CMS Launches ACCESS Model Testing Outcome-Based Payments for Chronic Care

The Centers for Medicare & Medicaid Services (CMS) is launching the ACCESS Model, a 10-year pilot program starting July 1, 2026, to test an outcome-aligned payment (OAP) approach for Medicare fee-for-service (FFS) beneficiaries with chronic diseases. The model aims to expand access to technology-supported care through a voluntary payment system based on condition-specific outcomes. Applications from participating organizations will be accepted on a rolling basis from January 2026 to January 2033. ACCESS includes four clinical tracks targeting common chronic conditions, and organizations can participate in multiple tracks. Medicare beneficiaries can enroll directly or through referrals, with the possibility to enroll in multiple tracks simultaneously. When enrolled in multiple tracks with the same provider, CMS will apply discounts to payments reflecting care integration efficiencies. Eligible participants must be Medicare Part B providers or suppliers and appoint a physician clinical director responsible for quality and compliance. They must also comply with federal and state regulations, including HIPAA and FDA requirements. CMS will maintain a public directory of participants, their clinical conditions, and risk-adjusted outcomes and will monitor quality, safety, and outcome standards, with the possibility of disenrollment for non-compliance. Payment under ACCESS will be outcome-based, with recurring payments tied to improvement in specific clinical measures rather than individual services. Primary care physicians and referring clinicians can bill a new co-management payment for care coordination activities, which will not require beneficiary cost sharing. ACCESS allows for an optional continuation period for ongoing clinical support in most tracks, with reduced payment reflecting decreased resource needs. CMS offers a patient incentive safe harbor to participating organizations that waive beneficiary cost sharing on OAPs. The co-management service billing codes will be issued by CMS in 2026, allowing clinicians to bill approximately $30 per review and an additional $10 for onboarding activities. No cost sharing or advance patient consent is required for these co-management services. CMS will host the ACCESS Tools Directory within its application portal to connect participants with optional software and hardware technologies. Vendors may offer promotions under strict compliance with inducement laws. The directory highlights CMS's support for tech-enabled chronic disease management. ACCESS is designed to complement existing Medicare Shared Savings Programs (MSSP) and Accountable Care Organizations (ACOs) by encouraging technology-enabled care coordination without impacting ACO benchmarks or performance calculations until 2028. The model will not qualify as an Advanced Alternative Payment Model (A-APM) or affect Merit-Based Incentive Payment System (MIPS) reporting. CMS excludes Medicare Advantage enrollees from the ACCESS program but notes that health plans may implement similar programs. Unlike mandatory CMMI models, ACCESS is voluntary, focusing on preventative care through technology and care coordination. CMS intends to rigorously evaluate ACCESS's impact on care quality and outcomes, using control groups for some beneficiaries to assess effectiveness without withholding standard Medicare services. The initiative reflects a shift toward payment structures incentivizing demonstrable health improvements in chronic condition management.