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
| Official URL: https://dsacms.github.io/cmmi-access-model/ValueSet/ACCESSEligibilityResultVS | Version: 0.9.8 | ||||
| Draft as of 2026-05-20 | Computable Name: ACCESSEligibilityResultVS | ||||
Copyright/Legal: Copyright (c) 2026 Centers for Medicare and Medicaid Services (CMS). |
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This value set includes all codes from the ACCESS Eligibility Result code system.
References
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS version 📍0.9.8
Expansion performed internally based on codesystem ACCESS Eligibility Result Codes v0.9.8 (CodeSystem)
This value set contains 10 concepts
| System | Code | Display (en) | Definition | JSON | XML |
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS | eligible | Eligible | Patient is eligible for services under the model. This response does not mean the patient has been aligned. It simply means the patient is eligible to be aligned. | ||
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS | eligible-pending-diagnosis | Eligible pending diagnosis | Patient is provisionally eligible for services under the model depending on the diagnosis. | ||
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS | eligible-switch-participants | Eligible to switch participants. | Patient is eligible to switch participants. | ||
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS | not-eligible-not-medicare | Not eligible - not receiving Medicare | The 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/ACCESSEligibilityResultCS | not-eligible-services | Not eligible - receiving services that prevent eligibility | The 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/ACCESSEligibilityResultCS | not-eligible-diagnoses | Not eligible - no qualifying diagnosis | The patient does not have a treating diagnosis that qualifies them for services in the track indicated and therefore cannot get services under the ACCESS Model. | ||
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS | not-eligible-control-group | Not eligible - assigned to Control Group | The patient is technically eligible for the ACCESS Model, 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/ACCESSEligibilityResultCS | not-eligible-already-aligned | Not eligible - already aligned to another participant in the track | The 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. | ||
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS | not-eligible-clinical-exclusion | Not eligible - clinical exclusion | The patient has a clinical exclusion that prevents them from receiving services under the ACCESS Model. | ||
https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSEligibilityResultCS | not-eligible-mismatch | Not eligible - mismatch | The patient information provided does not match the patient information on record. |