Frequently Asked Questions

The ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) is a CMS Innovation Center program that tests outcome-aligned payments in Original Medicare. It expands access to technology-supported care options that help people improve their health and manage chronic conditions including hypertension, diabetes, chronic pain, and depression/anxiety.

The ACCESS Model begins July 5, 2026 and runs for 10 years through June 30, 2036. Applications for the first performance period must be submitted by April 1, 2026.

Yes, participation in the ACCESS Model is completely voluntary for both organizations and patients. Organizations choose to apply and participate, and Medicare beneficiaries choose whether to enroll with ACCESS care organizations.

ACCESS focuses on four clinical tracks covering common chronic conditions:

• eCKM (Early Cardio-Kidney-Metabolic): Hypertension, dyslipidemia, obesity/overweight, prediabetes
• CKM (Cardio-Kidney-Metabolic): Diabetes, chronic kidney disease (3a/3b), cardiovascular disease
• MSK (Musculoskeletal): Chronic musculoskeletal pain
• BH (Behavioral Health): Depression and anxiety

ACCESS is unique in several ways:

1. Outcome-aligned payments — Payment is tied directly to health outcomes, not activities or volume
2. Technology-supported care — Designed specifically for digital health and remote monitoring approaches
3. Flexible care delivery — Organizations can deliver care virtually, in-person, or through hybrid approaches
4. Condition-specific tracks — Focused tracks with clear outcome measures for each condition area

ACCESS is open to Medicare Part B-enrolled organizations (excluding DME, POS, and laboratory suppliers) that can demonstrate the ability to deliver technology-supported care. Organizations must designate a Medicare-enrolled physician Clinical Director to oversee care quality and compliance.

Organizations must be enrolled in Medicare Part B to participate. If you're not currently enrolled, you should begin the enrollment process immediately, as it can take several months to complete. You may apply while enrollment is in process, but must be enrolled before treating ACCESS patients.

Yes, organizations can apply to participate in one or more clinical tracks, provided they demonstrate the required clinical expertise and infrastructure for each track. You don't need to participate in all tracks.

ACCESS is available nationwide. Organizations can serve patients across states, subject to applicable telehealth and licensure requirements. Rural patients receive a payment adjustment in qualifying tracks to encourage access in underserved areas.

Yes, if a patient has qualifying conditions in multiple tracks, they can receive care through multiple tracks simultaneously. Organizations are responsible for coordinating care across tracks.

Outcome-Aligned Payments (OAPs) are recurring payments for managing a patient's qualifying conditions, with full payment tied to achieving measurable health outcomes. Unlike fee-for-service, which pays for specific activities, OAPs reward results regardless of how care is delivered.

Each clinical track has specific, guideline-informed outcome measures and targets. CMS determines payment based on the overall share of patients who meet their defined outcomes, compared to a minimum threshold. This means organizations can earn full payment through strong overall performance even if some individual patients don't meet their targets.

Organizations that don't meet minimum performance thresholds may receive reduced payments. The specific payment adjustment depends on your performance level relative to the threshold. Organizations that consistently fail to meet quality, safety, or outcome standards may be terminated from the model.

Some ACCESS organizations may choose to waive standard Medicare cost-sharing for patients to reduce barriers to care. However, participation is always voluntary, and patients retain all standard Medicare benefits and protections regardless of cost-sharing arrangements.

Primary care providers and referring clinicians can bill a new ACCESS Co-Management Payment for documented review of patient progress updates from ACCESS organizations and associated coordination activities.

Payment Details:

• Base payment: ~$30 per service (subject to geographic and standard Medicare adjustments)
• Onboarding bonus: ~$10 additional one-time payment for assisting with beneficiary onboarding (requires CMS-specified modifier)
• Frequency: Once per 4 months per beneficiary per track
• Annual maximum: ~$100 per year per beneficiary per track
• Cost-sharing: No Part B beneficiary cost-sharing for this service

To bill, the clinician must review the ACCESS Care Update and document a brief note in the EHR noting the assessment and any care-coordination action (medication change, problem list update, monitoring instruction, or referral). The G-code, modifier, and detailed billing guidance will be released by CMS in 2026.

ACCESS organizations need technology infrastructure to support:

• Remote patient monitoring and data collection
• Virtual care delivery (telehealth)
• CMS API integration for eligibility, enrollment, and reporting
• Electronic health records and care documentation
• Secure communication with patients and other providers

Not all digital health tools require FDA clearance. The requirement depends on the intended use and risk level. FDA-authorized devices must have appropriate clearance. Some software falls under FDA enforcement discretion. General wellness apps and certain clinical decision support may not require authorization. Document your regulatory analysis for each technology.

