The Substance Access BEI is an optional Beneficiary Engagement Incentive that allows participants in certain CMS Innovation Center models to consult with eligible beneficiaries about the possible use of eligible hemp products to improve symptom control. Participants implementing this BEI may elect to furnish such hemp products up to $500 a year, per eligible beneficiary, subject to model requirements and safeguards.
Note: Medicare does not pay the participant for the products, and beneficiaries should not be asked to submit a Medicare claim for the product.
Model participants will have the option to offer this BEI in three Innovation Center models:
Participants may begin offering the Substance Access BEI for both ACO REACH Model and EOM starting April 1, 2026. The BEI will become available to eligible LEAD participants on January 1, 2027.
Participants must submit required quarterly reports to CMS and provide supplemental information upon request, consistent with participation documentation.
For more information on the Innovation Center models that include the Substance Access BEI, visit the ACO REACH, EOM, and LEAD model webpages.
Frequently Asked Questions
Which organizations are eligible for the Substance Access BEI?
Only participating organizations in ACO REACH, EOM and LEAD may offer the Substance Access BEI, and only if they:
- Elect the Substance Access BEI for the applicable performance period; AND
- Submit and maintain a CMS-required Implementation Plan describing, at minimum, the specific eligible hemp product(s) and dosing information, the amount/frequency of distribution, beneficiary eligibility criteria, safeguards/oversight, and other requirements outlined in participation agreements; AND
- Are approved by CMS (CMS may reject or suspend participation based on the Implementation Plan, compliance history, or other program integrity concerns).
Which beneficiaries are eligible for the Substance Access BEI?
Only beneficiaries currently aligned to participating organizations that have elected to offer the Substance ACCESS BEI in the REACH, EOM or LEAD models may receive the BEI. Additional beneficiary eligibility criteria are defined in each model’s participation documentation and implementation plan, but generally includes:
- Being age 18 or older;
- Not meeting the model’s frailty exclusion;
- Not having specified disqualifying conditions; and
- Not being pregnant or breastfeeding.
In addition, a physician must determine that use is appropriate and must document required shared decision-making (including medication review and follow-up planning). At a minimum, this includes a documented discussion of potential benefits and risks, the beneficiary’s goals and preferences, and a review of current medications and potential interactions.
DISQUALIFYING CONDITIONS ARE SPECIFIED IN MODEL PARTICIPATION DOCUMENTATION AND ARE INTENDED TO REDUCE PATIENT SAFETY RISKS.
What is an “‘eligible hemp product” for purposes of this BEI?
Eligible hemp products are limited to federally legal hemp-derived products containing no more than 0.3% delta-9 THC and expressly excludes inhalable products, any products containing more than 3 mg per serving of tetrohydrocannabinols (such as delta-8-tetrahyrdocannabinol, delta-10-tetrahyrdocannabinol, and tetrahydrocannabinolic acid) in an orally administered form, and any products containing cannabinoids not naturally produced or capable of being produced by or in the cannabis plant during its cultivation.
The definition operates within the 2018 Farm Bill’s hemp provisions and does not override the Controlled Substances Act or authorize Schedule I substances. To be eligible, hemp products must also comply with applicable state and local laws.
If the legal limits on hemp-derived products changes, as with Section 781 of the FY2026 Agriculture Appropriations Act, CMS will adjust its definition in accordance with the law.
How are eligible hemp products procured and furnished?
Model participants are responsible for their own procurement and operational approach (including contracting, ordering, storage, inventory controls, and distribution workflows), consistent with model requirements and applicable law.
Eligible hemp products must be furnished and provided directly by a qualified physician affiliated with the participant organization, as specified by the model participation agreements.
Note: Model participants cannot instruct beneficiaries to purchase retail products and submit receipts for reimbursement under the BEI.
What are the key program integrity and contracting requirements?
Program integrity guardrails are described in model participation documentation and include:
- The BEI (and product availability) must not be marketed to induce beneficiaries to select or remain aligned to a participant organization; AND
- Participants may not enter into arrangements that provide remuneration to induce selection of a particular manufacturer or seller, and payments must be consistent with fair market value and not tied to the volume or value of referrals or other business; AND
- Participants must implement safeguards against abuse, including monitoring and oversight, and CMS may suspend or prohibit participation for integrity concerns.
What quality and safety standards apply to products?
Model participants are required to meet quality and safety standards requirements for products that at a minimum, must:
- Meet federal, state and local production, quality, and safety laws and other mandated standards; AND
- Come from a legally compliant source and high-quality farm, consistent with 2018 Farm Bill hemp requirements, AND
- Be tested by a third party for potency (including accurate cannabinoid measurement) and for contaminants and microbial hazards with negative results.