More Details Emerge on CMS ACCESS Model
The Centers for Medicare & Medicaid Services (CMS) is moving forward with its new ACCESS model for payment reform, with more details emerging as implementation approaches. The initiative is being scrutinized for its potential impact on primary and maternal care providers. This payment model is one of several federal policy shifts affecting the financial landscape for healthcare clinics.
- The ACCESS model's formal name is Advancing Chronic Care with Effective, Scalable Solutions, and it is a voluntary 10-year program scheduled to begin on July 5, 2026. Its focus is on shifting payments for chronic disease management for Medicare beneficiaries away from a fee-for-service structure to one based on achieving measurable health outcomes. - This model will utilize "Outcome-Aligned Payments" (OAPs), which will provide recurring payments to healthcare organizations for managing conditions such as hypertension, diabetes, and chronic musculoskeletal pain. Full payment will be contingent on demonstrating clinical improvements, like a specific reduction in a patient's blood pressure. - Any provider or organization enrolled in Medicare Part B is eligible to participate in the ACCESS model. This includes primary care practices, specialty groups, and organizations that provide technology-enabled care like remote monitoring and telehealth services. - While the ACCESS model focuses on chronic conditions that can be comorbidities during pregnancy, a different CMS initiative, the Transforming Maternal Health (TMaH) Model, is more directly aimed at maternal and infant health. This 10-year model, which began in 2025, specifically targets Medicaid and CHIP beneficiaries, who account for 41% of all births in the U.S. - A primary goal of the TMaH model is to expand access to midwives and doulas as a strategy to improve maternal health outcomes and reduce disparities. The program provides up to $17 million in funding to participating state Medicaid agencies to support this and other goals. - The TMaH model is structured around three pillars: increasing access to care, building workforce capacity (including midwives), improving quality and safety, and promoting whole-person care delivery. Its aims include reducing low-risk cesarean sections and severe maternal morbidity. - Fifteen states were selected to participate in the TMaH model, including Alabama, California, and New Jersey. Virginia is not one of the participating states.