TEMPO (Technology-Enabled Meaningful Patient Outcomes for Digital Health Devices) is an FDA pilot program launched in connection with the ACCESS Model. It allows manufacturers of certain digital health devices that are not yet FDA-authorized for a specific intended use to request that FDA exercise enforcement discretion when their device is offered to or by ACCESS participants.

Manufacturers participating in TEMPO collect real-world data during ACCESS participation that may support future FDA marketing submissions. ACCESS participants using TEMPO devices must obtain enhanced consent from beneficiaries, informing them that the device is in an FDA pilot and that certain data will be shared with FDA. TEMPO participation is optional — ACCESS participants can use FDA-authorized devices without participating in TEMPO.

All ACCESS participants must be HIPAA-covered entities or business associates and must:

• Implement required privacy and security safeguards
• Maintain secure systems for patient data
• Follow HIPAA requirements for data sharing with referring providers
• Use secure, interoperable systems for care coordination

You can use FDA-cleared consumer devices according to their cleared indications. However, using consumer devices in clinical contexts may require additional validation. Review each device's clearance carefully to ensure appropriate use in your ACCESS care protocols.

To be considered for the first performance period beginning July 5, 2026, applications must be submitted by April 1, 2026. Applications received after this date will be considered for a January 1, 2027 start. After initial cohorts, CMS will review applications on a rolling basis.

For the first cohort, expect approximately 2-3 months between the application deadline and notification. Rolling applications after the initial cohorts may have variable review timelines depending on CMS capacity.

Required documentation typically includes:

• Medicare Part B enrollment confirmation
• Clinical Director credentials and attestation
• Organization legal documentation
• FDA authorizations for medical devices
• HIPAA compliance attestation
• Technology platform description
• Clinical protocols for target tracks

Yes, the application portal allows you to save your progress and return to complete your application later. Your information will be saved as a draft until you submit.

No, there is no fee to apply for the ACCESS Model.

Yes, approved organizations can apply to add additional clinical tracks after their initial approval, subject to CMS review and approval of expanded capabilities.

Patients voluntarily sign up directly with participating ACCESS care organizations, either on their own initiative or upon referral from their provider. CMS will maintain a public directory of all ACCESS participants to help patients and providers find appropriate organizations.

No. Participating in ACCESS does not change Medicare benefits, coverage, or rights. Patients keep all standard Medicare protections and can continue to see any Medicare provider.

ACCESS is designed to complement, not replace, traditional care:

• PCPs can refer patients to ACCESS organizations
• ACCESS organizations send regular electronic updates on patient progress
• PCPs can bill co-management payments for coordination activities
• Patients continue seeing their PCP for routine care

ACCESS is designed to work alongside Accountable Care Organizations and other shared savings models. ACCESS organizations coordinate with patients' existing care teams, including ACO providers, to ensure integrated care delivery.

ACCESS care organizations can deliver care through multiple modalities as clinically appropriate:

• In-person visits
• Virtual/telehealth consultations
• Asynchronous communication (messaging, apps)
• Remote patient monitoring
• Hybrid approaches combining multiple methods

ACCESS is being tested in Original Medicare, not Medicare Advantage. However, MA organizations may independently adopt similar outcome-aligned payment arrangements with their contracted providers outside of the ACCESS Model.

For MA plans implementing similar arrangements outside of ACCESS, payments to providers for outcome-aligned care would typically count as medical expenses in the Medical Loss Ratio calculation. Consult with compliance experts for specific arrangements.

Yes, state Medicaid programs could implement similar outcome-aligned payment models for chronic condition management. States interested in such approaches should consult with CMS about potential pathways and coordination opportunities.

You have several options:

1. AI Assistant — Use our AI-powered chat for instant answers
2. Email — Contact ACCESSModelTeam@cms.hhs.gov
3. Interest Form — Submit the interest form to receive updates and webinar invitations
4. Documentation — Review the Request for Applications and official CMS materials

CMS hosts informational webinars and sessions for prospective ACCESS participants. Submit the interest form to be notified of upcoming events.

• Check the official CMS Innovation Center ACCESS Model page
• Submit the interest form to join the mailing list
• Follow CMS Innovation Center announcements
• Check back on this website for updates