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However, GUIDE Individuals have the choice, and are not required, to offer reprieve through an adult day center or a 24-hour facility. Extra GUIDE Reprieve Providers requirements and information surrounding the payment for such services are specified in the Involvement Arrangement. GUIDE Participants in the new program track that are categorized as safety net service providers will be eligible to receive a one-time facilities payment of $75,000 (geographically changed by the Geographic Adjustment Factor [GAF] to cover some of the upfront expenses of developing a brand-new dementia care program.

The infrastructure payment is intended for providers who wish to establish brand-new dementia care programs and require resources to start. GUIDE Participants qualified as a safeguard supplier based on the percentage of their patient population that is dually eligible for Medicare and Medicaid or get the Part D low-income aid.

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To qualify as a GUIDE safety net supplier, a brand-new program candidate should have had a Medicare FFS beneficiary population consisted of a minimum of 36% recipients receiving the Part D low-income aid 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 be subject to beneficiary cost-sharing.

When an aligned beneficiary is re-assessed and designated to a new tier, the GUIDE Individual will be qualified to bill the G-code for the established patient payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second efficiency year will be needed to repay the whole worth of their facilities payment to CMS.

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After the second performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not needed to repay the facilities payment. The main 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 Charge 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 bill under traditional Medicare fee-for-service for all services that are not consisted of under the DCMP. CMS might include or get rid of codes over time to show modifications in PFS billing codes.

The care team might consist of the beneficiary's primary care service provider, and if not, the care team is required to identify and share details with the recipient's medical care provider and professionals and lay out the care coordination services needed to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals data associated with the performance determines that CMS utilizes to identify the GUIDE Participant's performance-based modification to the DCMP.GUIDE Individuals in the recognized program track must be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Design Performance Duration.

Yes, GUIDE recipient and company overlap with the Shared Cost savings Program is permitted. The GUIDE Model is created to be suitable with other CMS designs and programs that aim to improve care and lower costs. CMS believes targeted support for individuals with dementia and their caretakers will help improve population-based care results overall.

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As an example, if an ACO is getting involved in both the GUIDE Design and the Shared Savings Program throughout Efficiency Year 2024 and then restores and begins a 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 Benchmark Year 3. GUIDE Break Service claims will not be counted towards ACO expenses, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in numerous CMS Innovation Center models or Medicare value-based care efforts to accelerate innovation in care delivery, minimize the cost of care, and enhance population health. Participants and recipients 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 expenses or estimation of shared savings/shared losses.

Overlapping individuals need to follow GUIDE billing guidance as stated below. ACO REACH claim decreases will not apply to DCMP. ACO REACH will consist of DCMP expenditures for functions of positioning calculations. However, GUIDE Respite Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and throughout of the GUIDE Model.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH ought to stop billing the Medicare Doctor Cost Set up Providers consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Individuals taking part in both designs should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Method Paper.

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The GUIDE Individual should not bill Medicare individually for the services supplied in the detailed evaluation. The extensive evaluation (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 suitable Medicare-covered professional service that corresponds to the services rendered.