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The Centers for Medicare & Medicare Services' ("CMS") Innovation Center will begin accepting applications on January 12 for the recently announced Advancing Chronic Care with Effective, Scalable Solutions ("ACCESS") Model—a nationwide voluntary alternative payment model for Medicare Part B commencing July 5, 2026 that will run for 10 years and focus on chronic conditions affecting over two-thirds of Medicare beneficiaries such as diabetes, high blood pressure, and depression.1 Health care organizations, such as physician groups, must be enrolled in Medicare Part B to be eligible to participate as an ACCESS "Participant" and must take responsibility for delivering integrated, coordinated services—in person, virtually, asynchronously, or through other technology-enabled modalities—to Medicare patients to manage those patients' chronic conditions for a twelve-month period. Participants must designate a Medicare-enrolled Medical Director to oversee care quality and compliance. The Model will initially encompass four non-mutually-exclusive clinical tracks corresponding to common chronic conditions2:
- Early Cardio-Kidney-Metabolic ("eCKM"): Hypertension, dyslipidemia, obesity, overweight with marker of central obesity, and prediabetes.
- Cardio-Kidney-Metabolic ("CKM"): Diabetes, chronic kidney disease, and atherosclerotic cardiovascular disease.
- Musculoskeletal: Chronic musculoskeletal pain.
- Behavioral Health: Depression and anxiety.
Unlike many other CMS Innovation Center models, the ACCESS Model will use voluntary, prospective alignment—meaning that patients with "Original" or fee-for-service ("FFS") Medicare will be able to choose to enroll in the Model directly through an ACCESS Participant or be referred by their health care provider.
Outcome-Aligned Payments
The ACCESS Model seeks to reduce Medicare expenditures for chronic conditions and keep organizations accountable while preserving or enhancing quality of care.3 The Model will make Outcome-Aligned Payments ("OAPs"), which are fixed recurring payments for helping patients successfully manage their qualifying chronic conditions and achieve their target clinical outcomes, instead of traditional Medicare FFS payment for each visit or service provided.4 CMS has not yet specified the OAP amounts.
Clinical Outcome Adjustment
Full payment is contingent on achieving clinical outcome targets ("OAP Measures") for improvement or control of their aligned Medicare patients' qualifying chronic conditions.5 Patients will have baseline measurements taken for relevant clinical benchmarks (e.g., blood pressure for hypertension) and performance targets will be determined annually based on each beneficiary's baseline.6
ACCESS Model participants will not be required to show that every aligned beneficiary meets their outcome targets. CMS will define a minimum Outcome Attainment Threshold ("OAT")—set at 50 percent for the ACCESS Model's first performance year—to qualify for full payment.7 CMS will compare an ACCESS Model participant's Outcome Attainment Rate ("OAR")—the percentage of beneficiaries who completed an initial 12-month care period and met all required OAP Measure targets—to the OAT.8 Participants with an OAR equal to or higher than the OAT will earn the full OAP. Participants with a lower OAR will have their payments reduced by a Clinical Outcome Adjustment.9 The Clinical Outcome Adjustment will be capped at a 50 percent reduction to the full OAP amount. To improve accessibility and encourage participation, the OAT will be lower for a participant's first year of participation and when a new clinical track is initiated.10 CMS indicates that it will use risk-adjusted outcomes for public reporting on ACCESS Participants' performance, but it has not yet explained its risk adjustment methodology or how risk adjustment may affect the Clinical Outcome Adjustment performance thresholds and OAP payment amounts.
Substitute Spend Adjustment
The Model also introduces a "Substitute Spend Adjustment" that lowers OAP if less than a specified percentage of patients do not receive "substitute" services from other Medicare providers and suppliers for the same condition during their ACCESS care period outside of the ACCESS program.11 For the model's first performance year, the threshold to earn the full OAP will be set at 90 percent, meaning that the Substitute Spend Adjustment will be capped at a 25 percent reduction to the full OAP amount.12 This policy is meant to prevent duplicative care, reduce Medicare spending, and ensure comprehensive care delivery both within and outside the Model.
