CMS ACCESS: What Providers Need to Know (FAQ)

CMS ACCESS represents a meaningful shift in how Medicare reimburses chronic care management, but what is ACCESS?

Keep reading for a breakdown of what it is, how it works, and where remote patient monitoring (RPM) fits in.

For more information, download our free guide to CMS ACCESS.

What is CMS ACCESS?

ACCESS is a new CMS payment model that replaces traditional fee-for-service reimbursement with prospective, outcome-based payments.

Instead of billing for individual services, participating organizations receive a combination of fixed monthly payments tied to clinical outcomes over a defined care period, and the potential for additional lump-sum payments based on those clinical outcomes.

It’s designed specifically to support improved access to technology-enabled care for Medicare Part B beneficiaries.

How is the ACCESS program different from traditional Medicare reimbursement?

Under fee-for-service, reimbursement is tied to:

• Visits
• Procedures
• Time-based services

Under ACCESS:

• Payment is decoupled from visit volume
• Providers are reimbursed for managing a patient’s condition over time
• Clinical performance directly impacts total reimbursement

For aligned beneficiaries, fee-for-service billing for the same conditions is not permitted during the care period.

How do payments work under ACCESS?

ACCESS uses Outcome-Aligned Payments (OAPs) structured around a 12-month care period:

• Providers receive monthly installments for months 1–6 when a beneficiary is aligned in one or more of the four clinical tracks eligible for the program
• 50% of total potential payment is paid in months 1–6
• The remaining 50% is withheld and reconciled based on outcomes at the end of the period

If outcome thresholds are met, full payment is released. If not, payment is reduced within defined limits.

For the initial 18 months of the program, CMS has capped downward payment adjustments to 50% for clinical outcome measures. This means ACCESS participants will be reimbursed no less than 50% of the potential total Medicare reimbursement.

The ACCESS program is also unique in that it is one of the few CMS initiatives that allows participants to waive the beneficiaries’ 20% co-pay.

Reimbursement Amounts by Clinical Track

CMS has defined fixed annual payment amounts for each clinical track, split into initial and (when applicable) follow‑on periods:

Important Notes About These Payments

• These amounts represent the total allowed reimbursement, including Medicare’s 80% share and the beneficiary’s 20% coinsurance
• ACCESS participants may waive the 20% coinsurance as a uniform policy
• When a beneficiary is enrolled in multiple tracks with the same participant, CMS applies a 5% multi‑track discount to the lower‑cost track(s)
• Monthly payments equal 1/12 of the Medicare portion of the annual amount
• Months 7–12 payments are withheld and reconciled based on outcome performance

What patient populations are included?

ACCESS focuses on high-prevalence, high-cost chronic conditions across four tracks:

Cardio-Kidney-Metabolic (CKM)

Examples include:

• Hypertension
• Obesity/Overweight
• Prediabetes

Early-stage cardiometabolic risk (eCKM)

Examples include:

• Diabetes mellitus
• CKD Stage 3a/3b
• Atherosclerotic cardiovascular disease (ASCVD)

Musculoskeletal (MSK)

Examples include:

• Chronic musculoskeletal pain (3+ months)
• Conditions involving bones, joints, muscles, and connective tissue

Behavioral Health (BH)

Examples include:

• Depression
• Anxiety

These populations are well-suited to continuous monitoring and intervention outside of traditional office visits.

Why is CMS introducing this?

ACCESS reflects a broader shift toward:

• Outcome accountability
• Preventive and continuous care
• Flexible, technology-supported delivery models

The goal is to improve chronic disease management while reducing avoidable utilization.

Where does RPM fit into ACCESS?

RPM aligns closely with the operational requirements of ACCESS. To succeed under the model, providers need to:

• Collect clinical data at regular intervals
• Monitor progress against defined targets
• Intervene between visits

RPM enables all three.

Rather than functioning as a standalone billing opportunity, RPM becomes part of the care delivery infrastructure that supports outcome performance.

It’s also worth noting that CMS has explicitly stated that the use of cellular blood pressure cuffs to monitor beneficiaries aligned to the eCKM and CKM clinical tracks is the gold standard in care delivery for the management of the applicable chronic conditions.

Can providers still bill RPM codes under ACCESS?

For aligned beneficiaries, traditional fee-for-service billing is restricted, including certain RPM-related services.

Additionally, some RPM-related codes (such as device setup) are included on the model’s substitute spend list, meaning:

• If billed by another provider for the same condition,
• They may negatively impact performance-based reimbursement

This reinforces the need for coordinated program-level care delivery rather than fragmented billing.

Is there financial risk?

Risk is structured and limited.

Key considerations:

• Full payment is achievable without perfect outcomes across all patients
• Performance thresholds are designed to be attainable
• Downside risk is capped (both clinically and financially)
• Reimbursement amounts are tied to clinical outcomes and other potential downward adjustments related to duplicative billing for the same patient by other Medicare providers

In practice, this creates accountability without excessive exposure; however, reimbursement amounts are significantly lower than traditional fee-for-service reimbursements under RPM CPT codes.

How should providers think about getting started?

A practical entry point includes:

• Identifying a target population (e.g., hypertension, diabetes)
• Evaluating current gaps in between-visit care
• Implementing tools to support continuous monitoring and engagement
• Aligning clinical and billing teams on model requirements

The focus should be on building repeatable workflows for longitudinal care.

How does this compare to traditional RPM program?

Traditional RPM

• Reimbursed through CPT codes
• Dependent on time thresholds and device usage

ACCESS

• Reimbursed based on clinical outcomes over time
• Incorporates monitoring as part of a broader care model

This represents a shift from activity-based reimbursement to performance-based reimbursement.

Where does Smart Meter fit in?

Smart Meter does not administer the ACCESS program.

We support participants by enabling:

• Scalable RPM program infrastructure
• Reliable, continuous patient data collection
• Ongoing patient engagement outside the clinic

These capabilities are foundational to delivering care effectively under outcome-based reimbursement models like ACCESS

What’s the bottom line?

CMS ACCESS signals a continued move toward paying for patient outcomes, not interactions.

For providers already investing in remote monitoring, value-based care, and longitudinal care strategies, this model represents a natural next step, not a complete reset.

Source

Smart Meter. “CMS ACCESS Program 2026: Advancing Chronic Care with Effective, Scalable Solutions.” SmartMeterRPM, 2026.