Clinical Tracks
ACCESS launched on July 5, 2026 with four clinical tracks that address many of the most common chronic conditions affecting more than two-thirds of people with Medicare. On September 15, 2026, CMS announced five additional tracks that start April 1, 2027.
New Tracks Start April 1, 2027
On September 15, 2026, CMS announced new tracks for heart failure, COPD, substance use disorder, and tobacco cessation, plus a new follow-on period for chronic musculoskeletal pain. Current participants and applicants do not need to reapply. See the section Tracks Coming in April 2027 below, or read the CMS announcement.
Each track groups related conditions that are commonly treated using similar types and levels of care. Participating organizations are responsible for managing all qualifying conditions in a track, supporting integrated, patient-centered care.
Track Structure
Each track includes condition-specific measures and outcome targets informed by clinical guidelines — such as patient improvement or control in biomarkers like blood pressure, HbA1c, lipids, or weight, or in validated Patient Reported Outcome Measures (PROMs) of pain, mood, and function.
Outcome Measures Summary
The following table summarizes qualifying conditions and outcome measures for each clinical track:
| Track | Qualifying Conditions | Outcome-Aligned Payment Measures |
|---|---|---|
| eCKM | Hypertension, OR two or more of: dyslipidemia, obesity/overweight with central obesity, prediabetes | Control or minimum improvement in blood pressure (BP), lipids, weight, and HbA1c |
| CKM | One or more of: diabetes mellitus, chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD) | Control or minimum improvement in BP, lipids, weight, and HbA1c; [CKD and diabetes only] Submission of eGFR and UACR data |
| MSK | Chronic musculoskeletal pain | Minimum improvement in pain intensity, interference, and overall function (assessed via validated PROM) |
| BH | One or more of: depression, anxiety | Minimum improvement in symptoms (PHQ-9 for depression, GAD-7 for anxiety); Submission of PGIC at end of period; WHODAS 2.0 12-item functional assessment (optional in Year 1) |
Clinical Definitions
- Outcome targets are guideline-based and defined in consultation with clinical experts. "Control" refers to meeting guideline-directed targets.
- Obesity is defined as BMI ≥ 30. Overweight is defined as BMI 25–29.99 along with a marker of central obesity (waist circumference > 40 inches/102 cm for men or > 35 inches/88 cm for women).
- Chronic kidney disease includes Stage 3a and 3b only.
- Chronic pain is defined as pain lasting more than three months. Musculoskeletal disorders include conditions affecting bones, joints, muscles, and connective tissues.
Early Cardio-Kidney-Metabolic (eCKM)
Early Cardio-Kidney-Metabolic (eCKM)
Focuses on early-stage metabolic conditions before they progress to more serious diseases. Early intervention can prevent progression to diabetes, heart disease, and kidney disease.
eCKM Eligibility
Patients qualify for eCKM with hypertension alone, OR with two or more of the following: dyslipidemia, obesity (BMI ≥ 30) or overweight (BMI 25–29.99) with central obesity marker, or prediabetes.
eCKM Outcome Measures
The eCKM track uses the following OAP Measures. Each measure is met if the beneficiary achieves either the Control target or the Minimum Improvement target:
| Measure | Control Target | Minimum Improvement |
|---|---|---|
| Blood Pressure | Systolic BP < 130 mmHg | 15 mmHg reduction in systolic BP |
| Weight | BMI < 30 kg/m² AND no more than 5% weight gain | 5% weight reduction |
| HbA1c (prediabetes only) | Final HbA1c < 6.5% | N/A |
| LDL-C (dyslipidemia only) | Final LDL-C < 100 mg/dL | 30 mg/dL reduction |
Baseline Required for All
Baseline HbA1c and LDL-C are required for all eCKM beneficiaries at the start of each Care Period. For beneficiaries without prediabetes or dyslipidemia, success is defined as submission of the baseline measure.
Who Benefits
Patients with early-stage metabolic conditions who can benefit from lifestyle modifications, remote monitoring, and technology-supported coaching to prevent disease progression.
