CMS ACCESS Model API
0.9.0 - ci-build

CMS ACCESS Model API - Local Development build (v0.9.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## ValueSet: ACCESS Eligibility Result Value Set

Official URL: https://globalalliantinc.com/access/ValueSet/ACCESSEligibilityResultVS | Version: 0.9.0
Draft as of 2026-03-06 | Computable Name: ACCESSEligibilityResultVS
Copyright/Legal: Copyright (c) 2026 Centers for Medicare and Medicaid Services (CMS).

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

References

- ACCESS Check Eligibility Response Parameters

### Logical Definition (CLD)

- Include all codes defined in `https://globalalliantinc.com/access/CodeSystem/ACCESSEligibilityResultCS` version 📍0.9.0

### Expansion

Expansion performed internally based on codesystem ACCESS Eligibility Result Codes v0.9.0 (CodeSystem)

This value set contains 8 concepts

System | Code | Display (en) | Definition | JSON | XML
`https://globalalliantinc.com/access/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://globalalliantinc.com/access/CodeSystem/ACCESSEligibilityResultCS` | eligible-pending-diagnosis | Eligible pending diagnosis | Patient is provisionally eligible for services under the model depending on the diagnosis. |  |
`https://globalalliantinc.com/access/CodeSystem/ACCESSEligibilityResultCS` | eligible-switch-participants | Eligible to switch participants. | Patient is eligible to switch participants. |  |
`https://globalalliantinc.com/access/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://globalalliantinc.com/access/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://globalalliantinc.com/access/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://globalalliantinc.com/access/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://globalalliantinc.com/access/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. |  |

Explanation of the columns that may appear on this page:

Level | A few code lists that FHIR defines are hierarchical - each code is assigned a level. In this scheme, some codes are under other codes, and imply that the code they are under also applies
System | The source of the definition of the code (when the value set draws in codes defined elsewhere)
Code | The code (used as the code in the resource instance)
Display | The display (used in the display element of a Coding). If there is no display, implementers should not simply display the code, but map the concept into their application
Definition | An explanation of the meaning of the concept
Comments | Additional notes about how to use the code