Last updated: June 15, 2026

June 2026 Status:

• ACCESS launches July 5, 2026. The model goes live in less than three weeks. More than 150 organizations have been accepted for the first cohort, most of which had not previously served Medicare beneficiaries.
• Cohort 1 application window is closed. The May 15, 2026 deadline has passed. If you missed it, the next entry point is January 1, 2027 — applications for that cohort are open now and due by October 1, 2026. After that, cohorts begin quarterly, with rolling admissions accepted through April 1, 2033.
• ACCESS FHIR Implementation Guide published. Healthie's current status (June 2026): CMS published the ACCESS FHIR Implementation Guide (v0.9.1) at dsacms.github.io/cmmi-access-model. The current path for participants is to extract data via Healthie's API, transform to CMS FHIR format, and submit via the ACCESS APIs directly. Native ACCESS API integrations are on our roadmap — contact us for the latest status and to discuss your implementation approach.

The 10-year ACCESS program finally aligns Medicare payment with outcomes-focused care. The model launches July 5, 2026. Here's what you need to know.

If you deliver tech-enabled chronic care, the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) is the most significant Medicare payment development in years. Launching July 5, 2026, it creates a real payment pathway for the kind of care Healthie customers deliver every day: longitudinal, technology-supported, outcomes-focused care for people living with chronic conditions. We're here to help you understand what it means and how to prepare.

Here's the problem ACCESS is solving: Medicare has never had a great way to pay for tech-enabled care. Traditional Medicare pays for activities — a visit here, a procedure there. But that's not how modern chronic care works. When you're helping someone manage diabetes, hypertension, anxiety, or chronic pain, you're building a relationship over months and years.

If your organization delivers care for any of these conditions — whether that's diabetes management, virtual MSK programs, behavioral health support, or integrated chronic care — ACCESS creates a pathway to sustainably serve Medicare patients.

What ACCESS Is

ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) is a 10-year voluntary CMS Innovation Center model that runs July 5, 2026 – June 30, 2036, operating nationwide. It replaces visit-based fee-for-service with prospective per-beneficiary payments tied to measurable clinical outcomes.

Designed for Original Medicare beneficiaries with qualifying chronic conditions, participation is at the organizational level (single Medicare Part B-enrolled TIN).

Four clinical tracks:

• eCKM (Early Cardio-Kidney-Metabolic): Hypertension plus two or more of dyslipidemia, obesity/overweight with central adiposity, or prediabetes. Outcome measures: control/improvement in systolic BP, lipids, weight, HbA1c.
• CKM (Cardio-Kidney-Metabolic): Diabetes, chronic kidney disease, or atherosclerotic cardiovascular disease. Outcome measures: BP control, LDL-C, weight/BMI, HbA1c.
• MSK (Musculoskeletal): Chronic musculoskeletal pain. Outcome measures: improvement in pain intensity, function, and patient-reported outcomes.
• BH (Behavioral Health): Depression and/or anxiety. Outcome measures: patient-reported outcomes on PHQ-9, GAD-7.

How ACCESS Payments Work (50/50 Split Model)

CMS has clarified the payment mechanics that affect cash flow planning:

• 50% prospective: Paid quarterly during the care period
• 50% withheld: Subject to reconciliation based on whether your patient population meets Outcome Attainment Thresholds (OAT)
• Year 1 OAT: 50% of aligned beneficiaries must meet outcome targets for full reconciliation payment
• Substitute Spend adjustment: Up to 25% reduction if patients receive duplicative services from other Medicare providers

Financial planning note: Budget for 50% payment during the care period. Don't count on the withheld 50% until performance is reconciled. Organizations with tight cash flow should plan accordingly.

Blood Pressure Data: The Most Restrictive Technical Requirement

For eCKM and CKM tracks, blood pressure collection has strict technical requirements that will disqualify manual data entry:

✅ Required: Validated upper-arm cuff devices with timestamped, source-verifiable transmission

❌ Prohibited: Manual entry, patient-reported values, or unverifiable data

📊 Standard: Each submission must average 3+ readings per 2025 AHA/ACC guidelines

What this means for Healthie customers: Your RPM device integrations need to support automated data transmission with audit trails — not just display. If you're currently using manual BP entry workflows, you'll need to transition to connected devices before eCKM/CKM participation. Check our Devices & Integrations documentation to confirm your BP cuff supports source-verifiable transmission, or contact our team to identify compatible devices.

Healthie integrates with wearables and RPM devices, including Fitbit, Apple Health, Withings, Dexcom, and others. Device readings flow into the client's Metrics tab automatically. For additional RPM vendors, check our Integrations Marketplace or use our API to connect your existing platform.

⚠️ Important for eCKM/CKM applicants: Before your ACCESS application, confirm with your device vendor that their Healthie integration supports automated transmission with a timestamped audit trail meeting CMS source-verifiable transmission requirements. Not all device integrations meet this standard. Contact us to discuss device compatibility for your track.

