CMS ACCESS Model 2026: What ACOs and Primary Care Practices Need to Know
The ACCESS Model is live, but participation should begin with a workflow question, not a technology demo.
CMS launched the voluntary ACCESS Model in July to expand technology-supported chronic care for people with Original Medicare. CMS lists August 17, 2026, as one of the model’s rolling start dates, and more than 150 organizations had been accepted as of August 12.
That creates new options for ACOs, primary care practices, and chronic-care providers.
It also creates a familiar healthcare problem: adding another technology-enabled service without first deciding how it fits into the patient’s existing care.
At Chirpy Bird, we think the right ACCESS conversation starts with seven questions:
Who is the patient? Who is the partner? Who makes the referral? Who receives the data? Who acts on it? Who documents the work? And who remains accountable?
Get those answers first. Then look at the technology.
1. Start With What ACCESS Is Actually Designed to Do
ACCESS stands for Advancing Chronic Care with Effective, Scalable Solutions.
CMS designed the 10-year model to test whether Original Medicare can pay for technology-supported chronic care based more directly on patient outcomes rather than a fixed list of individual activities.
Participating ACCESS organizations receive Outcome-Aligned Payments, or OAPs, for managing qualifying conditions. Full payment depends on performance against defined health outcomes. Care may include telehealth, connected devices, apps, lifestyle coaching, counseling, medication management, diagnostic services, patient education, and other technology-supported methods when clinically appropriate.
That makes ACCESS different from simply buying a remote-care platform.
The technology supports the service.
The outcome remains the point.
CMS has organized ACCESS around four clinical tracks:
Early cardio-kidney-metabolic, or eCKM: hypertension, dyslipidemia, obesity or overweight with central-obesity markers, and prediabetes
Cardio-kidney-metabolic, or CKM: diabetes, stage 3a or 3b chronic kidney disease, and atherosclerotic cardiovascular disease
Musculoskeletal, or MSK: chronic musculoskeletal pain
Behavioral health, or BH: depression and anxiety
For practices, this creates the first decision point.
Do not ask only:
“Do we have Medicare patients with these diagnoses?”
Ask:
“Which patients have a care gap that an ACCESS organization may actually help us solve?”
That is a much better starting place.
2. Determine Patient Fit Before You Build the Referral Workflow
Eligibility is necessary.
Patient fit is different.
ACCESS is currently available to people with Original Medicare, and patients voluntarily sign up directly with participating ACCESS organizations, either independently or following a referral. They retain their Medicare benefits and freedom to see other Medicare providers.
A diagnosis, however, should not automatically trigger a referral.
Before you refer, consider:
Does the patient need more support between office visits?
Is disease control currently poor or unstable?
Would ongoing monitoring, coaching, therapy, or behavioral support add value?
Can the patient use the technology required by the ACCESS organization?
Does the patient already participate in another chronic-care program?
Would the new service duplicate existing care?
Can your practice receive and use the information the ACCESS organization sends back?
Consider a patient with hypertension who already has strong blood pressure control, reliable follow-up, home monitoring, and an established care-management relationship.
That patient may technically fit an ACCESS clinical track.
But the practice should still ask what additional clinical problem the referral solves.
Now compare that patient with someone whose blood pressure remains uncontrolled between visits, struggles with medication adherence, and needs more frequent support than the practice can currently provide.
The same diagnosis can present a very different care opportunity.
ACCESS patient selection should be clinical, not merely categorical.
3. Vet the ACCESS Partner, Not Just the Platform
CMS has accepted more than 150 organizations into the ACCESS launch group, representing a wide range of technology-supported care approaches. Importantly, CMS notes that appearance on the accepted-applicant list is not an endorsement or guarantee of final participation. Organizations must still meet applicable requirements and receive final approval.
That makes partner due diligence important.
A polished technology demonstration should not be enough.
When evaluating an ACCESS organization, ask:
Clinical fit
Which ACCESS tracks does the organization support?
Which conditions does it actually manage well?
What clinical outcomes does it measure?
Who provides clinical oversight?
Patient experience
What technology must patients use?
What happens when a patient struggles with the technology?
How does the organization handle language, literacy, disability, or access barriers?
What happens when the patient disengages?
Escalation
What triggers a clinical escalation?
Who receives the alert?
How quickly must someone act?
When does the patient return to the referring clinician for management?
Data exchange
What information comes back to your practice?
In what format?
Where does it arrive?
Can it enter your normal EHR workflow?
ACCESS participants must comply with Medicare enrollment, applicable licensure, HIPAA, FDA, quality, and clinical-oversight requirements. CMS also requires participating organizations to use secure systems for enrollment, reporting, data sharing, and coordination.
That should establish the regulatory floor.
Your organization still needs to determine whether the partner fits your operating model.
4. Design the Referral as the Beginning of Co-Management
This is one of the most important points for primary care practices and ACOs:
An ACCESS referral is not a clinical handoff that makes the patient someone else’s problem.
