Advancing Chronic Care with Effective, Scalable Solutions (CMMI / CMS) — Electronic Version
This document explains the CMS Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model and requests your voluntary agreement to participate. Cercanos Care is a participating organization under this 10-year initiative (July 5, 2026 – June 30, 2036), administered by the CMS Innovation Center (CMMI). Please read carefully and contact us with any questions before submitting your consent.
1. Purpose of This Consent
The ACCESS Model tests Outcome-Aligned Payments (OAPs) for technology-enabled, clinician-guided chronic care in Original Medicare. Cercanos Care will provide coordinated ongoing care for your chronic condition(s) using technology-enabled services that may include:
Telehealth and virtual visits with licensed clinicians
Remote monitoring through FDA-authorized wearable devices or mobile applications
Digital coaching and asynchronous care (secure messaging, health check-ins, medication reminders)
Coordination with your primary care physician and specialists through secure electronic updates
This program complements — it does not replace — your existing care team. Your primary care doctor or referring clinician will receive regular electronic updates on your progress.
2. Clinical Tracks — Qualifying Conditions
The ACCESS Model includes four initial clinical tracks. Your care team has identified the applicable track(s). Cercanos will be a participant of the three ACCESS model tracks listed below:
Track
Qualifying Conditions
eCKM — Early Cardio-Kidney-Metabolic
Hypertension; dyslipidemia; obesity/overweight with central adiposity; prediabetes
Note: You may not be enrolled in both eCKM and CKM simultaneously. You may participate in multiple tracks with the same or different ACCESS organizations.
3. Your Rights as a Participant
Voluntary participation: Enrollment is entirely your choice. Declining will not affect your Medicare coverage or access to any other care.
Right to disenroll: You may withdraw at any time after 90 days from the start of your alignment period, without penalty, by notifying Cercanos Care.
No additional cost: There are no Medicare co-pays or deductibles for services delivered under the ACCESS Outcome-Aligned Payments. Standard Medicare rules apply to all other services.
Retained Medicare rights: You retain all Original Medicare rights. Enrollment in ACCESS does not restrict access to any Medicare-participating provider.
Multiple tracks: You may enroll in more than one track (eCKM/CKM exclusion applies) with the same or different participating organizations.
4. Data Use and Privacy
To deliver care under the ACCESS Model, Cercanos Care will:
Exchange your health information with CMS through HL7 FHIR®-compliant APIs, including eligibility verification, beneficiary alignment, and outcome data reporting.
Share care plans and clinical updates electronically with your primary care physician and referring clinicians involved in your care.
Submit aggregate outcome data to CMS for model evaluation. Risk-adjusted results are reported at the organization level only — your individual identity is not publicly disclosed.
All data exchange is conducted in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable federal and state privacy laws. For full details, refer to Cercanos Care’s Notice of Privacy Practices.
5. Technology-Enabled Services
As part of your ACCESS Model care, you may be asked to use one or more of the following technology tools:
Remote monitoring device (e.g., blood pressure cuff, glucometer, wearable sensor) that transmits readings to your care team
Mobile application or digital health platform for coaching, reminders, or symptom tracking
Telehealth platform for virtual clinician visits
Specific tools are determined clinically and will be discussed with you separately. You are not required to use any particular technology as a condition of enrollment.
6. Payment Information
You will not receive any financial payment or incentive for participating. Cercanos Care has selected to waive your Medicare cost-sharing amount for ACCESS-covered services.
7. Disenrollment and Switching
You may disenroll from the ACCESS Model after 90 days from the start of your alignment period. To request disenrollment, contact Cercanos Care at the information below. You may also switch to a different ACCESS-participating organization offering the same clinical track, subject to the same 90-day rule.
Upon disenrollment, all standard Original Medicare benefits remain fully intact and you may seek care from any Medicare provider without restriction.
8. Required Clinical Exclusions
Certain medical conditions prevent enrollment in the ACCESS Model for patient safety reasons. If you have any of the conditions listed below for your applicable track, you may not be enrolled or may be disenrolled from the program. Your clinical team will validate these criteria before initiating services.
Active thyrotoxicosis or severe electrolyte imbalances
Active untreated eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder)
Pregnancy
Moderate to severe dementia or severe cognitive impairment; acute or unstable psychiatric conditions (active suicidal/homicidal ideation or psychosis)
Patients receiving dialysis for ESRD (CKM/eCKM-specific exclusion)
Patients age 81 or older with an indication of frailty during any part of the measurement period; patients receiving hospice or palliative care; patients age 66 or older who enter long-term nursing home care during the intervention window
Moderate to severe dementia or severe cognitive impairment
Any psychiatric disorder with distinct psychotic features (schizophrenia, major depression with psychotic features, Bipolar I Disorder)
Active and severe untreated eating disorders; pregnancy
Patients enrolled in a Certified Community Behavioral Health Clinic (CCBHC) program (BH-specific exclusion)
Patients age 81 or older with an indication of frailty; patients receiving hospice or palliative care; patients age 66 or older who enter long-term nursing home care
9. Model Evaluation — Important Notice
The ACCESS Model will be evaluated using a federally-funded randomized design with beneficiary-level randomization. Before verifying your eligibility or enrolling you, Cercanos Care is required to inform you of the following:
This service is offered as part of a new CMS payment model test.
Your data may be shared with CMS for model evaluation purposes, subject to federal privacy and security protections.
You may be randomly assigned to a comparison group (control group), in which case you would not be eligible to participate in the clinical track for a 12-month period, while continuing to have full access to all your usual Medicare benefits and services without any restriction.
Such assignment will not affect your Medicare benefits, rights, or coverage in any way.
The randomization ratio in the first year of the model is 90:10 (intervention:control). CMS will communicate your assignment to Cercanos Care through the Eligibility and Alignment APIs. If you are assigned to the control group, Cercanos Care will notify you using CMS-standardized language.
RFA Reference: ACCESS Model Request for Applications v1.1 — CMS Innovation Center — Last Modified February 12, 2026 This document must be retained in the patient’s record. Version: July 2026 — Cercanos Care Compliance Office
10. Electronic Consent and Acknowledgment
By completing the fields below and signing, I confirm that:
I have read and understood this Informed Consent document in full.
I have had the opportunity to ask questions and have received satisfactory answers.
I voluntarily agree to participate in the ACCESS Model through Cercanos Care.
I understand I may withdraw at any time after 90 days from my alignment start date, without penalty.
I authorize Cercanos Care to exchange my health information with CMS and my care team as described in Section 4, in compliance with HIPAA.
I understand that my signature below constitutes my electronic signature with the same legal effect as a handwritten signature, pursuant to the E-SIGN Act (15 U.S.C. § 7001 et seq.) and Florida Stat. § 668.50 (UETA).
Auto
Draw your signature above using mouse or touch
Complete the section below only if signing on behalf of the patient as an authorized representative.
Contact Information
Cercanos Care
8600 NW 36th St, Suite 501 · Doral, FL 33166
Phone: 305-831-2358
Email: privacy@cercanoscare.com · www.cercanoscare.com