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GUIDE Individuals have the choice, and are not required, to make offered break through an adult day center or a 24-hour facility. Additional GUIDE Break Solutions requirements and details surrounding the payment for such services are defined in the Involvement Arrangement.

The infrastructure payment is planned for suppliers who desire to establish new dementia care programs and need resources to begin. GUIDE Individuals certified as a security net company based on the percentage of their client population that is dually qualified for Medicare and Medicaid or receive the Part D low-income aid.

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To certify as a GUIDE safeguard supplier, a new program applicant should have had a Medicare FFS beneficiary population made up of a minimum of 36% recipients receiving the Part D low-income aid or 33.7% recipients who are dually qualified 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 appointed to a new tier, the GUIDE Individual will be eligible to bill the G-code for the recognized client payment rate related to that tier the following month. GUIDE Individuals that withdraw or are terminated before the start of the second performance year will be required to pay back the entire worth of their infrastructure payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are terminated from the GUIDE Design are not needed 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 replace fee-for-service payment for some existing Medicare Doctor Cost Arrange (PFS) services, including chronic care management and primary 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 expense under standard Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional details, including a total list of duplicative codes, is offered in the Ask for Applications (Table 8, pg. 35). CMS might add or get rid of codes gradually to show changes in PFS billing codes.

The care group might include the recipient's main care service provider, and if not, the care group is required to recognize and share information with the recipient's primary care company and professionals and lay out the care coordination services needed to handle the beneficiary's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the performance measures that CMS uses to figure out the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the recognized program track ought to be prepared to begin providing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Design Efficiency Period.

Yes, GUIDE recipient and service provider overlap with the Shared Cost savings Program is permitted. The GUIDE Model is designed to be suitable with other CMS designs and programs that intend to improve care and minimize costs. CMS thinks targeted assistance for individuals with dementia and their caretakers will assist enhance population-based care results overall.

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The Dementia Care Management Payment (DCMP), the per beneficiary monthly GUIDE payment, will be included in 2024 Shared Savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be included in Shared Savings Program criteria calculations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and after that renews and starts a brand-new agreement duration as of January 1, 2025, that ACO would have their Shared Cost savings Program criteria based on 2022, 2023 and 2024, and would have DCMPs counted in Criteria Year 3. GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Individuals might take part in multiple CMS Development Center designs or Medicare value-based care initiatives to speed up development in care shipment, reduce the expense of care, and enhance population health. Participants and beneficiaries are qualified to take part in the GUIDE Model and the ACO REACH Model. 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 cost of care expenditures or calculation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH should cease billing the Medicare Physician Fee Schedule Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Method Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Methodology Paper.

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The GUIDE Individual must not bill Medicare individually for the services provided in the extensive assessment. The thorough assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not eligible for the GUIDE Model, the GUIDE Individual can bill for a proper Medicare-covered expert service that represents the services rendered.