What is the CMS ACCESS Model? A guide for practices and ACOs

By Jay Chowdappa, MD, co-founder and CEO, Zynix AI · Updated October 6, 2026

Key takeaways

The CMS ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) is a voluntary, 10-year CMS Innovation Center model in Original Medicare. It began July 5, 2026 and pays Medicare Part B enrolled organizations recurring Outcome-Aligned Payments for technology-supported chronic care, with full payment tied to patients reaching measurable health outcomes.

• Four initial tracks cover cardio-kidney-metabolic conditions (early and established), chronic musculoskeletal pain, and depression or anxiety; more tracks start April 1, 2027.
• Participants must be Medicare Part B enrolled providers or suppliers (not durable medical equipment or laboratory suppliers) and must designate a Medicare-enrolled Medical Director.
• Primary care and referring clinicians do not enroll: they refer patients, receive care updates and may bill a co-management payment for documented review and coordination.
• CMS expects ACCESS payments to have no effect on Shared Savings Program and ACO REACH benchmark calculations in 2026 and 2027, and includes them from 2028.

CMS says Original Medicare has historically lacked a payment option for technology-supported care, because fee-for-service pays for a defined set of activities. ACCESS tests a different approach: pay organizations to manage a condition, and tie full payment to measurable improvement. This guide walks through the model from the CMS source pages.

What is the CMS ACCESS Model?

ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. It is a voluntary CMS Innovation Center model, run under Section 1115A of the Social Security Act, that tests an outcome-aligned payment approach in Original Medicare for technology-supported care that helps people prevent and manage chronic disease.

The model runs for 10 years: it began on July 5, 2026 and runs through June 30, 2036. CMS says it focuses on conditions affecting more than two-thirds of people with Medicare, including high blood pressure, diabetes, chronic musculoskeletal pain and depression. The CMS model page lists the stage as active, with more than 160 participants.

The care itself can include clinician consultations, lifestyle and behavioral support, counseling, medication management, care coordination and monitoring with FDA-authorized devices, delivered in person, virtually or asynchronously as clinically appropriate.

Who can participate in the ACCESS Model?

Participating organizations must be Medicare Part B enrolled providers or suppliers, excluding durable medical equipment and laboratory suppliers. Each must have an active Taxpayer Identification Number, meet state licensure, HIPAA and FDA requirements (or be subject to FDA enforcement discretion), and designate a Medicare-enrolled Medical Director responsible for clinical quality and compliance oversight. Organizations not yet enrolled in Part B must enroll to participate.

Patients must have Original Medicare and a qualifying condition in one of the tracks. They sign up directly with a participating organization, on their own or after a referral, and can enroll in more than one track. CMS may randomly assign a small share of them to a control group for evaluation, and enrolling never changes a patient’s Medicare benefits or choice of provider.

Which conditions and tracks does ACCESS cover?

ACCESS starts with four clinical tracks, and a participant is responsible for managing all qualifying conditions in a track it offers. Each track has condition-specific measures and outcome targets informed by clinical guidelines.

Patients enroll in either eCKM or CKM, not both. Starting April 1, 2027, CMS adds tracks for heart failure, chronic obstructive pulmonary disease, substance use disorder and tobacco cessation, plus a follow-on track for chronic musculoskeletal pain. Current participants and applicants do not need to reapply for the new tracks.

How does ACCESS pay participants?

ACCESS pays an Outcome-Aligned Payment: a recurring payment for managing a patient’s qualifying condition, with full payment tied to achieving measurable health outcomes rather than to specific activities or devices. CMS gives the example of helping a patient with hypertension lower blood pressure by 15 mmHg from their starting point.

• Panel-level performance. CMS bases payment on the overall share of an organization’s patients who meet their targets, compared with a minimum threshold that rises each participation year, so full payment is possible even if some patients miss their target.
• Care periods. Most tracks have an initial year of care followed by an optional continuation period at a reduced rate.
• Rural adjustment. A fixed adjustment applies to rural patients in qualifying tracks.
• Billing. During an active care period, participants and their affiliated entities may bill only ACCESS G-codes for aligned patients, not other Medicare fee-for-service claims.

Payment amounts and performance targets are in a separate CMS document linked from the model page. Primary care and referring clinicians do not need to enroll in ACCESS. When they review a participant’s care updates and complete a coordination activity, such as a medication adjustment or a problem-list update, they may bill a co-management payment a limited number of times a year, with no patient cost-sharing.

How does ACCESS work with ACOs?

CMS describes ACCESS as complementing ACOs and other risk-bearing arrangements by giving them new care options for patients with chronic conditions. For 2026 and 2027, CMS anticipates no impact from ACCESS payments on benchmark and performance year calculations for the Medicare Shared Savings Program and ACO REACH. Beginning in 2028, those expenditures are included.

