require resources to get started. GUIDE Individuals qualified as a safeguard service provider based on the percentage 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 qualify as a GUIDE security net supplier, a new program applicant should have had a Medicare FFS beneficiary population comprised of a minimum of 36% beneficiaries receiving the Part D low-income aid or 33.7% recipients who are dually qualified for Medicare and Medicaid. Accepting the facilities 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 Individual will be eligible to bill the G-code for the recognized client payment rate connected with that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be required to repay the entire value of their infrastructure payment to CMS.

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After the 2nd efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not required 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 replace fee-for-service payment for some existing Medicare Doctor Fee Set Up (PFS) services, consisting of persistent care management and principal care management, transitional care management, advance care planning, and technology-based check-ins.

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The GUIDE Design is not a total-cost-of-care model, so GUIDE Individuals will continue to costs under standard Medicare fee-for-service for all services that are not included under the DCMP. Extra details, consisting of a complete list of duplicative codes, is available in the Ask for Applications (Table 8, pg. 35). CMS might include or remove codes in time to reflect changes in PFS billing codes.

The care group may include the recipient's main care provider, and if not, the care team is required to recognize and share info with the recipient's main care service provider and experts and outline the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will provide GUIDE Participants data connected to the performance determines that CMS utilizes to figure out the GUIDE Participant's performance-based modification to the DCMP.GUIDE Participants in the established program track should be prepared to begin providing services under the GUIDE Design on July 1, 2024, and bill for those services during the Model Efficiency Duration.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Design is developed to be suitable with other CMS models and programs that intend to enhance care and reduce spending. CMS believes targeted support for individuals with dementia and their caretakers will assist enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be consisted of in 2024 Shared Savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Savings Program standard computations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program during Performance Year 2024 and after that restores and begins a brand-new arrangement period as of January 1, 2025, that ACO would have their Shared Cost savings Program standard based on 2022, 2023 and 2024, and would have DCMPs counted in Standard Year 3. Nevertheless, GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 throughout of the GUIDE Model.

GUIDE Individuals might take part in several CMS Innovation Center designs or Medicare value-based care efforts to speed up development in care shipment, minimize the cost of care, and improve population health. Participants and recipients are qualified to take part in the GUIDE Model and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Respite Service claims in the REACH ACOs' overall expense of care expenses 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 toward ACO expenses, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals also participating in ACO REACH must stop billing the Medicare Doctor Cost Schedule Solutions included under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants getting involved in both models need to follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare independently for the services supplied in the detailed assessment. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS determines the recipient is not qualified for the GUIDE Design, the GUIDE Participant can bill for a proper Medicare-covered expert service that corresponds to the services rendered.