The CMS Innovation Center's ACCESS model (Advancing Chronic Care with Effective, Scalable Solutions) begins its first performance period on July 5, 2026. It was announced last December as one of five new models, and it is the one most likely to land on an independent practice's desk, because it accepts Medicare Part B-enrolled organizations of almost any size on a rolling basis and pays for outcomes in specific chronic conditions rather than for visits.
The Innovation Center held a webinar for primary care physicians and referring clinicians on June 4 and has another on health IT and interoperability requirements scheduled for July 23. We watched the first, read the request for applications and the technical FAQ, and talked with several practices trying to decide. Here is what the model does, the part most summaries leave out, and the questions we think a practice should answer before applying.
Key takeaways
- ACCESS replaces fee-for-service with recurring outcome-aligned payments for enrolled patients in a condition track. Participants and their affiliates cannot bill Medicare fee-for-service for other services to those patients during an active care period.
- Patients enroll voluntarily, directly or after a referral. Nobody is attributed to you by claims history.
- A primary care practice does not have to participate to take part: referring clinicians can bill a co-management payment of about $30 per service, up to four times a year per patient per track.
- Full payment requires that enough patients hit clinical targets; if fewer than half do, payment is reduced proportionally, up to 50 percent.
- Applications are rolling through 2033. Waiting a year costs you little if you are not ready to produce outcome data today.
How the payment works
ACCESS pays what CMS calls outcome-aligned payments: recurring, per-beneficiary payments for managing a patient's qualifying condition over a care period, with full payment tied to measurable clinical improvement across the organization's enrolled patients. This is not a bonus on top of visits. For a beneficiary who is aligned to an ACCESS participant and in an active care period, the participant and its affiliated entities may not submit Medicare fee-for-service claims for other services; billing for those patients runs through ACCESS G-codes only. Most tracks include an optional continuation period at a reduced rate after the initial care period.
The outcome test is set at the organization level. If fewer than 50 percent of an organization's patients meet their targets, the payment is reduced proportionally, subject to a maximum reduction of half of the gross payment. In other words, the model has downside, and the downside is measured on your panel, not on any single patient.
The four initial tracks are early cardio-kidney-metabolic disease, established cardio-kidney-metabolic disease, musculoskeletal conditions, and behavioral health. Four more tracks are scheduled for April 1, 2027: heart failure, COPD, substance use disorder and tobacco cessation. Existing participants will not need to reapply for the new tracks. The model runs ten years.
| Track | Starts | Conditions covered |
|---|---|---|
| Early cardio-kidney-metabolic (eCKM) | July 5, 2026 | Hypertension, dyslipidemia, prediabetes, obesity or overweight with a marker of central obesity |
| Cardio-kidney-metabolic (CKM) | July 5, 2026 | Diabetes, chronic kidney disease stages 3a and 3b, atherosclerotic cardiovascular disease |
| Musculoskeletal (MSK) | July 5, 2026 | Chronic musculoskeletal pain |
| Behavioral health (BH) | July 5, 2026 | Depression and anxiety |
| Heart failure, COPD, SUD, tobacco cessation | April 1, 2027 | Track-specific measures to be published |
How patients get in
Enrollment is voluntary. A person with Original Medicare who has a qualifying condition may sign up directly with a participating organization or enroll after a referral from a primary care practitioner or another clinician. There is no claims-based attribution of the kind Shared Savings Program practices are used to. A small share of enrollees will be randomly assigned to a comparison group for the evaluation. The practical consequence is that a participant's panel is built one enrollment at a time, and the outreach and consent work sits with the organization.
Two ways a practice can be involved
This is the part we think most practices should read twice.
| ACCESS participant | Referring clinician | |
|---|---|---|
| Who | A Medicare Part B-enrolled organization (not a DMEPOS or laboratory supplier) with a designated physician clinical director | Any primary care practitioner or other clinician who refers a patient and co-manages |
| Payment | Recurring outcome-aligned payments per enrolled patient, reduced if outcomes fall short | Co-management payment of about $30 per service, plus a $10 onboarding modifier at the start, capped at four services a year per patient per track |
| Fee-for-service billing | Excluded for aligned patients during active care periods; ACCESS G-codes only | Continues as normal for the practice's own visits |
| Beneficiary cost sharing | Per the model's payment design | None on the co-management service |
| Obligations | Standards-based API reporting, HIPAA, state licensure and FDA requirements for any technology, participation agreement terms | Receive care updates from the participant by a secure electronic method; document the co-management |
For most independent primary care practices, the referring role is the realistic entry point this year. The co-management payment is modest, around $100 a year per patient per track, but it comes without the fee-for-service exclusion and without the outcome risk. The participant role fits organizations built to run remote monitoring, titration and outreach at scale, which is why technology-enabled care companies are so clearly part of the intended audience.
