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

Artifacts

This page lists all FHIR artifacts defined in the ACCESS Model API Implementation Guide, organized by API.

Capability Statements

These statements define the expected capabilities of systems implementing the ACCESS Model APIs. Each capability statement describes the operations, resources, and interactions that must be supported.

ACCESS Eligibility API Capability Statement Capabilities for systems implementing the Eligibility API
ACCESS Alignment API Capability Statement Capabilities for systems implementing the Alignment API
ACCESS Unalignment API Capability Statement Capabilities for systems implementing the Unalignment API
ACCESS Data Reporting API Capability Statement Capabilities for systems implementing the Data Reporting API

Shared Resources

This section defines the operations, code systems, and value sets that are used across multiple ACCESS APIs.

Operations

These are the custom operations that can be supported by and/or invoked by systems conforming to the ACCESS Model APIs.

SubmissionStatus Check the status of asynchronous operation requests

Abstract Profiles

These profiles define base structure and terminologies common across other profiles. Abstract profiles cannot themselves be instantiated.

ACCESS Condition Profile Base abstract condition profile requiring ICD-10-CM codes for diagnoses across all ACCESS APIs. Provides the basis for other Condition-based profiles for the ACCESS Model.

Profiles

These define constraints on FHIR resources for use across multiple ACCESS APIs.

ACCESS Submission Status Response Parameters Output parameters for the $submission-status operation
ACCESS eCKM Track Condition Profile Condition profile for Early Cardio-Kidney-Metabolic (eCKM) track with extensible binding to eCKM diagnosis codes
ACCESS CKM Track Condition Profile Condition profile for Cardio-Kidney-Metabolic (CKM) track with extensible binding to CKM diagnosis codes
ACCESS MSK Track Condition Profile Condition profile for Musculoskeletal (MSK) track with extensible binding to MSK diagnosis codes
ACCESS BH Track Condition Profile Condition profile for Behavioral Health (BH) track with extensible binding to BH diagnosis codes

Value Sets

These define sets of codes used by systems conforming to the ACCESS Model APIs.

ACCESS Track Value Set Value set including all ACCESS Model track codes
ACCESS eCKM Track Qualifying Diagnoses ICD-10-CM diagnosis codes that qualify a patient for the Early Cardio-Kidney-Metabolic (eCKM) track
ACCESS CKM Track Qualifying Diagnoses ICD-10-CM diagnosis codes that qualify a patient for the Cardio-Kidney-Metabolic (CKM) track
ACCESS MSK Track Qualifying Diagnoses ICD-10-CM diagnosis codes that qualify a patient for the Musculoskeletal (MSK) track
ACCESS BH Track Qualifying Diagnoses ICD-10-CM diagnosis codes that qualify a patient for the Behavioral Health (BH) track

Code Systems

These define new code systems used by systems conforming to the ACCESS Model APIs.

ACCESS Track Code System Codes for each of the ACCESS Model tracks (eCKM, CKM, MSK, BH)

Supporting Examples

These are example instances that are referenced by multiple API examples across the implementation guide.

Patient Example Example US Core patient with Medicare Beneficiary Identifier (MBI) used across multiple API examples
Practitioner Example Example US Core practitioner with NPI used in data reporting examples
Organization Example Example US Core organization representing an ACCESS participant
Condition - Type 2 Diabetes Example Example ACCESS CKM Track condition for Type 2 Diabetes Mellitus (ICD-10-CM E11.9)
Condition - Essential Hypertension Example Example ACCESS eCKM Track condition for Essential Hypertension (ICD-10-CM I10)
Condition - Major Depressive Disorder Example Example ACCESS BH Track condition for Major Depressive Disorder (ICD-10-CM F32.9)
Condition - Osteoarthritis Example Example ACCESS MSK Track condition for Osteoarthritis (ICD-10-CM M19.90)

Eligibility API

This section defines the operations, profiles, code systems, and value sets that are specific to the ACCESS Eligibility API, which allows participants to check if patients are eligible for the ACCESS model.

Operations

These are the custom operations that can be supported by and/or invoked by systems conforming to the ACCESS Eligibility API.

CheckEligibility Submit basic patient information to check eligibility for the ACCESS model

Operation Profiles

These define constraints on FHIR resources for systems conforming to the ACCESS Eligibility API.

