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GUIDE Participants have the choice, and are not required, to make available reprieve through an adult day center or a 24-hour center. Extra GUIDE Reprieve Solutions requirements and details surrounding the payment for such services are specified in the Participation Agreement.

The infrastructure payment is intended for service providers who wish to develop new dementia care programs and need resources to begin. GUIDE Individuals certified as a security net provider based upon the proportion of their patient population that is dually qualified for Medicare and Medicaid or receive the Part D low-income subsidy.

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To qualify as a GUIDE security internet supplier, a new program applicant must have had a Medicare FFS recipient population consisted of a minimum of 36% beneficiaries receiving the Part D low-income subsidy 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 go through recipient cost-sharing.

When an aligned recipient is re-assessed and assigned to a brand-new tier, the GUIDE Participant will be qualified to bill the G-code for the recognized patient payment rate related to that tier the following month. GUIDE Individuals that withdraw or are ended before the start of the 2nd efficiency year will be needed to repay the whole value of their facilities payment to CMS.

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After the 2nd performance year, GUIDE Participants that withdraw or are ended from the GUIDE Model are not required to repay the facilities 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 Doctor Fee Set Up (PFS) services, consisting of persistent care management and principal 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 Participants will continue to bill under conventional Medicare fee-for-service for all services that are not included under the DCMP. CMS may include or eliminate codes over time to show modifications in PFS billing codes.

The care group may include the recipient's primary care provider, and if not, the care team is required to determine and share details with the recipient's medical care company and experts and detail the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will provide GUIDE Participants data related to the performance measures that CMS uses to identify the GUIDE Individual's performance-based adjustment to the DCMP.GUIDE Participants in the established program track ought to be prepared to start providing services under the GUIDE Model on July 1, 2024, and costs for those services throughout the Design Performance Period.

Yes, GUIDE recipient and service provider overlap with the Shared Savings Program is permitted. The GUIDE Model is developed to be suitable with other CMS designs and programs that intend to enhance care and decrease spending. CMS thinks targeted assistance for people with dementia and their caregivers will help enhance population-based care results overall.

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As an example, if an ACO is getting involved in both the GUIDE Model and the Shared Savings Program throughout Efficiency Year 2024 and then renews and starts a brand-new agreement duration 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 Respite Service claims will not be counted towards ACO expenditures, shared cost savings, nor benchmarking start in 2024 for the duration of the GUIDE Model.

GUIDE Participants might take part in numerous CMS Development Center designs or Medicare value-based care initiatives to accelerate innovation in care shipment, decrease the cost of care, and enhance population health. Participants and recipients are qualified to take part in the GUIDE Design and the ACO REACH Model. For the rest of CY 2024, ACO REACH will not consist of the Dementia Care Management Payment (DCMP) or Break Service declares in the REACH ACOs' overall cost of care expenditures or computation of shared savings/shared losses.

Overlapping participants should follow GUIDE billing assistance as stated below. ACO REACH claim reductions will not use to DCMP. ACO REACH will consist of DCMP expenditures for functions of alignment computations. GUIDE Break Service claims will not count toward ACO expenditures, shared cost savings, or benchmarking in 2025 and for the period of the GUIDE Design.

Since January 1, 2025, GUIDE Individuals likewise taking part in ACO REACH ought to terminate billing the Medicare Doctor Fee Set up Services included under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both designs need to follow the GUIDE billing requirements in the GUIDE Participation Contract and GUIDE Payment Methodology Paper.

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The GUIDE Participant need to not bill Medicare individually for the services supplied in the thorough assessment. The extensive assessment (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.