CMS ACCESS Model

ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a voluntary, ten-year CMS Innovation Center model that pays Medicare Part B-enrolled organizations a flat, outcome-adjusted annual amount per aligned beneficiary for technology-enabled management of chronic cardio-kidney-metabolic, musculoskeletal, and behavioral health conditions. It is the first Medicare payment model designed around technology-delivered care, and its eligibility rules are the clearest federal statement of what any health technology company must be, or partner with, to bill Medicare Part B. Treat this page as orientation; payer’s change their habits often and without notice. Checked August 2026 against the Request for Applications v1.1 (February 12, 2026), the Technical FAQs (updated March 18, 2026), the Payment Amounts and Performance Targets document, and the model page. CMS revises these without notice; the model page controls.

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Key facts

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Timeline

CMS reported more than 150 organizations accepted as of August 17, 2026, most of which “have not previously served Medicare beneficiaries.”¹

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Participant eligibility

From the RFA’s Participant Eligibility Criteria, a participant must:²

• “Be a Medicare Part B–enrolled organizational entity, identifiable by a single TIN, that is eligible to bill under the Medicare Physician Fee Schedule (PFS).” Participation is “defined at the organizational TIN level, not the individual practitioner level.”
• “Be a legal entity formed under applicable state, federal, or Tribal law, and authorized to conduct business in each state in which it operates.”
• “Maintain active Medicare Part B enrollment under a single TIN.”
• “Designate and maintain a Medicare-enrolled physician as Medical Director, responsible for oversight of care delivery and model performance.” The Medical Director must be an MD or DO who is an employee of, or under contract with, the participant; the participant may contract with a self-employed physician or “a physician employed by a professional entity or physicians’ group.” (The model page and FAQs call this role the “physician Clinical Director.”)
• “Ensure that all physicians and non-physician practitioners furnishing or supervising care are individually Medicare-enrolled, participating providers or suppliers who have reassigned their Medicare billing rights to the participating TIN and practicing within applicable licensure and scope-of-practice standards.”
• Maintain a current roster of Medicare-enrolled practitioners, with NPIs, furnishing or supervising care under the TIN.
• Complete CMS program integrity screening under 42 C.F.R. Part 424.

Ongoing conditions include compliance “with all applicable federal and state laws and regulatory requirements, including licensure and scope-of-practice standards under 42 C.F.R. § 424.516; HIPAA obligations as a covered entity; and FDA requirements for any technologies used that qualify as medical devices,” and disclosure to CMS of “any material changes in ownership, licensure, or exclusion status.” Not yet enrolled? The RFA is explicit: “Organizations not enrolled in Medicare Part B must enroll to participate in ACCESS,” and applications “will not be fully approved for participation until the Medicare enrollment process is complete.” The application asks the applicant to certify that enrollment “will be completed prior to execution of the Participation Agreement.” Enrollment is required for participation, not for applying. Technology companies. The RFA and FAQs do not use “technology company” or “digital health company” as a participant category, and impose no ownership test beyond disclosure of 5%-or-greater owners and commonly owned TINs. Three roles exist in the model’s documents: the Part B-enrolled participant; vendors that self-certify into the non-endorsing ACCESS Tools Directory; and device manufacturers in the FDA’s parallel TEMPO pilot.³ Whether the participant TIN may be a lay-owned corporation is a question of state law, not of the model. See NPI, enrollment, and licensure.

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Tracks and outcome measures

Participants must manage all qualifying conditions within a track. CMS may add tracks in later years. Track-specific exclusions apply: for example, ESRD dialysis patients in CKM/eCKM and CCBHC enrollees in BH.⁴

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Payment

Outcome-Aligned Payments (OAPs) are flat, per-beneficiary annual allowed amounts per track, not per condition, with a higher Initial Period (12 months) and a lower Follow-On Period. Amounts effective July 5, 2026 through December 31, 2027 (allowed amount = 80% Medicare plus 20% coinsurance):⁵ A $15 rural add-on applies to the eCKM and CKM initial period. A 5% multi-track discount applies to the lower-cost track where a beneficiary is in more than one. Mechanics. Participants submit monthly claims with track-specific G-codes to their MAC; the claims process as zero-paid and the Innovation Payment Contractor pays. Monthly payments equal one-twelfth of the Medicare portion and are capped at 50% of the annual amount; the remaining 50% is withheld and reconciled after the 12-month care period through two adjustments:

• Clinical Outcome Adjustment: based on the share of aligned beneficiaries meeting outcome targets against an Outcome Attainment Threshold of 50% for the first 18 months; the reduction is capped at 50% of the OAP.
• Substitute Spend Adjustment: reduces payment for duplicative fee-for-service spending on the same condition. Participants and financially affiliated entities certify they will not bill FFS for aligned beneficiaries’ track conditions during the care period.

OAPs exclude drugs, labs, imaging, and DMEPOS, which unaffiliated entities bill separately. Claims must be submitted within 90 days of the date of service. Co-Management Payment. Referring and primary care clinicians outside the participant receive roughly $30 per service, plus about $10 for a first-time onboarding modifier, at most once per four months per beneficiary per track, with no beneficiary cost-sharing.

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Waivers and flexibilities

Under § 1115A, CMS waives the MIPS provisions and the Part B payment-percentage rule for OAPs, pays outside FFS, withholds payment on outcomes, and grants “program waivers as needed to … allow for services to be provided via telehealth, asynchronously, and/or directly through the applicable technology.” Participants who forgo OAP cost-sharing rely on the CMS-sponsored model patient incentive safe harbor at 42 C.F.R. § 1001.952(ii)(2); if they collect cost-sharing they must disclose the expected amount before enrollment and apply it uniformly. Devices may be furnished on loan or for keeps consistent with the beneficiary engagement incentive rules. Waivers end on termination; withdrawal requires 180 days’ notice.²

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Health IT requirements

Certified EHR technology under 45 C.F.R. Part 170; USCDI data (§ 170.213); outcome-measure submission via the CMS FHIR API; electronic “ACCESS Care Updates” to referring and primary care clinicians.

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Where to verify

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Sources

1. CMS, ACCESS Model accepted applicants (updated Aug. 17, 2026), including the May 15, 2026 deadline-extension notice.
2. CMS Innovation Center, ACCESS Model Request for Applications, v1.1 (Feb. 12, 2026): Participant Eligibility Criteria at 13–14; Medical Director at 22; timeline (Table 2) at 12–13; waivers at 39; Appendix A application questions.
3. CMS, ACCESS Technical FAQs (updated Mar. 18, 2026); FDA, TEMPO pilot notice, 90 Fed. Reg. (Dec. 8, 2025).
4. RFA Table 1 at 6–7 and Appendices B and D.
5. CMS, ACCESS Payment Amounts and Performance Targets, Table 1 (effective July 5, 2026 – Dec. 31, 2027). The monthly-with-50%-withhold cadence replaced the quarterly cadence described in RFA v1.0.