What Is the CMS ACCESS Model?
The Centers for Medicare and Medicaid Services (CMS) has launched a bold new reimbursement initiative. Called the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model, it aims to transform how behavioral health care is paid for and delivered across the United States.
Unlike traditional fee-for-service reimbursement, the ACCESS model ties payments directly to patient outcomes. Providers receive compensation based on measurable improvements in chronic conditions. For behavioral health, those conditions are depression and anxiety, tracked through the PHQ-9 and GAD-7 assessment scales.
The program is voluntary and spans 10 years. It begins July 5, 2026, and reflects CMS’s growing confidence in digital-first, technology-supported behavioral health care — an approach that gained significant momentum after the COVID-19 pandemic.
17 Behavioral Health Providers Selected
The First Batch of Exclusive Participants
CMS has so far selected 17 organizations to participate exclusively in the model’s behavioral health track. In total, 85 organizations will participate in this clinical track out of 150 selected across all tracks. However, the remaining 68 will combine behavioral health participation with tracks focused on chronic musculoskeletal care, cardio, kidney, and metabolic conditions.
The 17 exclusive behavioral health participants are:
- April Health by Wysa
- Concert Health
- Headspace
- Headway
- Holon Health
- Innerwell
- Jimini Health
- Limbic Care
- M3 Information
- Mindoula Health
- Navigator Healthcare (partner with Meomind)
- Nolia Health
- Oaks Integrated Care
- Psychiatry Faculty Practice
- Sleep Reset
- SonderMind
- The Brain and Memory Health Group
Application Deadline Extended
This list is not final. CMS has extended the application deadline to May 15, 2026, for organizations that want to join before the July start date. Applicants who miss the May 15 deadline may still be considered for a January 1, 2027 start date, if selected.
How Providers Are Preparing
Technology, Workflows and Training Adjustments
Several of the selected organizations have already begun adjusting their internal operations. These adjustments span technology infrastructure, clinical workflows, and staff training. Moreover, ACCESS participation requires all selected organizations to complete Medicare enrollment, including Medicare Part B, if not already enrolled.
Headspace: Tailoring Services for Medicare Patients
Headspace, a virtual mental health provider primarily serving employer markets and direct-to-consumer clients, sees ACCESS as a meaningful expansion opportunity. Traditional Medicare represents a new population for the company.
“We’ll be bringing on a few additional team members to help build a cohesive member experience bespoke for this population,” said Tom Pickett, CEO of Headspace. He added that the company views ACCESS as an experiment — one that could reshape how mental health care is delivered and paid for if it succeeds. Headspace is focused on tailoring services to Medicare patients and building strong collaboration with primary care providers.
Furthermore, Pickett acknowledged that early margins may look different. Even so, he said the company’s internal modeling shows positive unit economics in conservative scenarios, with further upside as it scales.
SonderMind: Building Real-Time Care Coordination
SonderMind, a mental health platform connecting individuals with therapists and psychiatrists, will focus on scaling its measurement and reporting capabilities. The goal is to give primary care clinicians and care coordinators real-time visibility into patient progress.
“Right now, when a PCP refers someone for mental health care, they’re essentially sending them into a black box,” said Mark Frank, CEO and co-founder of SonderMind. ACCESS addresses that directly by creating care coordination with shared accountability, which should strengthen referral relationships over time.
Frank also noted that ACCESS standardizes a care coordination framework that SonderMind previously had to build from scratch for each health system partnership — a significant operational advantage.
Holon Health: Rewarding Existing Clinical Strengths
Holon Health, a virtual provider of integrated mental health, primary care and substance use disorder treatment, was also selected to participate. Dr. Traci Sweet, co-founder and chief clinical officer, described the model as a meaningful step toward value-based reimbursement — particularly because of its emphasis on measurement-based care and population attribution.
Holon will verify its existing reporting infrastructure and ensure that its virtual platform’s data outputs are correctly formatted for ACCESS reporting requirements. Importantly, Dr. Sweet noted that the model rewards practices Holon already follows, rather than requiring the company to build entirely new capabilities.
She views ACCESS as creating “a competitive differentiation that traditional models cannot replicate” and expects it to serve as a foundation for future reimbursement reform — not a ceiling.
Jimini Health: Adapting AI for Outcomes-Based Care
Jimini Health, an AI-backed mental health startup, also joined the first cohort. CEO Luis Voloch acknowledged that ACCESS payment rates are not especially high. Nevertheless, he emphasized that participation represents a significant step in enabling technology-driven, outcomes-based reimbursement.
“More broadly, for all companies participating in ACCESS and for the system itself, we are all adapting our technologies and care models to meet the ACCESS requirements,” Voloch said.
Payment Structure and Timeline
How Reimbursement Works Under ACCESS
Participants bill monthly through the standard Medicare claims system using ACCESS track-specific codes. A higher payment rate applies in the first year for new patients or those requiring more intensive care. After that, a lower rate covers continued management of established patients.
Additionally, CMS will pay 100% of the monthly installment for the first six months. Then, from months seven through twelve, CMS pays 50% upfront and withholds the remaining 50% until a year-end performance evaluation is complete. Annual financial audits apply to organizations that exceed specific spending thresholds.
Major Health Plans Backing the Model
Several major health plans have already pledged to align their payment arrangements with the ACCESS model. These include United Healthcare, Humana, Centene, Cigna and CVS Health. This backing reinforces provider confidence that ACCESS could serve as a stepping stone toward broader value-based care adoption across both public and private payers.
Why This Model Matters for the Field
A Long-Awaited Shift in Behavioral Health Reimbursement
For decades, behavioral health providers have operated under rigid fee-for-service structures that rewarded volume over outcomes. The ACCESS model challenges that status quo directly. By tying reimbursement to measurable patient improvement, it aligns financial incentives with clinical goals.
Providers also see the model as a signal that CMS supports modern care delivery — including telehealth and digital therapeutic tools — for the Medicare population. This is especially significant given that a majority of ACCESS behavioral health participants have not previously served Medicare beneficiaries.
Outcomes Accountability at Scale
The 10-year program will test outcome-aligned payments across conditions that affect more than two-thirds of Medicare beneficiaries. For the behavioral health track, success is measured through validated clinical scales (PHQ-9 for depression, GAD-7 for anxiety). This specificity gives providers a clear framework for demonstrating value.
As Dr. Sweet of Holon Health put it, ACCESS “creates a common language with health plans and referring providers around care coordination expectations and outcomes accountability.” That shared accountability — long absent from behavioral health — could meaningfully reduce care fragmentation over time.
In summary, the CMS ACCESS model represents one of the most consequential reimbursement shifts in behavioral health in years. Early participants are investing in infrastructure, technology and training to make it work. If it succeeds, it could fundamentally change how mental health care is paid for — well beyond CMS.
