ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model

Digital technologies are transforming the way care is delivered, helping people manage chronic conditions with continuous support beyond the doctor’s office. For example:

• Telehealth software helps patients interact with their health care providers from anywhere.
• Wearable devices continuously monitor sleep, heart rate, movement, blood sugar and other functions.
• Apps coach people to make lifestyle changes that can benefit both their behavioral and physical health.  

Technology-supported care services can be especially valuable for people in communities with limited local care options, especially in rural areas.

Background

Original Medicare has historically lacked a payment option to adequately support novel technology-supported care. Fee-for-service methodologies pay for a defined set of activities that do not typically align with the way technology-supported care is delivered.

Innovation

The ACCESS Model will address this gap by testing Outcome-Aligned Payments (OAPs), a payment option for Medicare-enrolled care organizations. Participating organizations will receive recurring payments for managing patients’ qualifying conditions, with full payment tied to achieving measurable health outcomes. The model focuses on clinical improvement or control of a condition based on each person’s starting point, for example, helping a patient with hypertension lower their blood pressure by 10 mmHg. By rewarding outcomes rather than defined activities (or volume of services delivered), ACCESS gives clinicians greater flexibility to deliver modern technology-supported care in ways that best improve patient health.

Goals

The ACCESS Model aims to:

• Empower people to achieve their health goals by improving patient access to new technology-supported care options to manage their chronic conditions.
• Expand clinicians’ ability to offer innovative, technology-enabled care through a straightforward payment pathway.
• Ensure that technology-supported care is clinician-guided, accountable, and coordinated.
• Promote transparency by publishing risk-adjusted health outcomes of technology-supported care so patients and referring clinicians can make informed choices.

Design

ACCESS care organizations are expected to offer integrated, technology-supported care that 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

Care may be provided in-person, virtually, asynchronously, or through other technology-enabled methods as clinically appropriate.

To support safe and effective care, participating organizations must enroll in Medicare Part B as providers or suppliers and comply with applicable state licensure requirements and 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 physician Clinical Director responsible for clinical oversight and compliance. CMS will monitor clinical performance and publicly report aggregated, risk-adjusted results to help patients make informed choices.

ACCESS is designed to complement traditional care. PCPs and referring clinicians can refer patients to ACCESS organizations and will receive regular electronic updates on patient progress. PCPs and referring clinicians may also bill a new co-management payment for documented review of patient updates and associated coordination activities, such as medication adjustments or problem list updates, strengthening collaboration between ACCESS organizations and traditional providers.

ACCESS will focus on four clinical tracks addressing many of the most common chronic conditions:  

• 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
• Cardio-kidney-metabolic conditions (CKM): diabetes, chronic kidney disease (3a or 3b), and atherosclerotic cardiovascular disease, including heart disease
• Musculoskeletal conditions (MSK): chronic musculoskeletal pain
• Behavioral health conditions (BH): depression and anxiety

CMS may consider additional tracks and conditions in the future.

Each track groups related conditions that are commonly treated using similar types and levels of care. Participating organizations are responsible for managing all qualifying conditions in a track, supporting integrated, patient-centered care.  Each track includes a set of condition-specific measures and outcome targets informed by clinical guidelines—such as patient improvement or control in biomarkers like blood pressure, hemoglobin A1c (HbA1c), lipids, or weight, or in validated Patient Reported Outcome Measures (PROMs) of pain, mood and function.  

Most tracks include an initial year of care followed by an optional continuation period at a reduced rate, facilitating continued patient support.  

To promote access in underserved areas, a fixed adjustment will be applied to rural patients in qualifying tracks.

To balance accountability with model accessibility, CMS will base payment on the overall share of an organization’s patients who meet their outcome targets, allowing organizations to earn full payment through strong overall performance even if some individual patients do not meet their target. CMS will publish risk-adjusted outcomes, recognizing and rewarding excellent clinical performance.

Patients voluntarily sign up directly with participating ACCESS care organizations, either on their own or upon referral from their provider. To help patients and PCPs choose the most appropriate ACCESS organizations for their conditions, CMS will maintain a directory of all ACCESS participants including the conditions they treat and their risk-adjusted outcomes.

Patients with Original Medicare retain all of their rights, coverage, and benefits, including the freedom to see any Medicare health care provider. 
 

ACCESS participants must be Medicare Part B–enrolled organizations (excluding Durable Medical Equipment, Prosthetics, Orthotics, and Supplies and laboratory suppliers) and designate a Medicare-enrolled Medical Director to oversee care quality and compliance. Organizations not enrolled in Medicare Part B must enroll to participate in ACCESS. For more information about participant requirements and responsibilities, please see the Detailed FAQs and the Request for Applications. Applications will be reviewed on a rolling basis. Complete the ACCESS Model Interest Form to be notified about model updates.

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.

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.   

• Detailed FAQs
• Modernizing America's Care for Better Health - December 4, 2025 HHS-CMS Event Recording
• Model Interest Form
• Request for Applications