ACCESS Model: CMMI’s New Technology-Enabled Chronic Care Model

The Center for Medicare and Medicaid Innovation (CMMI) recently announced a voluntary, 10-year Medicare payment and service delivery model: Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model.

The ACCESS Model tests whether a new payment methodology, Outcome Aligned Payments (OAPs) can better support technology-enabled care, improve health outcomes, and lower overall Medicare spending for high-prevalence, high-cost chronic conditions that affect more than two-thirds of people enrolled in Medicare. The ACCESS Model will focus on chronic conditions including high blood pressure, diabetes, chronic musculoskeletal pain, and depression.

The ACCESS Model is scheduled to begin on July 1, 2026 and the Request for Applications is now available. Applications are due on April 1, 2026.

The goal of an OAP is to provide regular payment to fund certain activities with the potential for additional earned financial incentives based on clinical improvement or control of a condition. Participants will receive reoccurring payments for managing patients’ qualifying conditions, but full payment will be reserved for achievement of measurable health outcomes goals (e.g., lowering a patient’s blood pressure by 10mmHg). CMMI has stated the intent behind the new OAP payment methodology is to reward outcomes rather than a defined activity (or the volume of services delivered).

At launch, the ACCESS Model will focus on four clinical tracks addressing some of the most common chronic conditions in Medicare. CMS has stated that additional tracks and conditions may be added in future years. Participants are responsible for managing all qualifying chronic conditions within the selected tracks and must integrate technology-enabled care in ways that support continuous, proactive chronic condition management.

1. Early cardio-kidney-metabolic conditions (eCKM): hypertension (high blood pressure), dyslipidemia (high or abnormal lipids, including cholesterol), obesity or overweight with marker of central obesity, and prediabetes;
2. Cardio-kidney-metabolic conditions (CKM): diabetes, chronic kidney disease (3a or 3b), and atherosclerotic cardiovascular disease, including heart disease;
3. Musculoskeletal conditions (MSK): chronic musculoskeletal pain; and
4. Behavioral health conditions (BH): depression and anxiety.

ACCESS Model participants may furnish technology-supported care, delivered either in-person or virtually, depending on the clinical context. CMS has indicated that such care may include:

• Clinician consultations
• Lifestyle and behavioral support (nutrition, exercise, smoking cessation)
• Therapy and counseling
• Patient education and care coordination
• Medication management
• Ordering and interpreting diagnostic tests and imaging
• Use or monitoring of Food and Drug Administration (FDA)-authorized devices, including devices or software, or devices that are subject to FDA enforcement discretion.

This flexibility is intended to support integrated, patient-centered care models that extend beyond traditional episodic encounters.

The ACCESS Frequently Asked Questions (FAQs) notes that the ACCESS Model is meant to integrate with a patient’s existing care team or other value-based models such as the Medicare Shared Savings Program and ACO REACH. Primary care physicians (PCPs) and referring clinicians can refer patients to ACCESS participating organizations and the ACCESS organizations will provide electronic updates on the patient’s progress. PCPs and other referring clinicians will be able to bill to CMS a new service code for their co-management, document review, and coordination activities. Participating organizations must enroll in Medicare Part B as providers or suppliers and comply with applicable state licensure requirements, as well as Health Insurance Portability and Accountability Act of 1996 (HIPAA) and FDA requirements (or otherwise be subject to FDA enforcement discretion). Organizations must also designate a medical director responsible for clinical oversight and compliance.

The model contains program integrity and reporting expectations. Participants must meet rigorous data reporting requirements and transmit outcome measure data via standardized APIs.

Health technology company representatives are already meeting in Washington, D.C., to discuss the ACCESS Model, as reported by Fierce Healthcare. Historically, no Medicare payment option has provided adequate support to novel, technology-supported care.

Medicare-participating entities interested in becoming ACCESS Partner Organizations for the first performance period should begin to prepare their applications. Applications received after April 1,2026 will not be eligible to participate prior to January 1, 2027.

Epstein Becker Green Staff Attorney Ann W. Parks contributed to the preparation of this post.