CMS specifically designed ACCESS to complement existing care.
ACCESS organizations must proactively send referring and primary care clinicians updates at key points:
Care initiation, including the care plan and baseline measures
Care escalation, when clinical needs change or care transitions
Care completion, with a summary of the care period
That means your referral workflow should answer what happens after the referral.
For example:
Who confirms that the patient enrolled?
Where does the first care update arrive?
Who monitors that inbox or system?
Who reviews the clinical information?
What findings require physician or APP attention?
Who updates medications or the problem list?
Where is that response documented?
How does the ACCESS organization receive feedback?
Without that workflow, ACCESS can become another stream of clinical information entering the practice with no clear destination.
We already have enough electronic information wandering around healthcare looking for someone to love it.
Do not create another orphan inbox.
5. Decide Where the Data Will Live
CMS is also building ACCESS around increasingly structured data exchange.
ACCESS organizations can currently send care updates through HIPAA-compliant electronic methods such as Direct Secure Messaging, network-supported push mechanisms, or secure eFax.
By July 2027, CMS requires ACCESS organizations to connect to a CMS-aligned Network or Health Information Exchange so structured information can be queried through existing clinical systems. This can include blood pressure, HbA1c, LDL cholesterol, weight, medications, and patient-reported outcomes such as PHQ-9 scores.
That is good directionally.
It does not eliminate the practice’s workflow problem.
Ask your IT and clinical teams:
Where will ACCESS data appear in the EHR?
Who reconciles outside data with the existing chart?
Can clinicians distinguish ACCESS-generated information from other remote data?
What values should trigger action?
Can quality teams use the data?
How will duplicates be handled?
What becomes part of the legal medical record?
Interoperability is not achieved merely because two systems exchanged a file successfully.
The receiving organization must be able to use the information safely and consistently.
6. Build Documentation Around the Co-Management Work
ACCESS also creates a direct financial reason for practices to define this workflow correctly.
Eligible Medicare Part B practitioners may receive an ACCESS Co-Management Payment for reviewing an ACCESS care update and completing at least one related care-coordination activity.
CMS currently sets the standard payment at $30, subject to geographic adjustment and sequestration. Eligible clinicians can generally bill it up to three times during a 12-month care period for each patient and ACCESS track. A one-time $10 Modifier AC may also apply when qualifying onboarding and technology-setup support occurs. Beneficiary cost-sharing does not apply.
But this is not payment for opening an email.
CMS requires the practitioner to review the update and perform at least one qualifying coordination activity. Examples include:
Medication adjustment or reconciliation
Updating the problem list
Changing monitoring or follow-up instructions
Coordinating with other clinicians
Communicating with the ACCESS organization
Documenting agreement or disagreement with its recommendations
CMS requires at least five minutes of practitioner time, and documentation must support review of the electronically shared clinical update. The diagnosis and HCPCS code must also correspond to the beneficiary’s ACCESS track.
So before your billing team gets excited about another G-code, build the clinical documentation process.
The payment follows the work.
The record needs to prove the work happened.
7. ACOs Should Decide How ACCESS Fits the Larger Care Strategy
ACCESS has particular implications for ACOs.
CMS says the model is intended to complement accountable-care arrangements. For 2026 and 2027, CMS anticipates that ACCESS Outcome-Aligned Payments will not affect MSSP or ACO REACH benchmark and performance-year calculations. Beginning in 2028, ACCESS expenditures are expected to enter those calculations.
That gives ACOs time to evaluate the model strategically.
Ask:
Which beneficiary populations may benefit?
Does ACCESS fill a gap in our existing chronic-care strategy?
Are we already paying another organization to provide similar care?
Who approves ACCESS referral relationships?
How will we monitor performance?
Can we identify duplicative services?
How will care updates support our quality strategy?
What financial implications should we begin modeling for 2028?
The right answer may be different by condition.
An ACO may see strong value in an ACCESS musculoskeletal partner but already operate an effective diabetes-management program internally.
That is fine.
ACCESS does not need to become an all-or-nothing strategy.
Build the Workflow Before You Add the Technology
ACCESS creates a meaningful new path for Medicare beneficiaries with chronic conditions to receive technology-supported care.
But technology alone does not create coordination.
A strong ACCESS strategy connects seven things:
Patient fit → clinical track → partner selection → referral → care updates → co-management documentation → ongoing governance
If one of those handoffs has no owner, that is where I would begin.
For ACOs, primary care practices, and chronic-care organizations, the question is not simply whether ACCESS is available.
The question is whether it improves the care model you already have without creating duplication, unclear accountability, or another disconnected stream of data.
Evaluate whether ACCESS complements your current care model.
Chirpy Bird can help your organization assess regulatory requirements, map the operational workflow, clarify ownership, and identify the controls needed before technology-supported care becomes another compliance project.
