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

The facilities payment is planned for providers who wish to develop brand-new dementia care programs and need resources to get begun. 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 receive the Part D low-income subsidy.

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To qualify as a GUIDE safety net provider, a new program applicant must have had a Medicare FFS beneficiary population made up of at least 36% recipients receiving the Part D low-income aid or 33.7% beneficiaries who are dually eligible 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 recipient cost-sharing.

When an aligned beneficiary is re-assessed and appointed to a brand-new tier, the GUIDE Participant will be eligible to bill the G-code for the recognized client payment rate related to that tier the following month. GUIDE Participants that withdraw or are ended before the start of the second performance year will be needed to repay the entire worth of their infrastructure payment to CMS.

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After the second efficiency year, GUIDE Participants that withdraw or are ended from the GUIDE Design are not needed to pay back the infrastructure payment. The main 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 replace fee-for-service payment for some existing Medicare Doctor Charge Set Up (PFS) services, consisting of chronic 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 expense under conventional Medicare fee-for-service for all services that are not consisted of under the DCMP. Additional info, consisting of a complete list of duplicative codes, is readily available in the Ask for Applications (Table 8, pg. 35). CMS may include or eliminate codes with time to show changes in PFS billing codes.

The care group may consist of the recipient's medical care company, and if not, the care group is required to determine and share information with the beneficiary's medical care company and professionals and detail the care coordination services required to manage the recipient's dementia and co-occurring conditions. CMS will supply GUIDE Individuals information associated with the performance measures that CMS utilizes to identify the GUIDE Participant's performance-based change to the DCMP.GUIDE Individuals in the established program track must be prepared to begin providing services under the GUIDE Design on July 1, 2024, and bill for those services throughout the Model Performance Period.

Yes, GUIDE beneficiary and supplier overlap with the Shared Cost savings Program is permitted. The GUIDE Design is developed to be suitable with other CMS designs and programs that aim to enhance care and lower spending. CMS believes targeted assistance for individuals with dementia and their caregivers will assist enhance population-based care results in general.

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The Dementia Care Management Payment (DCMP), the per recipient per month GUIDE payment, will be consisted of in 2024 Shared Cost savings Program expenditures. When 2024 ends up being a benchmark year, DCMPs will be included in Shared Cost savings Program standard estimations. As an example, if an ACO is taking part in both the GUIDE Design and the Shared Savings Program throughout Performance Year 2024 and after that restores and starts a new arrangement period since January 1, 2025, that ACO would have their Shared Cost savings Program criteria based upon 2022, 2023 and 2024, and would have DCMPs counted in Benchmark Year 3. GUIDE Break Service claims will not be counted toward 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 designs or Medicare value-based care efforts to accelerate innovation in care shipment, decrease the expense of care, and improve population health. Individuals and recipients are eligible 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 Break Service declares in the REACH ACOs' overall cost of care expenditures or estimation of shared savings/shared losses.

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

Since January 1, 2025, GUIDE Individuals likewise getting involved in ACO REACH ought to cease billing the Medicare Doctor Cost Set up Solutions consisted of under the DCMP (See Exhibit 5 in the GUIDE Payment Method Paper (PDF)). Participants taking part in both models should follow the GUIDE billing requirements in the GUIDE Participation Agreement and GUIDE Payment Approach Paper.

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The GUIDE Participant need to not bill Medicare separately for the services supplied in the thorough assessment. 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 corresponds to the services rendered.