CMS expanded the ACCESS Model on September 15, 2026. The new condition tracks matter—but the larger revenue-cycle development is the payment architecture.
Starting April 1, 2027, ACCESS will add tracks for heart failure, chronic obstructive pulmonary disease (COPD), substance use disorder, tobacco cessation, and extended support for certain chronic musculoskeletal conditions. The voluntary model operates in Original Medicare and tests technology-supported care delivered through an outcome-aligned payment approach.
For revenue-cycle leaders, the signal is straightforward: ACCESS moves clinical outcomes, beneficiary alignment, active-care periods, claims controls, and payment reconciliation into one operating model.
What CMS changed
CMS announced that the new tracks will begin April 1, 2027. They expand an existing model that already includes early cardio-kidney-metabolic conditions, more advanced cardio-kidney-metabolic conditions, chronic musculoskeletal pain, depression, and anxiety.
CMS reported 160 participating organizations at launch. It also said three out of four people with Medicare qualify for at least one ACCESS track.
Participation is voluntary. ACCESS is available to people with Original Medicare; Medicare Advantage enrollees are not eligible, although Medicare Advantage plans may offer similar programs. Beneficiaries retain their Medicare rights, coverage, and freedom to see any Medicare provider.
The payment architecture is the real change
Traditional Medicare fee-for-service payment is generally tied to defined activities, services, or devices. ACCESS tests Outcome-Aligned Payments: recurring payments to Medicare-enrolled care organizations for managing qualifying conditions, with full payment tied to achieving measurable health outcomes.
That distinction changes the financial question. Instead of asking only whether a service was furnished and coded correctly, organizations must also demonstrate whether the patient met the applicable outcome target and whether the related payment was earned, reduced, or reconciled correctly.
The clinical model may involve virtual care, health coaching, remote monitoring, connected devices, wearables, medication management, education, and coordination. The revenue model depends on connecting those activities to eligibility, alignment, measurement, and payment.
This is not fee-for-service with a new label
CMS states that ACCESS Outcome-Aligned Payments replace traditional fee-for-service billing for ACCESS participants when they bill ACCESS codes for aligned beneficiaries.
During an active care period, ACCESS participants and their affiliated entities may not submit other Medicare fee-for-service claims—directly or indirectly—for services they furnish to ACCESS-aligned beneficiaries. Only ACCESS G-codes may be billed for those beneficiaries during the active care period.
That makes beneficiary alignment and active-care dates critical financial controls. A revenue-cycle system must know who is aligned, when the care period begins and ends, which entities are affiliated, which claims are prohibited, and which ACCESS code is permitted.
Referring clinicians also have a payment path
ACCESS is designed to complement traditional care. Primary care and referring clinicians can receive electronic patient-progress updates from ACCESS organizations. CMS says those clinicians may bill a new co-management payment for documented review of the updates and associated coordination, including actions such as medication adjustments or problem-list updates.
The operational lesson is familiar: a clinical handoff does not become billable merely because data moved. The organization must preserve evidence that the clinician reviewed the information and performed the required coordination.
The RCM build list
- Eligibility and alignment: Confirm Original Medicare eligibility, condition-track eligibility, beneficiary consent, and alignment status.
- Active-care periods: Maintain authoritative start and end dates and use them in claim edits.
- ACCESS G-code rules: Validate the permitted code, timing, documentation, and payment status.
- Affiliate controls: Identify affiliated entities and prevent prohibited duplicate fee-for-service claims.
- Outcome evidence: Capture the baseline, target, measurement method, result, and supporting clinical data.
- Payment reconciliation: Tie recurring payments, performance results, adjustments, and exceptions back to the aligned beneficiary and active-care period.
- Co-management documentation: Preserve the referring clinician’s review, coordination, and resulting action.
- Audit history: Retain alignment changes, data submissions, claim edits, payment calculations, approvals, and corrections.
Why the signal extends beyond ACCESS
CMS said major payers representing 165 million Americans across Medicare Advantage, Medicaid, and private insurance pledged to adopt an outcomes-based payment structure aligned with ACCESS. A pledge is not the same as an implemented contract, but it is a meaningful market signal.
The underlying capabilities—eligibility, alignment, active-care dates, outcome measurement, claims suppression, documentation, and reconciliation—are reusable across value-based and technology-supported payment arrangements.
For 2026 and 2027, CMS says it expects no impact from ACCESS Outcome-Aligned Payments on Medicare Shared Savings Program and ACO REACH benchmark and performance-year calculations. Beginning in 2028, ACCESS expenditures are expected to be included in those calculations. ACOs and other risk-bearing organizations should therefore understand how referrals into ACCESS could affect downstream financial performance.
The RCM Signal
Digital care does not scale on clinical technology alone. Contracting, eligibility, beneficiary alignment, claims logic, outcome data, payment reconciliation, and audit evidence must operate as one system.
The question for revenue-cycle leaders is not only whether the organization can deliver the care. It is whether the organization can prove both the outcome and the payment path.
References
- Centers for Medicare & Medicaid Services. “CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic Conditions.” September 15, 2026.
- CMS Innovation Center. “ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model.” Page last modified September 15, 2026.
Editorial status note: This article reflects CMS materials available through September 16, 2026. It is an operational summary, not legal, coding, reimbursement, or clinical advice. Organizations should review the complete CMS model materials and their own participation agreements, affiliations, workflows, and compliance obligations.