Pro tip: If you're preparing for the January 2027 cohort, set up and test your device integration now — well before the October 1, 2026 application deadline. CMS will ask about your technical infrastructure in the application.

What Outcomes You Need to Measure (By Track)

ACCESS pays for improvement, which means CMS needs structured outcomes data. They've defined exactly what you need to measure by track:

eCKM / CKM tracks:

• Clinical metrics (BP, weight, HbA1c, labs): Use Metrics to track values over time. Set baseline at intake, monitor trends across the care episode. You can also create custom metrics for lab values like eGFR and UACR.
• For lab results, use our API to connect with CLIA-compliant lab partners, or create custom metrics for manual entry with source documentation in charting notes.

BH track:

• Validated assessments (PHQ-9, GAD-7): These are built into Healthie's Forms library with auto-scoring. Assign at intake for baseline, reassign at intervals to track improvement.

MSK track:

• Patient-reported outcomes (PGIC, pain intensity scales, WHODAS): Assign via Forms at intake and at defined intervals. Use Metrics to track trends.

Mandatory Care Coordination: Not Optional, With Deadlines

ACCESS requires electronic transmission of care updates to PCPs/referring providers on specific timelines:

• Care Initiation: Within 10 days of enrollment → Care plan, baseline measures, goals, contact info
• Care Completion: Within 30 days of period end → Outcomes achieved, medications, follow-up recommendations
• Care Escalation: Within 10 days of transition → Details when a patient's needs exceed ACCESS scope and require higher-level care

Interoperability with primary care — ACCESS is designed so tech-enabled care complements the patient's primary care relationship. You'll need to share care plans and updates with referring providers through secure, electronic means.

New as of July 2026: CMS is launching the ACCESS Directory — a public-facing directory to help Original Medicare beneficiaries find and compare participating organizations. Referring PCPs and clinicians can also use the directory to refer patients to ACCESS participants. No ACCESS enrollment is required for the referring PCP.

PCP co-management payment: Referring primary care providers can bill a Medicare co-management payment — with no beneficiary cost-sharing — for coordinating care with ACCESS participants at key clinical moments. This is an additional incentive for PCPs to refer patients to your organization and engage with care updates you send.

In Healthie: Use Direct Secure Messaging (Enterprise add-on via EMR Direct) or your HIE connection (via Zus Health) to fulfill care coordination transmission requirements.

Technical Infrastructure Requirements

ACCESS participants are NOT required to use Certified EHR Technology, but must meet minimum HIT expectations:

• §170.315(g)(10) compliance: Standardized APIs for patient/population services
• HIE connectivity: Required within 12 months of model start
• FHIR API submission to CMS: Participants must submit eligibility, alignment, and outcomes data via CMS's four ACCESS APIs — this is programmatic FHIR API submission, not a manual portal upload

The four CMS ACCESS APIs:

1. Eligibility API — Check beneficiary eligibility before enrollment
2. Alignment API — Align beneficiaries to participant and track; triggers FHIR Subscriptions for event notifications
3. FHIR Reporting API — Submit outcome data (OAP Measures) and patient-reported outcomes to CMS quarterly
4. BCDA API (optional) — Request Medicare Parts A, B, D claims data for care coordination; existing CMS API

Healthie's current status (June 2026): CMS published the ACCESS FHIR Implementation Guide (v0.9.1) at dsacms.github.io/cmmi-access-model. The current path for participants is to extract data via Healthie's API, transform to CMS FHIR format, and submit via the ACCESS APIs directly. Native ACCESS API integrations are on our roadmap — contact us for the latest status and to discuss your implementation approach.

ONC Certification: Healthie has been ONC certified since December 7, 2022, including §170.315(g)(10) for standardized API for patient and population services. Certification is included in all plans at no additional cost.

FHIR R4 API: Available as an Enterprise plan add-on via our FHIR API / HL7 integration (powered by Aidbox). This is the interoperability layer needed for CMS data exchange. Contact us to discuss your ACCESS interoperability requirements and Enterprise plan options.

HIE Connectivity: Available through Zus Health, which aggregates patient data from 270M+ patients and integrates directly into Healthie. This requires a separate contract between you and Zus Health.

Direct Secure Messaging: Available as an Enterprise add-on via our Direct Messaging integration with EMR Direct.

Patient Exclusions Are Extensive — Screen Carefully

ACCESS has detailed exclusion criteria that vary by track. Key exclusions many orgs miss:

• Patients enrolled in Medicare Advantage (ACCESS is Original Medicare only)
• Patients already enrolled in another ACCESS participant for the same condition
• Certain high-acuity conditions that disqualify enrollment in specific tracks
• Patients who have exercised their 90-day switch right recently

Clinical workflow note: Build screening questions into your intake forms to flag excluded patients before enrollment. CMS will audit clinical eligibility.