An ACO’s primary care practices can refer patients to participants and bill the co-management payment for documented review. A practice with its own technology-enabled chronic care program can also apply as a participant and serve patients not aligned to its ACO. Referrals must respect the Anti-Kickback Statute and the Physician Self-Referral Law, and CMS will publish a directory of participants and their risk-adjusted outcomes.

What are the key ACCESS dates?

ACCESS has rolling entry points rather than one application window. Dates are from the CMS pages listed in the source notes.

What does technology-supported care mean in daily operations?

Technology-supported care under ACCESS is a measured program: collect baselines, keep measurements coming, act on changes, report outcomes and keep the patient’s other clinicians informed. Most of that is operational work; clinicians own every clinical decision under the Medical Director.

• Outreach and enrollment. Reaching eligible and referred patients and scheduling baseline measurements.
• Monitoring workflows. Collecting device readings and questionnaires such as PHQ-9 or GAD-7 on schedule, and flagging missing data before a care period ends.
• Follow-up. Reminders, rescheduling and check-ins, with any symptom or reading outside the plan routed to a clinician by rule.
• Documentation prep. Drafting the care updates CMS requires at care initiation, escalation and completion, for a clinician to review before they go to the primary care practice.
• Data exchange and reporting. Sending updates by Direct Secure Messaging or an exchange, and reporting measures to CMS through its APIs.

This is where voice and text agents for outreach and follow-up and a shared work queue help. Agents can run reminders, scheduling and data collection within the rules and hours a care team sets, while an embedded care management platform with tasks, owners and escalation by rule keeps every flagged reading in front of a clinician. Medication changes, diagnoses and treatment plans stay with licensed clinicians. Zynix AI is an approved participant in the CMS ACCESS Model, a voluntary CMS Innovation Center model in Original Medicare for technology-supported chronic-condition care.

How should a practice or ACO prepare for ACCESS?

Start by deciding your role: participant, referring and co-managing practice, or both.

1. Check eligibility. Confirm Part B enrollment, an active TIN, state licensure, and who will serve as Medicare-enrolled Medical Director.
2. Size the opportunity by track. Count Original Medicare patients with qualifying conditions using population intelligence across claims, EHR and lab data.
3. Design measurement and escalation. Define how baselines and readings are collected, who reviews them, and which results go to a nurse or physician the same day.
4. Set up care updates. Arrange Direct Secure Messaging or an exchange connection with the primary care practices you will work with, ahead of the July 2027 network requirement.
5. Review billing and referral rules. Plan for G-code-only billing during active care periods and have counsel review referral arrangements.

For a referring practice or ACO, start with a co-management workflow: who reviews incoming care updates, how coordination is documented, and how those patients sit in your chronic care coordination program.

Frequently asked questions

What does ACCESS stand for in the CMS ACCESS Model?

ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions. It is a voluntary, 10-year CMS Innovation Center model in Original Medicare that began on July 5, 2026 and pays organizations recurring Outcome-Aligned Payments for technology-supported chronic care, with full payment tied to measurable patient outcomes.

Can an ACO or its practices take part in ACCESS?

Yes, in two ways. ACO practices can refer patients to ACCESS participants and bill a co-management payment for documented review of care updates, without enrolling. A practice with its own technology-enabled chronic care program can also apply as a participant and serve patients not aligned to its ACO.

When can organizations apply to the ACCESS Model?

CMS reviews applications on a rolling basis through an online participant portal, with rolling admissions through early 2033. Each cohort begins on a set start date; the first began July 5, 2026 for applications received by April 1, 2026. New tracks start April 1, 2027, and current participants and applicants do not need to reapply to join them.

Does technology make clinical decisions in an ACCESS program?

It should not. CMS requires each participant to designate a Medicare-enrolled Medical Director for clinical oversight. Technology and agents can handle outreach, reminders, scheduling, collecting readings and drafting care updates, but medication changes, diagnoses and treatment plans belong to licensed clinicians, and any concerning reading or symptom should be routed to a clinician by rule.

Related reading

• ACO LEAD Model: Why 2027 Will Reward ACOs That Can Execute Between Visits
• How To Automate Care Management With AI Agents
• What Is Value-Based Care AI? A Complete Guide for 2026

Source notes

CMS: ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model. https://www.cms.gov/priorities/innovation/innovation-models/access

CMS: ACCESS Technical Frequently Asked Questions. https://www.cms.gov/priorities/innovation/access-technical-frequently-asked-questions

CMS: ACCESS for Primary Care Providers and Referring Clinicians. https://www.cms.gov/priorities/innovation/access-primary-care-providers-referring-clinicians

About the author

Jay Chowdappa, MD is co-founder and CEO of Zynix AI. He is a physician, and ACOs led by him generated $300M+ in shared savings before he started Zynix AI to help care teams follow through on what their data already shows.