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A GUIDE Participant will be a Medicare Part B-enrolled provider or supplier, excluding DME and laboratory suppliers, that establishes a DCP to provide ongoing, longitudinal care to people with dementia.
<aside> đź“Ś The GUIDE Participant must participate under a single, Medicare Part B-enrolled Taxpayer Identification Number (TIN) that is eligible to bill under the PFS.
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The GUIDE Participant will be identified by a single TIN that is used to bill for GUIDE Model services, plus the National Provider Identifiers (NPIs) of individual Medicare-enrolled physicians and other non-physician practitioners who have re-assigned their billing rights to the GUIDE Participant’s billing TIN.
The GUIDE Participant will be required to maintain this list of physicians and non-physician practitioners (“GUIDE Practitioner Roster”) and keep it up to date throughout the course of the GUIDE Model, as it will be used to determine who is eligible to bill for GUIDE Model payments.
A GUIDE Participant must meet the care delivery requirements described in the “Care Delivery” section of this RFA.
If a GUIDE Participant cannot meet the GUIDE care delivery requirements alone, the GUIDE Participant may contract with one or more other providers, suppliers, or organizations, including both Medicare-enrolled and non-Medicare enrolled entities, to meet the care delivery requirements. These providers, suppliers, or organizations will be known as “Partner Organizations.”
For example, a multispecialty practice may contract with a Medicare enrolled home health agency to have an occupational therapist, who is employed by the home health agency, provide some of the required care delivery services.
In another example, a primary care physician may contract with a community-based memory care clinic, that is not a Medicare enrolled provider, in order to provide some of the required care delivery services.
The GUIDE Participant will be expected to maintain a list of Partner Organizations (“Partner Organization Roster”) and keep it up to date throughout the course of the GUIDE Model.
Both Medicare-enrolled and non-Medicare enrolled entities may contract with more than one GUIDE Participant.
In this example, the DCP is established by a multi-specialty practice and model services are billed under the practice’s TIN. The multi-specialty practice meets all care delivery requirements of the GUIDE Model, including in-home GUIDE Respite Services, without a Partner Organization.
In example two, the DCP is established by a geriatrics practice, which is the GUIDE Participant. The geriatrics practice partners with an occupational therapy practice and a home health agency to meet the care delivery requirements of the GUIDE Model. The occupational therapy practice and the home health agency are considered Partner Organizations within the DCP. All model services are billed by the GUIDE Participant, in this case the geriatrics practice’s TIN, and all practitioners must re-assign their billing rights to this TIN.
In example three, a home health agency establishes a new Medicare Part B-enrolled practice for the purposes of participating in GUIDE. The Part B-enrolled practice is the GUIDE Participant, and model services are billed under the practice’s TIN.