Providers caring for patients with chronic conditions have for years faced a persistent mismatch between how care is delivered and how Medicare pays for it. Managing chronic illness often requires ongoing monitoring, behavioral support and interventions outside traditional office visits, yet Medicare’s fee‑for‑service (FFS) structure has historically only reimbursed discrete services, ignoring services that can provide sustained improvement in patient health. CMS has now acknowledged that by doing so it has been limiting the providers’ ability to better scale technology‑enabled care, focusing on ongoing management rather than episodic treatment.
Through its Center for Medicare and Medicaid Innovation (CMMI), on July 5, 2026, CMS has launched the ACCESS Model—Advancing Chronic Care with Effective, Scalable Solutions—as a voluntary, 10‑year test of whether an outcome‑aligned payment (OAP) approach can sustainably expand access to chronic care services not well supported through traditional Medicare reimbursement.
Key Highlights of ACCESS
- Scope: Traditional Medicare reimbursement tied to management of specific chronic conditions
- Purpose: Testing whether outcome‑aligned payment improves care delivery
- Focus: Technology‑supported care for four high‑impact diagnoses
- Timeline: First phase begins July 5, 2026 (applications for this phase must have been submitted by April 1, 2026); applications submitted after April 1, 2026 and by October 1, 2026 will be considered for the next phase that begins January 1, 2027
- Participation Structure: Voluntary, for a 10-year participation
Scope of ACCESS Model
ACCESS is structured around specific chronic conditions, rather than population‑wide risk, and focuses on conditions where CMS judges that ongoing management and prevention efforts have the greatest potential impact in FFS Medicare. The selected chronic conditions, also called “tracks” by CMS, affect more than two‑thirds of Medicare beneficiaries. They are:
- High blood pressure
- Diabetes
- Chronic musculoskeletal pain
- Depression
Organizations that participate in ACCESS must be Medicare Part B–enrolled providers or suppliers, excluding certain categories such as durable medical equipment and laboratory suppliers. Eligible participants must designate a Medicare‑enrolled physician clinical director responsible for clinical oversight, quality, and compliance with model requirements, and must demonstrate the ability to furnish technology‑supported care for one or more of the model’s qualifying chronic conditions. Because CMS evaluates applications based on organizational readiness, clinical leadership and the ability to meet detailed participation and reporting requirements, interested organizations will want to carefully assess their eligibility and application approach before submitting materials to CMS.
Outcome-Aligned Payments
A defining feature of ACCESS is its use of OAPs, which CMS describes as recurring payments tied to whether patients experience measurable improvement in their health over time. OAP measures are condition-specific metrics that hold participating providers accountable for beneficiary outcomes. Unlike traditional Medicare reimbursement driven by the volume of services provided, payment under ACCESS represents a shift toward aligned incentives: providers earn full payment only when beneficiaries meet OAP measure targets relative to each beneficiary’s baseline.
Outcome targets—clear benchmarks for beneficiary success published by CMS—are specific to the selected condition tracks and focus on either control or improvement of OAP measures. Beneficiary clinical data and patient-reported data are measured against the targets for condition tracks to which the beneficiary is aligned.
How Providers are Paid
The ACCESS model is designed to promote continued improvement and management of chronic illness over time. To this end, participating providers must submit monthly claims to CMS, and CMS will pay 100% of the projected annual OAP amount in monthly installments for the first 6 months of the 12-month care period. During the remaining 6 months (months 7 to 12) of the care period, CMS will withhold payment. After the 12-month care period, CMS will reconcile payment based on each beneficiary’s achievement of OAP Measure targets. This method continues annually during the term.
Technology as Key to Success
Technology plays a central role in the ACCESS Model, not as a separately reimbursed service, but as a core means by which participating organizations are expected to prevent and control chronic conditions between traditional clinical encounters. Integrated, technology‑supported care includes clinician consultations, lifestyle support, therapy and behavioral health counseling, patient education, diagnostic testing, care coordination, and medication management—services historically difficult to sustain under FFS Medicare.
CMS has also made clear that ACCESS is designed to accommodate the use and monitoring of FDA‑authorized devices or software, as well as certain digital health technologies, without tying payment to any specific tool or platform. Instead, the model places responsibility on participating organizations to determine how technology could be incorporated into care delivery to facilitate continuous care, rather than stand‑alone reimbursable services.
As CMS continues to shift payment toward outcomes, ACCESS presents a meaningful opportunity for organizations to align care delivery with results, making early evaluation of fitness, capabilities, partnerships, and participation timing important strategic steps for providers navigating this evolving landscape.