In Healthie: Create a custom ACCESS Eligibility Screening Form that automatically tags eligible patients. Use Saved Filters to build an "ACCESS Eligible — Not Yet Enrolled" view.

How to Set Up Healthie for ACCESS

Here's what we recommend building before your ACCESS program launches:

Step 1 — Patient Identification

• Create a tag: "ACCESS-Eligible" and apply to qualifying patients
• Build a Saved Filter: patients with relevant ICD-10 diagnoses who are Original Medicare
• Run a baseline report to size your potential ACCESS cohort

Step 2 — Outcomes Infrastructure (by track)

• eCKM/CKM: Set up connected BP device integration with source-verifiable transmission. Configure Metrics for BP, weight, HbA1c, LDL-C, eGFR, UACR. Build baseline intake template that captures all required measures.
• BH: Assign PHQ-9 and GAD-7 via Forms at intake. Set up recurring re-assessment automations at 90 and 180 days.
• MSK: Configure pain intensity and functional outcome scales via Forms. Set up PGIC tracking.

Step 3 — Charting Templates

• Create an ACCESS-specific charting template for each track that prompts documentation of required measures at every visit
• Use Smart Phrases for frequently documented care coordination language

Step 4 — Care Coordination Workflows

• Build a Task automation: when a patient is enrolled in ACCESS → create a Task for "Send care plan to PCP within 10 days"
• Build a second automation: 25 days after episode completion → create Task for "Send completion summary to PCP within 30 days"

Step 5 — Reporting

• Build a custom report: "ACCESS Patients — Outcome Measures by Track" showing baseline vs. current for each patient
• Set up a Saved Filter for "ACCESS patients approaching 12-month mark" for proactive outreach

Application Checklist (Current Cohort Schedule)

The Cohort 1 application window (May 15, 2026) is closed. CMS accepts applications on a rolling basis through April 1, 2033 — designed so every participant can complete at least three full years in the model. Upcoming entry points:

Cohort 2 — Starts January 1, 2027 · Application deadline: October 1, 2026

‍Cohort 3 — Starts April 1, 2027 · Application deadline: January 1, 2027

‍Cohort 4 — Starts July 1, 2027 · Application deadline: April 1, 2027

‍Subsequent cohorts — Quarterly starts, approximately 3 months prior each

CMS announces specific deadlines for each cohort on the ACCESS Model webpage.

For the January 1, 2027 cohort (deadline: October 1, 2026):

• [ ] Confirm your organization is Medicare Part B-enrolled (or begin enrollment — required for participation, not to apply)
• [ ] Designate a physician Clinical Director (MD or DO, Medicare-enrolled)
• [ ] Identify your target track(s) and confirm patient population eligibility
• [ ] If eCKM/CKM: Verify your BP device integration supports source-verifiable transmission — test it before applying
• [ ] Set up baseline outcomes tracking in Healthie for your target track
• [ ] Contact us to discuss FHIR API setup — allow 12–16 weeks for implementation
• [ ] Calculate cash flow impact of 50/50 payment split
• [ ] Design care coordination workflows with 10-day and 30-day trigger points
• [ ] Submit application by October 1, 2026 for January 1, 2027 cohort start

What Healthie Customers Already Have for ACCESS

Here's what's ready for you now, and what requires Enterprise plan or add-ons:

Included in all plans ✅

• ONC-certified EHR (since December 7, 2022, including §170.315(g)(10))
• BP monitoring and clinical documentation (manual/clinical)
• Outcomes tracking via Metrics (BP, weight, HbA1c, custom lab values)
• Validated assessments (PHQ-9, GAD-7) with auto-scoring in Forms library
• Patient Portal and secure messaging
• Customizable charting templates and Smart Phrases
• Tags, Saved Filters, and custom reporting for ACCESS cohort management
• Task automations for care coordination workflows

Enterprise plan add-ons 💰

• FHIR R4 API (via Aidbox) — required for ACCESS CMS API submission
• Direct Secure Messaging (via EMR Direct) — for care coordination transmissions

Separate contracts required

• Zus Health HIE — separate Zus contract, not a Healthie add-on

In progress ⏳

• Native ACCESS CMS API integrations (Eligibility, Alignment, Reporting) — building to published IG v0.9.1; contact us for current timeline

Additional Resources

• CMS ACCESS Model Overview
• Full Request for Applications (PDF)
• CMS ACCESS Technical FAQs
• ACCESS Accepted Applicants
• ACCESS FHIR Implementation Guide v0.9.1
• ACCESS API Implementation & Data Submission Slides – March 18, 2026 (PDF available on CMS ACCESS page)
• ACCESS PCP & Referring Clinician Webinar Slides – June 4, 2026 (PDF available on CMS ACCESS page)

Questions about ACCESS readiness? Reach out to our team or talk to your Customer Success Manager.

We'll continue updating this guide as CMS releases more details about ACCESS requirements and reporting.

Last updated: June 15, 2026

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