The questions to answer first
- Can you produce the outcome data today? If your EHR cannot report the share of diabetic patients with an A1c under 8 in the past 12 months, by provider, without a consultant, you are not ready for a model that pays on that number. Fix reporting first. Our closing gaps in care work usually starts here.
- How many patients would enroll? Count Medicare patients with two or more visits in the past year for a track condition. That is the ceiling on your enrollment, and outcome payments across a panel of 40 are noise. Across 400 they are a program.
- What does the fee-for-service exclusion do to your revenue? Model it. For a practice whose enrolled patients would otherwise generate four or five office visits a year each, the outcome-aligned payment has to cover that revenue plus the cost of the between-visit work. Read the payment rates in the request for applications before anyone gets excited.
- Who does the work between visits? Outcomes in these conditions move through outreach, medication titration and follow-up, not through the visit itself. If nobody in the practice has that role, the model will pay you for work you are not staffed to do.
- What does the interoperability requirement mean for your systems? Participants report measures to CMS through standards-based APIs and send care updates to referring clinicians electronically. The July 23 webinar covers this. Ask your EHR vendor before, not after.
- What is the downside? The 50 percent payment reduction is the obvious one. Read the participation agreement for data submission penalties and termination provisions too, and have counsel read it with you.
How this fits with what you already do
Practices with PCMH recognition or Shared Savings Program experience will recognize the machinery: patient registries, care management, outcome tracking, quality reporting. ACCESS adds a payment stream tied to specific conditions rather than total cost of care, and it changes how those specific patients are billed. A practice already in an ACO should check with the ACO about overlap rules before applying, and should check the Shared Savings Program's own application calendar for 2027, because value-based decisions are stacking up this summer.
Chronic care management billing is a separate question. CCM codes (99490, 99439, 99491) pay fee-for-service for time spent on care management each month. Because the model excludes fee-for-service claims for aligned patients during a care period, a participant should assume CCM cannot be billed for those patients unless the final billing guidance says otherwise. A referring practice that is not a participant is not subject to the exclusion.
Our honest read
For an organization that already runs registries, has a care manager or a remote monitoring program, and can quote its A1c and blood pressure control rates from memory, ACCESS is worth a serious look in the cardio-kidney-metabolic and behavioral health tracks. For a typical independent practice, the referring role is the right first step: refer patients who would benefit, bill the co-management payment, and watch how the participants in your market perform for a year. The rolling application means you lose nothing by waiting except a few months of payments you were not equipped to earn anyway.
If you want help assessing readiness, our practice transformation team does a registry and reporting review before any model application. Rates are on the pricing page.
Questions we hear
Is ACCESS the same as chronic care management billing?
No. CCM pays fee-for-service for monthly care management time. ACCESS pays recurring outcome-aligned payments and excludes fee-for-service claims for aligned patients during a care period. They are different payment systems, and a patient is in one or the other.
Does the model require a particular technology vendor?
No vendor is required. The model does set health IT and data requirements, including API-based reporting, which is what the July 23 session is about. Ask your EHR vendor whether they intend to support ACCESS reporting before you commit.
We missed the April 1 application date. Is the door closed?
No. April 1 was the deadline for the first cohort starting July 5. CMS accepts applications on a rolling basis through 2033 and has listed later entry dates in 2026. A practice that applies in the fall starts later rather than missing out.
What to do this month
- Pull the count of Medicare patients with two or more visits in the past year for each of the four track conditions.
- Run your current control rates (A1c, blood pressure, PHQ-9 response) by provider. If the report takes more than a day to produce, that is your first finding.
- Read the request for applications with counsel, with the fee-for-service exclusion and the payment reduction marked.
- Register for the July 23 health IT webinar and send the questions to your EHR vendor beforehand.
- Decide whether the referring role is enough for 2026, and if so, find out which ACCESS participants are enrolling in your market.