Cardio-Kidney-Metabolic (CKM)
Cardio-Kidney-Metabolic (CKM)
Addresses established cardiometabolic and kidney conditions requiring ongoing management. Focus is on disease control, complication prevention, and improved quality of life.
CKM Outcome Measures
The CKM track uses the following OAP Measures:
| Measure | Control Target | Minimum Improvement |
|---|---|---|
| Blood Pressure | Systolic BP < 130 mmHg | 15 mmHg reduction in systolic BP |
| Weight | BMI < 30 kg/m² AND no more than 5% weight gain | 5% weight reduction |
| HbA1c (diabetes only) | Final HbA1c < 7.5% | 1 percentage point reduction |
| LDL-C (dyslipidemia) | Final LDL-C < 100 mg/dL | 30 mg/dL reduction |
| LDL-C (ASCVD) | Final LDL-C < 70 mg/dL | 30 mg/dL reduction |
| eGFR (diabetes/CKD only) | Baseline submission | N/A |
| uACR (diabetes/CKD only) | Baseline submission | N/A |
Kidney Health Monitoring
Baseline eGFR and uACR are required only for beneficiaries with diabetes or CKD. These measures do not have performance targets — success is defined as submission of the baseline measure. Data is used for monitoring, evaluation, and public reporting.
Who Benefits
Patients with established diabetes, CKD, or cardiovascular disease who need comprehensive, coordinated management to control their conditions and prevent complications.
Musculoskeletal (MSK)
Musculoskeletal (MSK)
Targets chronic musculoskeletal pain conditions with a focus on functional improvement and pain reduction through multimodal, non-pharmacological approaches.
MSK Outcome Measures
The MSK track uses patient-reported outcome measures (PROMs) selected based on the beneficiary's anatomical site of pain. Participants must report one PROM from the options below, plus Pain Intensity and PGIC for all beneficiaries:
| PROM | Site of Pain | Minimum Improvement |
|---|---|---|
| PROMIS PF + PI | Any site / multiple sites | 2-point increase in PF AND 2-point reduction in PI (T-score) |
| Oswestry Disability Index (ODI) | Lower back | 8-point reduction (0–100 scale) |
| Neck Disability Index (NDI) | Neck | 8-point reduction (0–50 scale) |
| QuickDASH | Shoulder, arm, hand | 10-point reduction (0–100 scale) |
| KOOS JR | Knee | 10-point increase (0–100 scale) |
| HOOS JR | Hip | 10-point increase (0–100 scale) |
Additionally, all MSK beneficiaries must report:
- Pain Intensity (NRS) — Target: no more than 2-point increase from baseline
- PGIC — End-of-period submission required (no performance target)
No Control Targets
The MSK track does not establish control targets for pain and function measures. It is designed to incentivize minimum improvement rather than maintenance, reflecting the model's focus on functional restoration within a single 12-month Care Period.
Who Benefits
Patients with chronic musculoskeletal pain who can benefit from physical therapy, exercise programs, behavioral interventions, and technology-supported self-management.
Behavioral Health (BH)
Behavioral Health (BH)
Addresses common mental health conditions through technology-enabled therapy, coaching, and support services that complement traditional behavioral health care.
BH Outcome Measures
The BH track uses patient-reported outcome measures:
| Measure | Control Target | Minimum Improvement |
|---|---|---|
| PHQ-9 (depression) | If baseline < 10: maintain < 10 | If baseline ≥ 10: 5-point reduction |
| GAD-7 (anxiety) | If baseline < 10: maintain < 10 | If baseline ≥ 10: 4-point reduction |
| PGIC | N/A | End-of-period submission required |
| WHODAS 2.0 (12-item) | N/A | Optional in Year 1 (Effective Period) |
Baseline Score Requirements
Beneficiaries who score below 10 on both the PHQ-9 and GAD-7 at baseline are not eligible for the Initial Period. They may align directly in the Follow-On Period if referred by a provider with a documented history of depression or anxiety in the past 18 months.
Who Benefits
Patients with depression and/or anxiety who can benefit from digital therapeutics, app-based cognitive behavioral therapy (CBT), remote counseling, and technology-supported behavioral health services.
