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GUIDE Individuals have the alternative, and are not required, to make offered reprieve through an adult day center or a 24-hour center. Additional GUIDE Break Solutions requirements and information surrounding the payment for such services are specified in the Participation Agreement.

The facilities payment is intended for service providers who wish to develop brand-new dementia care programs and require resources to get going. GUIDE Individuals qualified as a safety net service provider based upon the proportion 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 qualify as a GUIDE security web supplier, a new program candidate need to have had a Medicare FFS recipient population consisted of at least 36% recipients receiving 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 break services will go through recipient cost-sharing.

When an aligned recipient is re-assessed and appointed to a 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 performance year will be required to repay the whole worth of their facilities 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 infrastructure payment. The primary 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 replace fee-for-service payment for some existing Medicare Physician Fee Schedule (PFS) services, including persistent care management and principal care management, transitional care management, advance care preparation, and technology-based check-ins.

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The GUIDE Model is not a total-cost-of-care model, so GUIDE Individuals will continue to costs under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS might include or remove codes over time to reflect modifications in PFS billing codes.

The care team might include the recipient's main care provider, and if not, the care group is required to determine and share details with the recipient's main care company and specialists and describe the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will offer GUIDE Participants information related to the performance determines that CMS uses to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the recognized program track must be prepared to begin furnishing services under the GUIDE Model on July 1, 2024, and bill for those services during the Design Efficiency Period.

Yes, GUIDE beneficiary and service provider overlap with the Shared Cost savings Program is enabled. The GUIDE Design is created to be compatible with other CMS designs and programs that aim to enhance care and minimize costs. CMS thinks targeted support for people with dementia and their caregivers will help enhance 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 Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program benchmark computations. As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Cost Savings Program throughout Efficiency Year 2024 and then renews and begins a new contract period since January 1, 2025, that ACO would have their Shared Savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. Nevertheless, GUIDE Reprieve Service claims will not be counted towards ACO expenses, shared savings, nor benchmarking beginning in 2024 throughout of the GUIDE Model.

GUIDE Participants may participate in several CMS Development Center designs or Medicare value-based care initiatives to accelerate development in care shipment, decrease the cost of care, and enhance population health. Individuals and recipients are eligible to take part in the GUIDE Model and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Respite Service declares in the REACH ACOs' total expense of care expenditures or computation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Individuals also taking part in ACO REACH should stop billing the Medicare Doctor Fee Schedule Providers consisted of under the DCMP (See Display 5 in the GUIDE Payment Approach Paper (PDF)). Participants taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Method Paper.

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The GUIDE Participant should not bill Medicare individually for the services supplied in the comprehensive evaluation. The detailed evaluation (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Model, the GUIDE Participant can bill for a suitable Medicare-covered expert service that represents the services rendered.