ACCESS Check Eligibility Request Parameters Input parameters for the $check-eligibility operation
ACCESS Check Eligibility Response Parameters Output parameters for the $check-eligibility operation

Value Sets

These define sets of codes used by systems conforming to the ACCESS Eligibility API.

ACCESS Eligibility Result Value Set Value set including all eligibility result codes

Code Systems

These define new code systems used by systems conforming to the ACCESS Eligibility API.

ACCESS Eligibility Result Code System Codes indicating the result of an eligibility check

Examples

These are example instances demonstrating the use of the Eligibility API.

Check Eligibility Request Example Example request for checking patient eligibility including participant ID, payer ID, patient details, and track
Check Eligibility Response - Eligible Example successful response indicating patient is eligible for the ACCESS Model

Alignment API

This section defines the operations, profiles, code systems, and value sets that are specific to the ACCESS Alignment API, which aligns eligible patients to participants for care under the ACCESS Model.

Operations

These are the custom operations that can be supported by and/or invoked by systems conforming to the ACCESS Alignment API.

Align Align a patient to a participant and ACCESS track

Operation Profiles

These define constraints on FHIR resources for systems conforming to the ACCESS Alignment API.

ACCESS Alignment Request Parameters Input parameters for the $align operation
ACCESS Alignment Response Parameters Output parameters for the $align operation

Value Sets

These define sets of codes used by systems conforming to the ACCESS Alignment API.

ACCESS Alignment Result Value Set Value set including all alignment result codes
ACCESS Event Type Value Set Value set including all event notification type codes

Code Systems

These define new code systems used by systems conforming to the ACCESS Alignment API.

ACCESS Alignment Result Code System Codes indicating the result of an alignment request
ACCESS Event Type Code System Codes for types of notification events that trigger subscription notifications

Examples

These are example instances demonstrating the use of the Alignment API.

Alignment Request Example Example request for aligning a patient including participant ID, payer ID, patient details, track, conditions, and notification endpoint
Alignment Request with Switch Consent Example Example request for aligning a patient with provider switch consent attestation after 90-day lock-in period
Alignment Response - Aligned Example successful response indicating patient has been aligned to the ACCESS participant
Alignment Response - Switch Approved Example successful response indicating patient provider switch has been approved and patient is re-aligned

Unalignment API

This section defines the operations, profiles, code systems, and value sets that are specific to the ACCESS Unalignment API, which allows manual unalignment of patients from participants.

Operations

These are the custom operations that can be supported by and/or invoked by systems conforming to the ACCESS Unalignment API.

Unalign Manually unalign a patient from a participant and ACCESS track

Operation Profiles

These define constraints on FHIR resources for systems conforming to the ACCESS Unalignment API.

ACCESS Unalignment Request Parameters Input parameters for the $unalign operation
ACCESS Unalignment Response Parameters Output parameters for the $unalign operation
ACCESS Clinical Exclusion Condition ICD-10-CM diagnosis codes that disqualify a patient from the ACCESS Model

Value Sets

These define sets of codes used by systems conforming to the ACCESS Unalignment API.

ACCESS Unalignment Result Value Set Value set including all unalignment result codes
ACCESS Unalignment Reason Value Set Value set including all unalignment reason codes

Code Systems

These define new code systems used by systems conforming to the ACCESS Unalignment API.

ACCESS Unalignment Result Code System Codes indicating the result of an unalignment request
ACCESS Unalignment Reason Code System Codes indicating the reason for an unalignment request

Examples

These are example instances demonstrating the use of the Unalignment API.

Unalignment Request Example Example request for unaligning a patient including participant ID, payer ID, patient details, track, and reason for unalignment (geographic relocation)
Unalignment Request - ESRD Example Example unalignment request for patient who developed end-stage renal disease (ESRD), demonstrating the no-longer-clinically-eligible reason code
Patient with ESRD - Unalignment Example Example patient Jane Smith who has developed ESRD making her ineligible for the ACCESS Model
End Stage Renal Disease Condition Example Example active ESRD diagnosis (ICD-10-CM N18.6) that disqualifies patient from ACCESS Model participation
Unalignment Response - Unaligned Example successful response indicating patient has been manually unaligned from the ACCESS Model

Data Reporting API

This section defines the operations, profiles, code systems, and value sets that are specific to the ACCESS Data Reporting API, which allows participants to submit data reporting information.

