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A beneficiary is qualified to get services under the GUIDE Design if they fulfill the following criteria: Has dementia, as validated by attestation from a clinician on the GUIDE Participant's GUIDE Practitioner Roster; Is registered in Medicare Components A and B (not registered in Medicare Benefit, including Unique Needs Plans, or rate programs) and has Medicare as their primary payer; Has not chosen the Medicare hospice advantage, and; Is not a long-lasting nursing home resident.

The table below shows a description of the five tiers. GUIDE Participants will report data on disease stage and caretaker status to CMS when a recipient is first aligned to an individual in the model. To ensure consistent recipient project to tiers across design individuals, GUIDE Participants must use a tool from a set of approved screening and measurement tools to measure dementia stage and caregiver concern.

GUIDE Participants need to notify recipients about the design and the services that beneficiaries can receive through the model, and they must record that a recipient or their legal representative, if relevant, approvals to receiving services from them. GUIDE Participants should then submit the consenting beneficiary's information to CMS and, within 15 days, CMS will confirm whether the beneficiary fulfills the design eligibility requirements before aligning the recipient to the GUIDE Participant.

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For a person with Medicare to receive services under the design, they should meet particular eligibility requirements. They will likewise require to discover a health care provider that is taking part in the GUIDE Model in their community. CMS will release a list of GUIDE Participants on the GUIDE site in Summer 2024.

For instant help, please find the list below resources: and . You may also contact 1-800-MEDICARE for specific information on concerns concerning Medicare benefits. For the purposes of the GUIDE Design, a caretaker is defined as a relative, or overdue nonrelative, who assists the recipient with activities of daily living and/or important activities of daily living.

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

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They may confirm that they have received a written report of a documented dementia diagnosis from another Medicare-enrolled professional. When a beneficiary is voluntarily lined up to a GUIDE Participant, the GUIDE Participant should attach a qualified ICD-10 dementia medical diagnosis code to each Dementia Care Management Payment (DCMP) monthly claim in order for it to be paid by CMS.The approved screening tools consist of 2 tools to report dementia stage the Clinical Dementia Ranking (CDR) or the Practical Assessment Screening Tool (QUICK) and one tool to report caretaker pressure, the Zarit Burden Interview (ZBI).

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GUIDE Individuals have the choice to seek CMS approval to use an alternative screening tool by sending the proposed tool, in addition to published proof that it stands and trustworthy and a crosswalk for how it represents the design's tiering thresholds. CMS has full discretion on whether it will accept the proposed alternative tool.

The GUIDE Design requires Care Navigators to be trained to deal with caregivers in recognizing and managing common behavioral changes due to dementia. GUIDE Participants will likewise assess the recipient's behavioral health as part of the detailed assessment and offer recipients and their caregivers with 24/7 access to a care employee or helpline.

For example, a lined up recipient would be considered disqualified if they no longer fulfill several of the beneficiary eligibility requirements. This might occur, for example, if the recipient ends up being a long-term nursing home resident, registers in Medicare Advantage, or stops receiving the GUIDE care delivery services from the GUIDE Individual (e.g., because they vacate the program service location, no longer wish to be aligned to the GUIDE Individual, or can not be contacted/are lost to follow-up). The GUIDE Model is not a total cost of care model and does not have requirements around specific drug treatments.

GUIDE Participants will be permitted to modify their service area throughout the period of the Model. The GUIDE Individual will recognize the beneficiary's main caregiver and evaluate the caregiver's understanding, requires, wellness, stress level, and other difficulties, consisting of reporting caregiver stress to CMS utilizing the Zarit Burden Interview.

The GUIDE Model is not a shared cost savings or overall expense of care design, it is a condition-specific longitudinal care design. In general, GUIDE Model participants will be paid a regular monthly dementia care management payment (DCMP) for each recipient. The GUIDE Design is developed to be compatible with other CMS accountable care designs and programs (e.g., ACOs and advanced primary care designs) that provide health care entities with chances to enhance care and decrease costs.

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DCMP rates will be geographically adjusted in addition to an Efficiency Based Modification (PBA) to incentivize premium care. The GUIDE Design will also spend for a defined amount of reprieve services for a subset of design recipients. Design individuals will use a set of new G-codes developed for the GUIDE Design to send claims for the month-to-month DCMP and the break codes.

Reprieve services will be paid up to an annual cap of $2,500 per beneficiary and will vary in system costs based on the type of break service utilized. Yes, the month-to-month rates by tier are readily available below.(New Patient Payment Rate)$150$275$360$230$390(Established Patient Payment Rate)$65$120$220$120$215GUIDE Individuals are accountable for paying Partner Organizations for GUIDE care shipment services that the Partner Organization offers to the GUIDE Individual's aligned recipients.

GUIDE Individuals and Partner Organizations will determine a payment arrangement and GUIDE Individuals must have agreements in location with their Partner Organizations to show this payment arrangement. GUIDE Individuals will likewise be anticipated to keep a list of Partner Organizations ("Partner Company Roster") and upgrade it as changes are made throughout the course of the GUIDE Design.