CMS Unveils the ACCESS Model: A New Era for Technology-Enabled Chronic Care

Key Takeaways 

• What is the ACCESS model? A new 10-year, voluntary CMS payment model (2026–2036) that replaces fee-for-service billing with fixed, outcome-aligned payments (OAPs) for managing chronic conditions.
• Who is eligible? Medicare Part B providers (primary care and specialists) who use technology to treat hypertension, diabetes, heart disease, kidney disease, musculoskeletal pain, or behavioral health issues.
• Technology requirement: Participants must use FHIR-based APIs to report outcomes and electronically share clinical updates with other providers.
• Financial incentive: Providers receive prospective monthly payments and can earn full reconciliation payments by meeting clinical targets like blood pressure control or HbA1c reduction.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center has launched a a new chronic care payment model: the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model.

For nearly a decade, programs like remote patient monitoring (RPM) and chronic care management (CCM) have demonstrated the power of using technology to connect with patients outside the office. These current programs have successfully normalized the use of technology to track vitals and coordinate care between visits.

However, the ACCESS model is not just another set of codes to add to a billing sheet. It is a distinct, 10-year voluntary model designed to take the successes of programs like RPM and CCM and package them into a new payment framework. It moves providers away from activity and minute counting and toward a system that leverages technology to expand patient access and reward what matters most: improved outcomes.

The ACCESS model offers a unique opportunity to secure revenue stability while delivering the high-tech, high-touch care your patients deserve. Here is everything healthcare organizations need to know about the program.

What is CMS's ACCESS Model?

The ACCESS model is a voluntary, nationwide payment model testing whether  outcome-aligned payments (OAPs) for technology-enabled chronic care can reduce Medicare expenditures while improving quality of care.

It is critical to understand how this differs from the remote care management programs organizations may be running today:

• Remote care management programs (e.g., RPM, CCM, advanced primary care management (APCM)): These are fee-for-service programs. Providers are reimbursed based on specific activities (e.g., taking a reading) or time spent (e.g., the 20-minute threshold for CPT 99457).
• ACCESS: This is a value-based program. Instead of billing for minutes or individual tasks, participants receive a fixed, recurring payment for managing a beneficiary's condition over a 12-month period.

In the ACCESS model, participants can still use some of the same technologies — e.g., cellular scales, blood pressure monitors, blood glucose meters — but payment is not tied to how many minutes are logged or data points are shared. Instead, full payment is contingent on achieving specific clinical targets, such as controlling blood pressure or lowering HbA1c.

Key ACCESS model facts:

• Duration: 10 years, running from July 5, 2026, through June 30, 2036.
• Scope: Nationwide; open to Medicare Part B-enrolled providers and suppliers (excluding DMEPOS and laboratory suppliers).
• Application: Applications open on Jan. 12, 2026. To be considered for the model’s 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 Jan. 1, 2027 start.

The 4 ACCESS Model Clinical Tracks

ACCESS focuses on conditions where technology-enabled care has proven most effective. It is organized into four distinct clinical tracks, grouping comorbid conditions that are often treated together.

1. Early cardio-kidney-metabolic (eCKM)
   1. Qualifying conditions: Hypertension (HTN), or two or more of: dyslipidemia, obesity/overweight (with central adiposity), and prediabetes
   2. Goal: Control or improvement in BP, lipids, weight, and HbA1c
2. Cardio-kidney-metabolic (CKM)
   1. Qualifying conditions: Diabetes mellitus, chronic kidney disease (stages 3a/3b), or atherosclerotic cardiovascular disease (ASCVD)
   2. Goal: Control or improvement in BP, lipids, and HbA1c (plus eGFR and UACR submission for CKD/diabetes)
3. Musculoskeletal (MSK)
   1. Qualifying conditions: Chronic musculoskeletal pain (lasting more than 3 months)
   2. Goal: Improvement in pain intensity, interference, and function (via PROMs)
4. Behavioral health (BH)
   
   1. Qualifying conditions: Depression or anxiety
   2. Goal: Control or improvement in symptoms (PHQ-9 or GAD-7) and submission of WHODAS 2.0

Getting Patients on Board With the ACCESS Model: Referral and Enrollment

Unlike many CMS models where patients are "attributed" to a practice based on historical claims data (often without the patient even knowing), patients must actively choose to participate in ACCESS like they would an RPM or CCM program.

There are two primary ways patients can enter an ACCESS program:

1. Direct enrollment

Patients can sign up directly with you if you are an ACCESS participant. Becoming an ACCESS participant may be ideal for specialists who already have a strong patient base.

• CMS provider directory: CMS will maintain a public-facing directory of ACCESS participants, allowing motivated patients to find technology-enabled care providers in their area.
• Your outreach: You can market your program directly to your existing panel or community, provided you adhere to CMS marketing guidelines.

2. Provider referral ("co-management" pathway)

Primary care practitioners (PCPs) and other clinicians who are not ACCESS participants themselves can also refer patients to established ACCESS participants.

