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GUIDE Individuals have the choice, and are not required, to make readily available reprieve through an adult day center or a 24-hour facility. Additional GUIDE Break Providers requirements and information surrounding the payment for such services are defined in the Involvement Agreement.

The facilities payment is intended for companies who wish to establish brand-new dementia care programs and need resources to start. GUIDE Participants certified as a security net service provider based upon the proportion 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 safeguard supplier, a new program candidate should have had a Medicare FFS recipient population consisted of at least 36% beneficiaries getting the Part D low-income subsidy 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 break services will be subject to beneficiary cost-sharing.

When an aligned recipient is re-assessed and designated to a new tier, the GUIDE Participant will be eligible to bill the G-code for the established client payment rate associated with that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the second efficiency year will be required to pay back the entire value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Individuals that withdraw or are terminated from the GUIDE Design are not needed 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 change fee-for-service payment for some existing Medicare Doctor Fee Arrange (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 design, so GUIDE Participants will continue to expense under standard Medicare fee-for-service for all services that are not included under the DCMP. Additional info, including a total list of duplicative codes, is available in the Demand for Applications (Table 8, pg. 35). CMS may include or get rid of codes with time to show modifications in PFS billing codes.

The care group might consist of the recipient's medical care service provider, and if not, the care team is required to determine and share info with the beneficiary's medical care service provider and specialists and lay out the care coordination services needed to manage the beneficiary's dementia and co-occurring conditions. CMS will offer GUIDE Participants data associated with the performance determines that CMS uses to figure out the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track need to be prepared to start furnishing services under the GUIDE Design on July 1, 2024, and bill for those services during the Design Performance Period.

Yes, GUIDE recipient and provider overlap with the Shared Cost savings Program is permitted. The GUIDE Design is designed to be compatible with other CMS models and programs that intend to enhance care and decrease spending. CMS believes targeted assistance for individuals with dementia and their caretakers will help improve population-based care outcomes in general.

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The Dementia Care Management Payment (DCMP), the per beneficiary per month GUIDE payment, will be included in 2024 Shared Cost savings Program expenditures. When 2024 becomes a benchmark year, DCMPs will be consisted of in Shared Savings Program criteria computations. As an example, if an ACO is taking part in both the GUIDE Model and the Shared Cost Savings Program throughout Performance Year 2024 and after that renews and starts a brand-new contract duration as of 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. However, GUIDE Break Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Design.

GUIDE Participants might participate in several CMS Development Center models or Medicare value-based care initiatives to speed up development in care delivery, decrease the expense of care, and improve population health. Individuals and recipients are eligible 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 Reprieve Service declares in the REACH ACOs' total cost of care expenses or calculation of shared savings/shared losses.

Overlapping participants ought to follow GUIDE billing guidance as set forth listed below. GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Model.

As of January 1, 2025, GUIDE Participants likewise participating in ACO REACH ought to discontinue billing the Medicare Doctor Fee Schedule Services included under the DCMP (See Exhibition 5 in the GUIDE Payment Approach Paper (PDF)). Individuals taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Involvement Contract and GUIDE Payment Method Paper.

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The GUIDE Individual need to not bill Medicare independently for the services provided in the detailed evaluation. The detailed assessment (and any re-assessments) is covered by the DCMP. If CMS figures out the beneficiary is not qualified for the GUIDE Design, the GUIDE Individual can bill for a proper Medicare-covered professional service that represents the services rendered.