Importantly, the OAP are intended to replace Medicare FFS payment for services provided to aligned beneficiaries. ACCESS participants will submit claims using model-specific G-codes and must not submit Medicare FFS claims for aligned beneficiaries during active care periods.13 The exclusion from Medicare FFS billing applies not only to the ACCESS participant but also its affiliated entities, meaning any other organization in which the ACCESS participant holds a 5 percent or greater direct or indirect ownership interest, in which an individual or entity exercises operational or managerial control over another entity, and any reassignment relationships under 42 C.F.R. § 424.80.14
Care Coordination and Co-Management Payment
To more fully support coordination of care, ACCESS Participants will be required to electronically share clinical updates with their aligned beneficiaries' primary care and referring health care providers and will be able to request certain Medicare claims data for those beneficiaries from CMS (through APIs) to support care coordination and monitoring.
Clinicians who co-manage ACCESS beneficiaries with an ACCESS Participant will be able to bill and collect a new co-management payment for documented review of ACCESS care updates and care coordination activities, such as medication adjustments or referrals.15 The co-management payment will be approximately $30 per service and may be billed once every four months per beneficiary per track, up to a limit of $100 per year.16
TEMPO Pilot Program
To further support the goals of the ACCESS Model, the U.S. Food and Drug Administration ("FDA") announced a companion pilot program, called the Technology-Enabled Meaningful Patient Outcomes ("TEMPO") for Digital Health Devices Pilot, that will test a "risk-based enforcement approach" for certain digital health devices that could improve patient outcomes in one of the four clinical use areas identified in the ACCESS Model (e.g., for cardio-kidney-metabolic, musculoskeletal, and behavioral health conditions). FDA expects to select up to about ten manufacturers in each of four specific clinical use areas to participate in the TEMPO Pilot. Manufacturers selected for participation may request FDA enforcement discretion for certain requirements, such as premarket authorization and investigational device requirements, enabling manufacturers to collect and share real-world data demonstrating a digital health device's performance for an intended use to improve patient outcomes in care covered by the ACCESS Model.
Request for Applications
The ACCESS Model will run from July 5, 2026, through June 30, 2036. CMS will begin accepting applications for the ACCESS Model on January 12, 2026. Applications must be submitted by April 1, 2026 to be considered for the first cohort beginning July 5, 2026.17 Applications will be accepted on a rolling basis from January 12, 2026 through April 1, 2033 to allow organizations to participate for at least a two-year period.18 ACCESS Participants will be defined at the Tax Identification Number ("TIN") level; organizations who wish to participate must be enrolled in Medicare Part B under a single TIN as providers or suppliers eligible to bill under the Medicare Physician Fee Schedule.19 DMEPOS and laboratory suppliers are not eligible to participate.20
Key Takeaways
The ACCESS Model reflects CMS's policy priorities of reducing costs while preserving quality and leveraging digital health technology to achieve better health outcomes. By paying for outcomes rather than delivery of care, the ACCESS Model intends to bridge the divide between encounter-based traditional fee-for-service and the use of technologies and devices in between those encounters. The OAP provides a predictable payment stream and gives providers and suppliers greater flexibility in how they utilize technology-supported care, such as telehealth therapy, wearable devices like movement trackers, and mobile apps, while still holding ACCESS Model participants accountable for results. The Model also presents significant new opportunities for health care technology and digital health companies to collaborate with ACCESS Participants and other clinicians responsible for co-managing patients' chronic conditions, particularly in cases where those digital health companies are already affiliated with physician group practices that are enrolled or can be enrolled in Medicare Part B and can apply to be ACCESS Participants.
Interested potential ACCESS participants should review the application questions that are now publicly available on the CMS Innovation Center website, begin to assess their readiness for coordinating and tracking chronic care using ACCESS tracks and outcome measures, identify gaps in data, analytics, and compliance infrastructure and tools, and monitor the CMS website for more detailed implementation and technical guidance.
Footnotes
1. ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model, https://www.cms.gov/priorities/innovation/innovation-models/access (Dec. 22, 2025).
2. ACCESS Technical Frequently Asked Questions.
3. Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation, Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model Request for Applications 4 (2025), https://www.cms.gov/priorities/innovation/files/access-rfa.pdf.
4. ACCESS Technical Frequently Asked Questions, https://www.cms.gov/priorities/innovation/access-technical-frequently-asked-questions (Dec. 18, 2025).
5. Id. at 5.
6. Id.
7. ACCESS Model Request for Applications 28.
8. Id. at 28.
9. Id.
10. Id.
11. Id. at 29.
12. Id.
13. Id. at 33.
14. Id.
15. Id. at 6-7.
16. Id. at 31.
17. Id. at 4.
18. Id. at 12.
19. Id. at 13.
20. Id. at 12-13.
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