Operations

These are the custom operations that can be supported by and/or invoked by systems conforming to the ACCESS Data Reporting API.

ReportData Submit data reporting information for the ACCESS model

Operation Profiles

These define constraints on FHIR resources for systems conforming to the ACCESS Data Reporting API.

ACCESS Data Reporting Bundle Contains the resources need to report patient data to the ACCESS Model
ACCESS Data Reporting Composition Defines constraints that represent common clinical concepts for ACCESS Model Data Reporting submissions. Includes optional additional-information section for supplementary resources
ACCESS Report Data Request Parameters Input parameters for the $report-data operation
ACCESS Report Data Response Parameters Output parameters for the $report-data operation

Value Sets

These define sets of codes used by systems conforming to the ACCESS Data Reporting API.

ACCESS Report Type Value Set Value set including all report type codes (e.g., baseline, end-of-quarter)
ACCESS Report Data Result Value Set Value set including all data reporting submission result codes

Code Systems

These define new code systems used by systems conforming to the ACCESS Data Reporting API.

ACCESS Report Type Code System Codes indicating the type of report (e.g., baseline, end-of-quarter)
ACCESS Report Data Result Code System Codes indicating the result of a data reporting submission
ACCESS Report Data Composition Section Code System Additional codes for composition sections used in ACCESS Model data reporting when LOINC codes are not available

Examples

These are example instances demonstrating the use of the Data Reporting API.

Report Data Request Example Example request for submitting data report including participant ID, track, and complete data bundle
Report Data Response - Success Example successful response indicating data submission was processed and recorded
Report Data Response - Duplicate Example response indicating data submission is a duplicate
Report Data Response - Patient Not Aligned Example response indicating patient is not currently aligned
Report Data Response - Reporting Period Closed Example response indicating the reporting period has closed
Report Data Response - Incomplete Data Example response indicating data submission is missing required elements
Report Data Response - Incorrect Track Example response indicating data doesn't match patient's aligned track
Submission Status OperationOutcome Example Example OperationOutcome showing detailed information about an incomplete data submission with severity, code, details text, and FHIRPath expressions
(Early) Cardio-Kidney-Metabolic (CKM/eCKM) Tracks
eCKM Report Data Request Example Example request Parameters for submitting a eCKM track data report
eCKM Report Data Bundle Example Example document bundle containing composition, patient, and clinical observations for the eCKM track
eCKM Report Data Composition Example Example composition organizing clinical data for the eCKM track reporting
CKM Report Data Request Example Example request Parameters for submitting a CKM track data report
CKM Report Data Bundle Example Example document bundle containing composition, patient, and clinical observations for the CKM track
CKM Report Data Composition Example Example composition organizing clinical data for the CKM track reporting
Blood Pressure Example Example blood pressure observation with systolic and diastolic components for the CKM/eCKM track
Blood Pressure Example 2 Example blood pressure observation with systolic and diastolic components for the CKM/eCKM track
Blood Pressure Example 3 Example blood pressure observation with systolic and diastolic components for the CKM/eCKM track
Body Weight Example Example body weight vital sign observation for the CKM/eCKM track
BMI Example Example body mass index vital sign observation for the CKM/eCKM track
Waist Circumference Example Example waist circumference vital sign observation for the CKM/eCKM track
HbA1c Example Example hemoglobin A1c laboratory observation for the CKM/eCKM track
eGFR Example Example estimated glomerular filtration rate laboratory observation for the CKM track
uACR Example Example urine albumin-creatinine ratio laboratory observation for the CKM track
LDL-C Cholesterol Example Example LDL-C observation for the CKM/eCKM track
HDL Cholesterol Example Example HDL observation for the CKM/eCKM track
Total Cholesterol Example Example total cholesterol observation for the CKM/eCKM track
Triglycerides Example Example triglycerides observation for the CKM/eCKM track
Lipid Panel DiagnosticReport Example Example lipid panel diagnostic report including total cholesterol, LDL, HDL, and triglycerides for the CKM/eCKM track
Musculoskeletal (MSK) Track
MSK Report Data Request Example Example request Parameters for submitting a MSK track data report
MSK Report Data Bundle Example Example document bundle containing composition, patient, and patient-reported outcomes for the MSK track
MSK Report Data Composition Example Example composition organizing clinical data for the MSK track reporting
PROMIS Physical Function Short Form 6b Example Example PROMIS Physical Function (PF) Short Form 6b QuestionnaireResponse for the MSK track
PROMIS Physical Function CAT Example Example PROMIS Physical Function CAT QuestionnaireResponse for the MSK track
PROMIS Pain Interference Short Form 6a Example Example PROMIS Pain Interference (PI) Short Form 6a QuestionnaireResponse for the MSK track
PROMIS Pain Interference CAT Example Example PROMIS Pain Interference CAT QuestionnaireResponse for the MSK track
Oswestry Disability Index Example Example Oswestry Disability Index (ODI) QuestionnaireResponse for the MSK track
Neck Disability Index Example Example Neck Disability Index (NDI) QuestionnaireResponse for the MSK track
QuickDASH Example Example Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) QuestionnaireResponse for the MSK track
Musculoskeletal PGIC Example Example Patient Global Impression of Change QuestionnaireResponse for the MSK track
KOOS JR Example Example KOOS JR QuestionnaireResponse for the MSK track
HOOS JR Example Example HOOS JR QuestionnaireResponse for the MSK track
PROMIS Pain Intensity NRS Example Example PROMIS Pain Intensity NRS QuestionnaireResponse for the MSK track
Behaviorial Health (BH) Track
BH Report Data Request Example Example request Parameters for submitting a BH track data report
BH Report Data Bundle Example Example document bundle containing composition, patient, and behavioral health assessments for BH track
BH Report Data Composition Example Example composition organizing clinical data for BH track reporting
Depression PHQ-9 Example Example PHQ-9 QuestionnaireResponse for the BH track
Anxiety GAD-7 Example Example GAD-7 QuestionnaireResponse for the BH track
WHODAS 2.0 Example Example WHODAS 2.0 QuestionnaireResponse for the BH track
Behavioral Health PGIC Example Example Behavioral Health PGIC QuestionnaireResponse for the BH track