• The incentive: These referring providers can bill a new ACCESS co-management payment. This pays them for reviewing the monthly clinical reports sent to them, ensuring they stay in the loop without losing revenue.
• The workflow: A PCP identifies a patient struggling with uncontrolled hypertension, refers them to an ACCESS program for remote monitoring and titration, and then bills for overseeing the care delivered.

ACCESS Participant Eligibility and Requirements: Who Can Apply?

Participation in the ACCESS model is determined at the organizational level, defined by a taxpayer identification number (TIN). While the model is open to a broad range of providers, CMS has set strict governance and integrity standards to ensure participants are capable of delivering advanced, technology-enabled care.

To apply for the model, organizations must meet the following criteria:

1. Organizational structure

• Must be: A Medicare Part B-enrolled entity eligible to bill the Medicare physician fee schedule (PFS). This includes physician practices, group practices, and hospital outpatient departments (HOPD).
• Must not be: A durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) supplier or a laboratory supplier. (Note: If you have a separate DME entity, that entity cannot be the ACCESS participant).
• Legal standing: You must be a legal entity authorized to conduct business in every state where you operate.
  

2. Clinical leadership (medical director)

CMS requires every participant to designate a medical director who is responsible for the oversight of care delivery and model performance.

• Qualifications: The medical director must be a medical doctor (MD) or doctor of osteopathy (DO) who is currently enrolled in Medicare.
• Role: They are accountable for ensuring the clinical quality and safety of the program.
  

3. Practitioner requirements

All individual practitioners (NPIs) delivering care under the TIN must be enrolled in Medicare and practicing within their state licensure and scope of practice.

4. Technology and data capability ("hard gate")

Since this is a data-driven model, participants must have the infrastructure to report outcomes electronically.

• FHIR standards: Participants must be able to submit OAP Measures data (like blood pressure readings and PHQ-9 scores) via CMS’s FHIR-based APIs.
• Interoperability: Participants are required to electronically share clinical updates with a beneficiary’s other healthcare providers to support care coordination.

The Outcome-Aligned Payment (OAP) Structure

The OAP methodology is the engine of the ACCESS model. It links a fixed payment to measurable clinical and patient-reported outcomes rather than service volume.

OAP tiers

The fixed payment is split into two tiers for a 12-month "care period":

• Initial period (first 12 months): A higher rate reflecting the heavy lifting of onboarding and achieving initial clinical improvement. This applies if a patient hasn’t been treated in this track for two years and if they are not yet at their clinical target.
• Follow-on period: A lower rate for maintenance. This applies to patients that participants are continuing to manage or those who are already at their clinical target when they enroll.

Performance withhold and reconciliation

CMS does not pay the full amount for ACCESS participation upfront.

1. In-period payments: Participants receive 50% of the total annual OAP amount in quarterly installments (triggered by submitting G-codes).
2. Withheld amount: The remaining 50% is withheld and reconciled after the 12-month period ends.
3. Adjustments: To receive the withheld amount, participants are measured against two thresholds:
   1. Clinical outcome adjustment: Did patients meet their targets? (outcome attainment rate)
   2. Substitute spend adjustment: Did patients avoid using other Medicare services for the same condition? (substitute spend rate)

Why Technology for the ACCESS Model is Non-Negotiable

The ACCESS model explicitly champions technology-enabled care. It recognizes that the traditional visit-based system is ill-equipped to manage chronic conditions that require continuous support. Success in ACCESS requires participants to:

• Use data: Collect and report clinical data (like vitals) electronically via APIs.
• Engage patients: Use tools like remote patient monitoring devices to track progress between visits.
• Coordinate care: Electronically share clinical updates seamlessly.

Why Should Practices or Virtual Care Providers Apply for ACCESS?

While adopting a new payment model is a significant decision, ACCESS represents the  alignment of financial incentive and clinical best practice. It may allow organizations to build a more resilient, patient-centered business. Here is why your practice should consider applying:

1. Escape the FFS grind: Move away from activity-based coding that requires strict time-logging. ACCESS pays for results, giving organizations the flexibility to deliver care however it is most effective.
2. Unlock new revenue: The model opens a new payment pathway for patients who might not qualify for traditional CCM or RPM, or for whom those codes are too administratively burdensome.
3. Enhance patient loyalty: By offering cutting-edge, technology-driven care, you differentiate your organization and provide continuous patient support.

Preparing for CMS's ACCESS Model

The first application deadline is April 1, 2026, for a July 2026 start date. Success in a performance-based model requires preparation:

• Audit your population: Identify how many of your patients would qualify for the eCKM or CKM tracks.
• Test your tech: Ensure you have a reliable platform for collecting patient-reported outcomes and device data.
• Build your workflows: Start integrating care management and remote monitoring into your daily routine now, so your team is ready when the model launches.

Ready to future-proof your practice? Prevounce can help you optimize your current RPM and CCM programs now to maximize revenue and clinical impact, ensuring you have the robust foundation needed to explore and export those capabilities into new options like ACCESS when you are ready. Book a consultation today or call (800) 618-7738.