CMS Issues New Guidance on ACCESS Model Payment Arrangements

WASHINGTON—The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMI) has issued additional updates on the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. The ACCESS model is a voluntary 10-year national test of a payment approach leveraging technology in care delivery. 

These updates include:

• Pledge by Medicare Advantage, Medicaid and private health insurance plans to adopt outcomes-based payment arrangements aligned with the ACCESS Model
• Updated frequently asked questions sheet (FAQs), with guidance on technical questions raised
• Model payment amounts and performance targets

The updated Technical FAQs address a broad range of operational and payment questions raised since the ACCESS Request for Applications (RFA) was published including:

• ACCESS participants and their affiliated entities may not submit Medicare fee-for-service (FFS) claims for other services furnished to their ACCESS-aligned beneficiaries during an active care period. Rather, only ACCESS-specific G-codes may be billed. That said, this exclusion applies only at the beneficiary level. For reassignment relationships, the exclusion applies only to organizations, not individual clinicians. This is intended to prevent duplicative Medicare payments but has practical implications for organizations that deliver both ACCESS-eligible chronic care services and other Medicare-covered services to the same patient population.
• Participants may furnish clinical items to beneficiaries on a loan or ownership basis “where there is a reasonable connection between the item and the furnishing of ACCESS services” but may not require beneficiaries to purchase clinical items as a condition of participation.
• Participants may use any HIPAA-compliant secure electronic method for meeting care coordination requirements. A participant-specific portal alone does not satisfy this requirement unless it “is part of an established data-sharing relationship or technical integration with the coordinating clinician that ensures the update is delivered to and accessible by that clinician.”
  The co-management payment for primary care practitioners and referring clinicians is confirmed at approximately $30 per service (up to once per four months per beneficiary per track), with an additional approximate $10 onboarding modifier available the first time it is billed. No Part B cost-sharing applies.

CMS includes ACCESS payment information in its Model Payment Amounts and Performance Targets guidance, which is effective July 5, 2026 through Dec. 31, 2027.

CMS will allow a $15 fixed additional payment for beneficiaries in rural areas aligned to early cardio-kidney-metabolic or cardio-kidney-metabolic clinical tracks during the initial period only. In addition, a 5% discount is applied to the lowest cost track when a beneficiary is enrolled in multiple tracks with the same participant. Notably, CMS has shifted from quarterly to monthly payments, a change from the original RFA’s design. Note however that there continues to be a remaining 50% withhold pending reconciliation after the 12-month care period based on any performance adjustments.

To access the full list of updates click here. For the updated FAQs click here.