Do GUIDE payments get added to MSSP expenditures?

Most GUIDE payments are excluded from Medicare Shared Savings Program (MSSP) expenditures. The Dementia Care Management Payment (DCMP), a flat monthly payment under the GUIDE model, does not count toward MSSP spending or shared savings during the performance year.

However, if a GUIDE performance year is later used to establish MSSP benchmarks, DCMPs may be included in those calculations.

How the Models Interact Financially

The GUIDE Model supports Medicare beneficiaries living with dementia through care coordination, navigation, and caregiver support. Its payments operate independently from the MSSP’s shared savings structure.

While DCMPs are excluded from current-year MSSP spending, CMS may incorporate them into future benchmark years, which serve as the spending baseline for measuring savings performance.

In other words, GUIDE participation may affect future MSSP benchmarks but not the actual shared savings calculations for the current year.

Respite Services Are Always Carved Out

Regardless of performance or benchmark year, GUIDE Respite Services—short-term relief for caregivers—are fully excluded from MSSP expenditures. These claims are invisible to MSSP for both performance and benchmark purposes.

How Medisolv Helps

Medisolv’s APP Reporting Package simplifies complex reporting and compliance processes by:

• Automating data aggregation across multiple care models

• Streamlining compliance workflows to ensure accurate, timely submissions

By reducing administrative burden and providing real-time visibility, Medisolv enables your organization to focus on delivering exceptional patient care while keeping up with evolving CMS models.

Want to learn more? Check out these Medisolv resources to better understand how models like MSSP and GUIDE fit within Medicare’s evolving quality programs.

• MSSP ACO QPP 2023 Requirements
• APM Performance Pathway (APP) Reporting Package | Medisolv 
• Medicare QPP: What it is, MIPS vs APMs, & How Medisolv Can Help