CMS Innovation Center Unveils ACCESS Model to Expand Technology-Supported Care for Chronic Disease

The model is slated to begin on July 1, 2026, with rolling applications and an initial cohort deadline in spring 2026. ACCESS emphasizes measurable improvements in health outcomes over the volume or type of services delivered and is designed to complement traditional fee‑for‑service care while improving prevention, care management, and patient choice.

What ACCESS Does

ACCESS addresses a longstanding payment gap in traditional Medicare fee-for-service by testing a recurring, outcomes‑tied payment for organizations that manage patients’ qualifying chronic conditions using clinician‑guided, technology‑enabled services such as telehealth, remote monitoring through US Food and Drug Administration (FDA)‑authorized devices, digital coaching, and virtual or asynchronous care. Under the OAPs, participating organizations can earn full payment based on the share of patients who meet guideline‑informed improvement or control targets, shifting financial incentives toward measurable results and enabling flexible, modern care delivery beyond the clinic walls. CMS will also provide increased reimbursement under the program to rural providers to promote access to the program in underserved areas.

CMS will publicly report risk‑adjusted outcomes for participating organizations to promote transparency and informed selection by patients and referring clinicians.

Who Can Participate and How Care Is Structured

ACCESS participants must be Medicare Part B‑enrolled providers or suppliers (excluding DMEPOS and laboratory suppliers), comply with licensure, HIPAA and applicable FDA requirements (or be under enforcement discretion), and designate a physician clinical director to oversee quality and compliance with the model’s requirements. Care provided as part of the model may be in‑person, virtual, asynchronous, or otherwise technology‑enabled as clinically appropriate, and is designed to complement primary and specialty care through regular electronic updates. Under ACCESS, primary care and referring clinicians can bill a new co‑management code to receive payment for documented review and coordination activities associated with beneficiary care updates. The new co-management code will not include any beneficiary cost‑sharing obligation. CMS will monitor participants’ performance with the model’s requirements and may terminate organizations that fail to meet quality, safety, or outcome standards.

Clinical Tracks and Outcome Measures

ACCESS initially includes four chronic condition tracks, with participants responsible for integrated management of all qualifying conditions in a selected track. Most tracks include an initial year of care with an optional reduced‑rate continuation period, which recognizes lower resource needs as care stabilizes. However, the musculoskeletal (MSK) track is focused on reducing chronic pain during the initial period of care and does not include a continuation period.

The initial four condition tracks and their outcome focuses are:

• eCKM: Used with patients diagnosed with hypertension, dyslipidemia, obesity/overweight with central adiposity, and prediabetes. The outcome focus for early cardio-kidney-metabolic (eCKM) includes control or improvement in blood pressure, lipids, weight, and HbA1c, based on individual baselines.

• Cardio‑Kidney‑Metabolic: Used with patients diagnosed with diabetes, chronic kidney disease (Stage 3a/3b), and atherosclerotic cardiovascular disease. The outcome focus includes control or improvement in blood pressure, lipids, weight, HbA1c, with eGFR and UACR data submission for chronic kidney disease and diabetes‑only subgroups.

• MSK: Used with patients diagnosed with chronic musculoskeletal pain. The outcome focus includes minimum improvement in pain intensity or interference and overall function using validated patient reported outcome measures during the initial designated period of care.

• Behavioral Health: Used with patients diagnosed with depression and anxiety. The outcome focus includes improvement in symptoms assessed using the Patient Health Questionnaire for depression and the Generalized Anxiety Disorder assessment for anxiety, as well as the World Health Organization Disability Assessment Schedule and patient reported outcome measurements for assessing overall function.

Payments to participants are determined by the overall share of patients meeting the program’s established targets, with outcome measure thresholds increasing as the model progresses.

Beneficiary Enrollment and Cost‑Sharing

Patient enrollment in the ACCESS model will be voluntary, and patients can either enroll directly or via a referral from their physician. Patients enrolled in the model retain all standard Medicare rights and benefits.

Additionally, under the ACCESS model, participating providers will have the option to forgo collection of beneficiary cost-sharing amounts (i.e., co-payments and deductibles) for OAPs as a standardized beneficiary engagement incentive. The co-management payments to a patient’s primary care physician or referring clinician will not require beneficiary cost-sharing.

Key Timelines and Application Process

CMS will post the Request for Applications (RFA) and accept rolling applications for participation in the ACCESS model beginning in Spring 2026. To be considered for the first performance period beginning on July 1, 2026, applications must be submitted by April 1, 2026; later applications will be considered for a January 1, 2027, start. Interested organizations can complete the CMS ACCESS model Interest Form to receive application notifications and updates. CMS will review applications on a rolling basis and publish detailed FAQs and technical guidance to support prospective participants.

Practical Implications and Next Steps for Stakeholders

Health care providers and digital health organizations seeking to participate in the ACCESS model must assess their readiness to meet participation requirements and manage patients across the specified tracks, including through remote monitoring, behavioral support, medication management, and evidence‑based interventions aligned to track‑specific metrics. Primary care and specialty practices should plan for co‑management workflows and electronic health records documentation to capture review of ACCESS model care updates and related coordination. Rural health care providers should evaluate opportunities enabled by rural payment adjustments. All prospective participants need to monitor the ACCESS RFA for payment rates, thresholds, and operational details, and submit timely applications to align with the July 2026 start.