ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a voluntary, 10-year payment model from the CMS Innovation Center that begins July 5, 2026, and runs through June 30, 2036. ACCESS tests Outcome-Aligned Payments (OAPs), a new payment approach in which participating organizations receive recurring payments for managing patients' qualifying chronic conditions, with full payment contingent on achieving measurable health outcomes.
ACCESS addresses a structural gap in traditional fee-for-service Medicare: existing care management codes (CCM, RPM) reimburse defined activities, which can limit the flexibility of technology-driven care delivery. ACCESS pays for outcomes. Participating organizations can deliver care in person, virtually, asynchronously, or through any combination, so long as the clinical targets are met.
Clinical Tracks:
ACCESS is organized into four clinical tracks:
Early Cardio-Kidney-Metabolic (eCKM): Hypertension, or two or more of dyslipidemia, obesity/overweight with central adiposity, and prediabetes. Outcome targets include blood pressure control, lipid improvement, weight reduction, and HbA1c improvement.
Cardio-Kidney-Metabolic (CKM): Diabetes, chronic kidney disease, or atherosclerotic cardiovascular disease. Outcome targets include HbA1c control, blood pressure management, and kidney function preservation.
Musculoskeletal (MSK): Chronic musculoskeletal pain. Outcome targets include pain reduction and functional improvement.
Behavioral Health (BH): Depression or anxiety. Outcome targets include PHQ-9 and GAD-7 score improvement.
Payment Structure:
Participating organizations receive prospective monthly payments over 12-month care periods. An initial care period (for new patients or patients not at clinical targets) pays a higher rate. A continuation period (for patients who have achieved initial targets) pays a reduced rate reflecting lower resource needs.
Full payment depends on meeting Outcome Attainment Thresholds (OATs). For the first model year, the OAT is 50%, meaning an organization earns full payment if at least 50% of its aligned patients meet their outcome targets. Payment is reduced proportionally if fewer patients meet targets.
Organizations may forgo collection of beneficiary cost-sharing (copays and deductibles) for OAPs as a beneficiary engagement incentive.
Technology Requirements:
Participants must use FHIR-based APIs to submit outcome data to CMS and must electronically share clinical updates with the patient's other providers. The model includes collaboration with the FDA's TEMPO (Technology-Enabled Meaningful Patient Outcomes) pilot, which provides a pathway for certain digital health device manufacturers to collect real-world performance data.
Relationship to Existing Programs:
ACCESS is designed to complement existing care. Referring clinicians (primary care, specialists) can bill a new co-management payment for reviewing ACCESS updates and coordinating care. CMS will maintain a public directory of participating organizations and their risk-adjusted outcomes.
ACCESS does not replace CCM, RPM, or APCM. Practices that are not ready for an outcomes-based model can continue to use traditional fee-for-service care management codes. ACCESS is one additional option in the connected care ecosystem.
Sources:
CMS.gov ACCESS Model page; CMS Innovation Center blog, "Improving ACCESS to Technology-Supported Care with Outcome-Aligned Payments" (December 19, 2025); CMS ACCESS Model Technical FAQs; AHA News coverage.
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