OFFICIAL CMS RESOURCES
The CMS guidance
behind ACCESS.
Find the official sources behind patient enrollment, clinical reviews, payment, and the broader expansion of continuous care.
Sources checked September 20, 2026
Can patients enroll directly?
Yes. Patients can sign up with an ACCESS provider themselves or with help from their clinician. An outside referral is not required.
Enrollment and referring-clinician guidance ↗Can patient costs be waived?
CMS allows ACCESS organizations to uniformly waive patient cost-sharing. HealthyConnect’s service choice: HealthyConnect ACCESS care is free to the patient. Co-management reviews also carry no patient cost-sharing.
Patient costs and clinician coordination ↗How are clinical reviews compensated?
CMS lists $30 per qualifying review, up to three times per 12 months per patient and track, plus a one-time $10 qualifying onboarding add-on. Review and coordination require at least five minutes; payment adjustments apply.
Payment amounts, frequency and documentation ↗Which professionals can bill?
Eligible Medicare Part B practitioners include physicians, NPs and several therapy professions. FQHCs, RHCs and enrolled pharmacies with specialty code A5 become eligible October 1, 2026.
Eligible practitioners and effective dates ↗How does ACCESS interact with ACOs?
CMS anticipates no impact from ACCESS outcome-aligned payments on MSSP and ACO REACH benchmark and performance calculations in 2026–2027. These expenditures enter those calculations in 2028.
ACO treatment in the model FAQs ↗Which conditions does ACCESS cover?
The model starts with cardio-kidney-metabolic, musculoskeletal and behavioral health tracks. CMS announces additional condition tracks for April 1, 2027.
Clinical tracks and model expansion ↗Where is payer expansion heading?
Seventeen pledged payers represent more than 165 million people, with aligned payment arrangements targeted by January 1, 2028. This describes potential reach across those plans; eligibility and availability depend on each arrangement.
Payer pledge and signatories ↗HEALTHYCONNECT DELIVERY
CMS sets the framework.
HealthyConnect brings it to your patients.
HealthyConnect delivers the ACCESS care service and bills Medicare directly. Your organization can introduce patients, receive care updates, and bill separately for qualifying clinical reviews.
HealthyConnect planning assumptions
The 1.5-track average, 7.5-minute modeled review, $80/hour review labor and estimated $267 per modeled review hour are HealthyConnect illustrations. The 45% to 90% senior-reach chart is a HealthyConnect planning scenario. These are separate from CMS payment rules and the payer pledge.
Review the financial assumptions ↗ · Review the expansion scenario ↗
Detailed reference documents
For readers who want the operating requirements behind HealthyConnect’s role as the ACCESS care provider.
Participation framework
The CMS model page maintains the Request for Applications, detailed FAQs and current supporting materials.
Open CMS participant resources ↗Traditional care management
CMS resources for the established care-management services compared elsewhere on this site.
Open CMS care-management resources ↗INDUSTRY PERSPECTIVES
What this shift could mean.
Julie Yoo and other industry voices explore the emerging continuous-care opportunity. Their commentary provides perspective alongside the official requirements above.
Read industry commentary ↗Understand the framework.
Let HealthyConnect handle the setup.
Photography
Illustrative stock photography; the people pictured are not presented as HealthyConnect patients, staff or endorsers.
- Clinical conversation: Silverkblack / Pexels, photo 39192358.
- Tablet at home: Mikhail Nilov / Pexels, photo 6972643.
- Pharmacy conversation: cottonbro studio / Pexels, photo 8657359.
START WITH THE ESSENTIALS
Understand ACCESS. Meet your care partner.
CMS administers ACCESS. HealthyConnect delivers ongoing care alongside the patient’s existing providers.
ABOUT THESE EXPLANATIONS
Official requirements. HealthyConnect interpretation. Clear distinctions.
CMS requirements
Official links support model and payment statements. Read the applicable CMS guidance for eligibility and billing details.
HealthyConnect’s operating approach
Workflows, staffing arrangements and supported connections describe HealthyConnect’s offering or an explicitly labeled proposed deployment.
Illustrative economics
Examples state their assumptions. Estimated revenue is not a guaranteed payment or a forecast of net profit.
Publisher: HealthyConnect, part of Remote Care Partners. A page-updated date records an editorial change, not an independent clinical review or a claim that every linked source was rechecked that day. Product concepts and fictional patient examples are labeled where shown.
Public web explanations and one-page summaries are available without contact confirmation. Detailed documents retain their contact-confirmation requirement.
Send a question or correction to HealthyConnect ↗