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GUIDE Participants have the option, and are not required, to make readily available break through an adult day center or a 24-hour center. Additional GUIDE Respite Solutions requirements and details surrounding the payment for such services are specified in the Participation Arrangement.

The infrastructure payment is meant for suppliers who wish to establish new dementia care programs and need resources to get started. GUIDE Individuals qualified as a safety net company based on the proportion of their patient 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 security web company, a brand-new program applicant need to have had a Medicare FFS beneficiary population made up of at least 36% beneficiaries 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 respite services will go through beneficiary cost-sharing.

When an aligned recipient is re-assessed and appointed to a brand-new tier, the GUIDE Individual will be eligible to bill the G-code for the established client payment rate related to that tier the following month. GUIDE Participants that withdraw or are terminated before the start of the 2nd performance year will be needed to pay back the whole worth of their facilities payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are terminated from the GUIDE Model are not needed to pay back the facilities payment. The primary design 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 Doctor Cost Set Up (PFS) services, including chronic care management and primary care management, transitional care management, advance care preparation, 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 conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS might add or get rid of codes over time to reflect modifications in PFS billing codes.

The care group may consist of the recipient's medical care company, and if not, the care group is needed to recognize and share info with the recipient's medical care company and specialists and detail the care coordination services required to handle the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Participants data associated with the performance determines that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Participants in the established program track must be prepared to begin furnishing services under the GUIDE Design on July 1, 2024, and expense for those services throughout the Design Efficiency Duration.

Yes, GUIDE beneficiary and provider overlap with the Shared Cost savings Program is allowed. The GUIDE Design is developed to be compatible with other CMS designs and programs that intend to enhance care and decrease spending. CMS believes targeted assistance for individuals with dementia and their caregivers will help improve population-based care results in general.

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As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Efficiency Year 2024 and then renews and starts a new agreement period 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 Standard Year 3. GUIDE Respite Service claims will not be counted towards ACO expenditures, shared savings, nor benchmarking beginning in 2024 for the duration of the GUIDE Design.

GUIDE Individuals may take part in multiple CMS Development Center models or Medicare value-based care efforts to accelerate development in care delivery, minimize the cost of care, and improve population health. Participants and recipients are qualified to take part in the GUIDE Design and the ACO REACH Design. For the rest of CY 2024, ACO REACH will not include the Dementia Care Management Payment (DCMP) or Reprieve Service declares in the REACH ACOs' overall expense of care expenses or calculation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as stated listed below. ACO REACH claim decreases will not use to DCMP. ACO REACH will include DCMP expenditures for purposes of alignment computations. GUIDE Reprieve Service claims will not count toward ACO expenditures, shared savings, or benchmarking in 2025 and for the duration of the GUIDE Model.

Since January 1, 2025, GUIDE Participants also taking part in ACO REACH should discontinue billing the Medicare Doctor Cost Schedule Solutions consisted of under the DCMP (See Exhibition 5 in the GUIDE Payment Methodology Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Arrangement and GUIDE Payment Approach Paper.

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The GUIDE Individual should not bill Medicare individually for the services offered in the detailed assessment. The extensive evaluation (and any re-assessments) is covered by the DCMP. If CMS identifies the beneficiary is not qualified for the GUIDE Design, the GUIDE Participant can bill for a suitable Medicare-covered professional service that represents the services rendered.