Tracks Coming in April 2027
On September 15, 2026, CMS announced that ACCESS will add five tracks starting April 1, 2027. This is the first expansion of the model since launch.
| New Track | Focus (as described by CMS) |
|---|---|
| Heart Failure | Continuous monitoring focused on function gains, symptom management, and quality of life |
| COPD (chronic obstructive pulmonary disease) | Support to maintain or improve lung function and ease symptoms |
| Substance Use Disorder | Care for opioid, alcohol, and other substance use disorders, with integrated support for co-occurring depression and anxiety |
| Tobacco Cessation | Assistance for people who stop tobacco use (nicotine dependence) |
| Chronic MSK Pain Follow-On | Extended care for chronic musculoskeletal pain beyond the initial 12-month Care Period. The MSK track launched without a follow-on period |
Details Still Pending
CMS has not yet published qualifying condition definitions, OAP measures, performance targets, or payment amounts for the new tracks. The RFA (version 1.1) and the Payment Amounts document still cover only eCKM, CKM, MSK, and BH. This page will update when CMS releases the details.
What we know so far:
- No reapplication needed. CMS states: "Current participants and applicants will not need to reapply to participate in the new tracks."
- Get updates. Complete the ACCESS Model Interest Form to receive updates about the new tracks.
- Reach. CMS says three of four Medicare beneficiaries qualify for at least one ACCESS track.
CMS Press Release: New ACCESS Tracks (September 15, 2026)
CMS adds Medicare options for substance use disorder, heart failure, and other common chronic conditions
Care Delivery Across All Tracks
Flexible Care Models
ACCESS care organizations can deliver care through multiple modalities — in-person, virtually, asynchronously, or through other technology-enabled methods as clinically appropriate.
ACCESS care organizations are expected to offer integrated, technology-supported care that may include:
- Clinician consultations — Virtual and in-person visits with physicians, nurses, and specialists
- Lifestyle and behavioral support — Nutrition counseling, exercise programs, smoking cessation
- Therapy and counseling — Mental health services, pain management counseling
- Patient education — Disease education and self-management training
- Care coordination — Communication with PCPs and other providers
- Medication management — Prescription management and adherence support
- Diagnostic services — Ordering and interpreting tests and imaging
- Device monitoring — FDA-authorized devices, wearables, and remote monitoring
Payment Structure by Track
Most tracks include an initial year of care followed by an optional continuation period at a reduced rate, facilitating continued patient support after initial improvement goals are met.
| Track | Initial Period | Follow-On Period |
|---|---|---|
| eCKM | 12 months | Yes, reduced rate ($180/yr) |
| CKM | 12 months | Yes, reduced rate ($210/yr) |
| MSK | 12 months | Not yet — a follow-on period starts April 1, 2027 |
| BH | 12 months | Yes, reduced rate ($90/yr) |
Rural Adjustment
For beneficiaries in rural areas enrolled in the eCKM or CKM tracks during the Initial Period, CMS provides an additional $15 to offset higher operational costs related to connected device distribution and support.
Multi-Track Participation
Organizations can participate in multiple clinical tracks if they meet the requirements for each. This allows comprehensive care organizations to address multiple conditions for their patient population.
Can an organization participate in all tracks?▼
Yes, organizations can apply to participate in one or more clinical tracks, provided they meet the eligibility and capability requirements for each track they wish to offer. Organizations must demonstrate clinical expertise and infrastructure for each track.
Can a patient be enrolled in multiple tracks?▼
Yes, if a patient has qualifying conditions in multiple tracks, they can receive care through multiple tracks simultaneously. Organizations are responsible for coordinating care across tracks.
Will CMS add more tracks in the future?▼
Yes. On September 15, 2026, CMS announced five new tracks that start April 1, 2027: heart failure, COPD, substance use disorder, tobacco cessation, and a follow-on period for chronic musculoskeletal pain. Current participants and applicants do not need to reapply. CMS may add more tracks and conditions later based on model performance and emerging evidence.
Next Steps
Understand How Payments Work
Learn about Outcome-Aligned Payments and how performance is measured
Check Your Eligibility
See the requirements for participating in ACCESS clinical tracks