CMS Launches ACCESS Model to Transform Chronic Care with Outcomes-Based Payments

The Centers for Medicare & Medicaid Services (CMS) is launching the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions), a voluntary 10‑year initiative starting in July 2026. This model is designed to advance technology‑supported care and outcomes-based payment approaches in traditional Medicare, focusing on chronic disease management. By moving away from fee‑for‑service reimbursement, ACCESS aligns payments with demonstrated improvements in patient outcomes. The model targets chronic conditions prevalent among Medicare beneficiaries, including hypertension, diabetes, chronic musculoskeletal pain, and depression, which affect over two-thirds of this population. Participation is open to Medicare Part B-enrolled providers excluding durable medical equipment and laboratory suppliers. Applicants must show the ability to implement technology tools, manage targeted population health, and regularly report outcomes to CMS. ACCESS emphasizes the integration of digital health tools such as remote monitoring devices, mobile applications, and telehealth platforms to monitor and manage chronic conditions beyond clinical visits. Patient enrollment occurs via participating providers or organizations, with CMS evaluating performance using benchmarks related to blood pressure control, glycemic management, pain and functional status, and depression screening and follow-up. Providers have flexibility in care delivery but must demonstrate scalable interventions with widespread patient impact. Regular submission of outcome and patient engagement data is mandatory, and payment adjustments will be made based on achievement of defined health outcomes. The model aims to supplement existing value-based care arrangements like accountable care organizations. Financially, ACCESS introduces performance-linked, risk-sharing reimbursements requiring providers to align workflows and technology investments to capture and report outcome data accurately. Providers managing ACCESS beneficiaries can also bill a new $30 Co-Management service fee every four months without cost sharing for patients. Compliance and regulatory adherence remain critical, with ongoing applicability of the Anti-Kickback Statute and Stark Law, and CMS plans to offer model-specific waivers for beneficiary incentives. Providers must navigate licensure, HIPAA, FDA, telehealth, and fraud avoidance requirements while structuring vendor relationships carefully. Key provider preparations include developing robust financial models simulating performance outcomes, advancing technology enablement with interoperability and cybersecurity considerations, and investing in digital literacy and access initiatives to reduce technology barriers. Strengthening governance and accountability through board-level oversight is essential for performance measurement, compliance, and risk management. Patient engagement strategies should address digital literacy, broadband access, and culturally appropriate services. CMS will release an implementation guide with additional details before the application window opens on January 12, 2026, closing April 1, 2026. ACCESS leverages Section 1115A regulatory flexibility under the Affordable Care Act to transition Medicare toward a value-driven reimbursement system, signaling an ongoing evolution in CMS Innovation Center model design.