Example Questionnaires

These questionnaire examples provide additional information to implementers and a better understanding of how the QuestionnaireResponse profiles interact with their associated questionnaires, particularly linkIds between the questionnaire items and the corresponding individual responses.

The Data Reporting API leverages USCoreQuestionnaireResponse profile, which requires a canonical URL for the underlying questionnaire associated with the questionnaire response. If the FHIR questionnaire is publicly available, it can be referenced through its canonical URL from the questionnaire response.

Otherwise, the questionnaire should be included in the ACCESS Data Reporting Bundle and referenced from the matching questionnaire response.

Musculoskeletal (MSK) Track
PROMIS Physical Function Short Form 6b Questionnaire Example Example PROMIS Physical Function (PF) Short Form 6b Questionnaire
PROMIS Physical Function CAT Questionnaire Example Example PROMIS Physical Function CAT Questionnaire
PROMIS Pain Interference Short Form 6a Questionnaire Example Example PROMIS Pain Interference (PI) Short Form 6a Questionnaire
PROMIS Pain Interference CAT Questionnaire Example Example PROMIS Pain Interference CAT Questionnaire
Oswestry Disability Index Questionnaire Example Example Oswestry Disability Index (ODI) Questionnaire
Neck Disability Index Questionnaire Example Example Neck Disability Index (NDI) Questionnaire
QuickDASH Questionnaire Example Example Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) Questionnaire
MSK PGIC Questionnaire Example Example Patient Global Impression of Change Questionnaire
KOOS JR Questionnaire Example Example KOOS JR Questionnaire
HOOS JR Questionnaire Example Example HOOS JR Questionnaire
PROMIS Pain Intensity NRS Questionnaire Example Example PROMIS Pain Intensity NRS Questionnaire
Behaviorial Health (BH) Track
PHQ-9 Questionnaire Example Example PHQ-9 Questionnaire
GAD-7 Questionnaire Example Example GAD-7 Questionnaire
WHODAS 2.0 Questionnaire Example Example WHODAS 2.0 Questionnaire
BH PGIC Questionnaire Example Example Behavioral Health PGIC Questionnaire