How does the ACCESS payment approach differ from traditional Medicare fee-for-service?
Traditional fee-for-service payments are tied to specific activities or devices. ACCESS introduces Outcome-Aligned Payments (OAPs) — a recurring payment for managing a patient’s qualifying condition, with payment tied to achieving measurable health outcomes. This approach rewards results, not activities, and enables flexible, technology-supported care that improves patients’ health.
Will participating in ACCESS change my Medicare coverage or costs?
No. Participating in ACCESS does not change Medicare benefits, coverage, or rights. Patients keep all standard Medicare protections and can continue to see any Medicare provider. Some ACCESS organizations may waive standard Medicare cost-sharing, but participation is always voluntary.
How does ACCESS support patient safety?
ACCESS embeds strong safeguards to support clinical quality and accountability. Organizations must enroll in Medicare Part B as providers or suppliers and designate a physician Clinical Director to oversee clinical quality and compliance. All participating organizations must comply with all applicable federal and state regulations — including licensure requirements and HIPAA and FDA requirements (or otherwise be subject to FDA enforcement discretion). CMS will monitor performance and may terminate organizations who fail to meet quality, safety, or outcome standards. To promote transparency, CMS will publish risk-adjusted outcomes in a public directory.
How will CMS protect personal health information?
ACCESS participants must comply with all Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy and security requirements as covered entities. CMS complies with HIPAA and other applicable federal laws to protect Medicare beneficiary information and has strict policies regarding use of that information for care coordination, reporting, and evaluation.
ACCESS participants will use secure, interoperable systems—including CMS APIs for eligibility, enrollment, and reporting—to sign up patients, share clinical data, track outcomes, and coordinate care with beneficiaries’ primary and referring clinicians.
How is performance measured and how are payments determined?
Each clinical track includes a set of guideline-informed, condition-specific measures and outcome targets. CMS determines payment based on the overall share of patients who meet their defined outcomes, compared to a minimum threshold that increases with each participation year. This balances accountability with accessibility and rewards strong overall performance.
How does ACCESS coordinate with primary care and referring providers?
ACCESS is designed to integrate with traditional care. Primary care and referring clinicians can refer patients to participating organizations, receive electronic updates from ACCESS organizations on their patients’ progress, and bill a new co-management payment for documented review and coordination activities.
How does ACCESS interact with Accountable Care Organizations (ACOs) and other shared savings models?
ACCESS complements ACO and other risk-bearing arrangements by empowering risk-bearing entities with new care options to support their patients with chronic conditions and meet quality and savings goals.
For 2026 and 2027, CMS will be making system changes to support model operations, and CMS anticipates that there will be no impact from ACCESS OAPs on ACO benchmark and performance year calculations for the Medicare Shared Savings Program and ACO REACH. Beginning in 2028, expenditures associated with ACCESS OAPs will be included in ACO benchmark and performance year calculations.
Risk-bearing entities may refer their aligned beneficiaries to ACCESS participants—who are all Medicare Part B-enrolled providers or suppliers— and should consider applicable legal requirements including compliance with the Anti-Kickback Statute and Physician Self-Referral Law. CMS will maintain a public directory of ACCESS participants, the conditions they treat, and their risk-adjusted outcomes to help ACOs make informed referral decisions.
ACCESS provides an outcome-aligned payment option that replaces traditional fee-for-service billing for ACCESS Participants for beneficiaries for whom the Participant bills ACCESS codes. To preserve model integrity and prevent duplicative Medicare payments, ACCESS Participants and their affiliated entities may not submit Medicare Fee-For-Service (FFS) claims (directly, or indirectly through another organization for which they provide contracted services) for other services furnished to their ACCESS-aligned beneficiaries during an active care period. Only ACCESS G-codes may be billed for aligned beneficiaries during active care periods. See the Request for Applications for more information.
Overall, ACCESS expands the set of options available to ACOs. For example, a primary care organization participating in an ACO may support its patients with chronic conditions by coordinating care with ACCESS participants serving its geography and billing ACCESS co-management codes for documented review of patient updates. If that primary care organization also offers its own technology-enabled chronic care program, such as a virtual musculoskeletal program, it may choose to also join ACCESS as a participant to expand its reach. As an ACCESS Participant, the organization could offer ACCESS services (billed using ACCESS G-codes) to beneficiaries who are not aligned to its ACO, while continuing to bill traditional Medicare FFS claims for its ACO-aligned beneficiaries who are not enrolled in ACCESS.
Can Medicare Advantage (MA) plans participate in ACCESS?
ACCESS is being tested in Original Medicare, but Medicare Advantage (MA) organizations may independently adopt similar outcome-aligned payment arrangements with their contracted providers. See Detailed FAQs for more information.
