CMS ACCESS Model API
0.9.8 - draft US

This page is part of the ACCESS Model IG v0.9.8 DRAFT (v0.9.8: Releases Draft) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions

CapabilityStatement: ACCESS Eligibility API Capability Statement

Official URL: https://dsacms.github.io/cmmi-access-model/CapabilityStatement/ACCESSEligibilityAPICapabilityStatement Version: 0.9.8
Active as of 2026-01-23 Computable Name: ACCESSEligibilityAPICapabilityStatement

Describes the expected capabilities of systems implementing the ACCESS Eligibility API for checking patient eligibility for the ACCESS Model.

Raw OpenAPI-Swagger Definition file | Download

Language: en

ACCESS Eligibility API Capability Statement

  • Implementation Guide Version: 0.9.8
  • FHIR Version: 4.0.1
  • Supported Formats: json, xml
  • Published on: 2026-01-23
  • Published by: Global Alliant, Inc.

Note to Implementers: FHIR Capabilities

Any FHIR capability may be 'allowed' by the system unless explicitly marked as 'SHALL NOT'. A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.

SHALL Support the Following Implementation Guides

FHIR RESTful Capabilities

Mode: server

The ACCESS Eligibility API supports checking patient eligibility for the ACCESS Model.

Security
Enable CORS: yes
Security services supported:

Implementations SHALL use TLS 1.3 and implement OAuth 2.0 Client Credentials flow for authentication. All PHI including MBI must be protected according to HIPAA requirements.

Capabilities by Resource/Profile

Summary

The summary table lists the resources that are part of this configuration, and for each resource it lists:

  • The relevant profiles (if any)
  • The interactions supported by each resource (Read, Search, Update, and Create, are always shown, while VRead, Patch, Delete, History on Instance, or History on Type are only present if at least one of the resources has support for them.
  • The required, recommended, and some optional search parameters (if any).
  • The linked resources enabled for _include
  • The other resources enabled for _revinclude
  • The operations on the resource (if any)
Resource TypeProfileRSUCSearches_include_revincludeOperations
Patient $check-eligibility, $submission-status
Core FHIR Resource
Patient
Reference Policy
Interaction summary

    Documentation

    Patient resource for ACCESS eligibility operations

    Extended Operations
    ConformanceOperationDocumentation
    SHALL$check-eligibility

    Check if a patient is eligible for the ACCESS Model. This operation requires the entityId query parameter (participant identifier) and a Parameters body including other required inputs. Returns eligibility status from ACCESSEligibilityResultVS: eligible, not-eligible-not-medicare, not-eligible-services, not-eligible-diagnoses, not-eligible-control-group, or not-eligible-already-aligned. Implements asynchronous processing with HTTP 202 Accepted response containing Content-Location header for status polling.

    SHALL$submission-status

    Poll the status of a previously submitted eligibility check request. Returns HTTP 202 while processing or HTTP 200 with result when complete.