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A beneficiary is qualified to get services under the GUIDE Design if they meet the following requirements: Has dementia, as verified by attestation from a clinician on the GUIDE Individual's GUIDE Professional Lineup; Is enrolled in Medicare Parts A and B (not enrolled in Medicare Benefit, including Unique Requirements Plans, or PACE programs) and has Medicare as their main payer; Has not chosen the Medicare hospice benefit, and; Is not a long-term nursing home resident.

The table listed below programs a description of the five tiers. GUIDE Participants will report data on illness phase and caretaker status to CMS when a recipient is first aligned to an individual in the design. To make sure constant recipient task to tiers across model participants, GUIDE Participants need to use a tool from a set of approved screening and measurement tools to measure dementia phase and caretaker problem.

GUIDE Participants must inform beneficiaries about the design and the services that beneficiaries can get through the design, and they need to record that a beneficiary or their legal agent, if appropriate, grant getting services from them. GUIDE Individuals need to then send the consenting beneficiary's information to CMS and, within 15 days, CMS will verify whether the recipient satisfies the design eligibility requirements before lining up the recipient to the GUIDE Individual.

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For a person with Medicare to receive services under the design, they must fulfill certain eligibility requirements. They will also require to discover a health care service provider that is taking part in the GUIDE Design in their neighborhood. CMS will release a list of GUIDE Participants on the GUIDE site in Summertime 2024.

For instant assistance, please discover the following resources: and . You may also get in touch with 1-800-MEDICARE for specific info on concerns regarding Medicare benefits. For the purposes of the GUIDE Design, a caregiver is defined as a relative, or unpaid nonrelative, who helps the beneficiary with activities of daily living and/or important activities of everyday living.

People with Medicare need to have dementia to be qualified for voluntary positioning to a GUIDE Participant and may be at any phase of dementiamild, moderate, or serious. When a person with Medicare is first evaluated for the GUIDE Design, CMS will depend on clinician attestation rather than the existence of ICD-10 dementia medical diagnosis codes on previous Medicare claims.

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Alternatively, they may confirm that they have actually gotten a written report of a recorded dementia medical diagnosis from another Medicare-enrolled practitioner. Once a beneficiary is voluntarily lined up to a GUIDE Individual, the GUIDE Individual should attach an eligible ICD-10 dementia medical diagnosis code to each Dementia Care Management Payment (DCMP) regular monthly claim in order for it to be paid by CMS.The approved screening tools include 2 tools to report dementia phase the Medical Dementia Rating (CDR) or the Functional Assessment Screening Tool (QUICKLY) and one tool to report caregiver pressure, the Zarit Concern Interview (ZBI).

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GUIDE Participants have the option to seek CMS approval to use an alternative screening tool by submitting the proposed tool, along with published proof that it is valid and trusted and a crosswalk for how it represents the model's tiering limits. CMS has complete discretion on whether it will accept the proposed option tool.

The GUIDE Design needs Care Navigators to be trained to work with caretakers in recognizing and managing common behavioral modifications due to dementia. GUIDE Participants will also examine the beneficiary's behavioral health as part of the detailed assessment and supply recipients and their caretakers with 24/7 access to a care staff member or helpline.

An aligned recipient would be considered disqualified if they no longer fulfill one or more of the beneficiary eligibility requirements. This might take place, for example, if the recipient becomes a long-term assisted living home homeowner, registers in Medicare Advantage, or stops getting the GUIDE care delivery services from the GUIDE Individual (e.g., because they move out of the program service location, no longer wish to be lined up to the GUIDE Participant, or can not be contacted/are lost to follow-up). The GUIDE Model is not a total expense of care design and does not have requirements around particular drug treatments.

GUIDE Participants will be allowed to modify their service area throughout the period of the Design. Applicants may pick a service area of any size as long as they will be able to supply all of the GUIDE Care Shipment Solutions to recipients in the identified service areas. Beneficiaries who reside in assisted living settings might receive positioning to a GUIDE Individual supplied they meet all other eligibility requirements. The GUIDE Participant will identify the beneficiary's main caretaker and assess the caretaker's understanding, needs, wellness, tension level, and other obstacles, consisting of reporting caretaker strain to CMS using the Zarit Problem Interview.

The GUIDE Model is not a shared savings or total expense of care model, it is a condition-specific longitudinal care model. In basic, GUIDE Design individuals will be paid a month-to-month dementia care management payment (DCMP) for each recipient. The GUIDE Model is created to be compatible with other CMS liable care models and programs (e.g., ACOs and advanced main care designs) that provide healthcare entities with chances to enhance care and lower spending.

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DCMP rates will be geographically adjusted along with an Efficiency Based Change (PBA) to incentivize high-quality care. The GUIDE Design will also pay for a specified amount of reprieve services for a subset of model recipients. Design individuals will use a set of brand-new G-codes created for the GUIDE Design to send claims for the month-to-month DCMP and the break codes.

Respite services will be paid up to a yearly cap of $2,500 per beneficiary and will vary in unit costs based on the kind of break service used. Yes, the month-to-month rates by tier are readily available listed below.(New Patient Payment Rate)$150$275$360$230$390(Developed Client Payment Rate)$65$120$220$120$215GUIDE Participants are accountable for paying Partner Organizations for GUIDE care shipment services that the Partner Organization provides to the GUIDE Individual's aligned recipients.

GUIDE Participants and Partner Organizations will identify a payment arrangement and GUIDE Individuals should have contracts in location with their Partner Organizations to reflect this payment plan. GUIDE Individuals will also be expected to maintain a list of Partner Organizations ("Partner Organization Lineup") and update it as changes are made throughout the course of the GUIDE Model.