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

ValueSet: ACCESS Alignment Result Value Set

Official URL: https://dsacms.github.io/cmmi-access-model/ValueSet/ACCESSAlignmentResultVS Version: 0.9.8
Draft as of 2026-05-20 Computable Name: ACCESSAlignmentResultVS

Copyright/Legal: Copyright (c) 2026 Centers for Medicare and Medicaid Services (CMS).

This value set includes all codes from the ACCESS Alignment Result code system.

References

Logical Definition (CLD)

 

Expansion

Expansion performed internally based on codesystem ACCESS Alignment Request Result Codes v0.9.8 (CodeSystem)

This value set contains 10 concepts

SystemCodeDisplay (en)DefinitionJSONXML
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  alignedAlignedPatient is eligible and has been aligned so the participant can now begin providing services to the patient under the ACCESS Model.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  aligned-switch-approvedAligned and switch approvedThe request to switch the patient's alignment from a different participant after the 90-day lock in period is accepted and the patient is considered switched and now re-aligned.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-control-groupNot aligned - assigned to Control GroupThe patient is technically eligible, but based on the randomized control group algorithm, the patient has been placed in the control group for 12 months and therefore cannot be aligned for 12 months.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-already-alignedNot aligned - already aligned to another participant in the trackThe patient is technically eligible, but is already aligned to another participant and receiving services under the ACCESS Model in the same track. A patient can only be aligned to one participant in each track. If a switch consent attestation is submitted, but the patient is still within the 90-day lock-in period, this response will be received.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-not-medicareNot aligned - not receiving MedicareThe patient either is not enrolled in Medicare Part A and Part B or dual eligible for Medicare and Medicaid, or they do not have Medicare as their primary insurance, so they are not eligible for services under the ACCESS Model.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-servicesNot aligned - receiving services that prevent eligibilityThe patient is receiving services (such as hospice, end stage renal disease (ESRD), etc.) making them ineligible to be part of the ACCESS Model.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-diagnosesNot aligned - no qualifying diagnosisThe patient does not have a treating diagnosis that qualifies them for service in the track indicated and therefore cannot get services under the ACCESS Model.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-clinical-exclusionNot aligned - clinical exclusionThe patient has a clinical exclusion that prevents them from receiving services under the ACCESS Model.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-mismatchNot aligned - mismatchThe patient information provided does not match the patient information on record.
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSAlignmentResultCS  not-aligned-no-switch-attestationNot aligned - no switch attestationParticipant switch request did not include switch consent attestation.

Description of the above table(s).