The AfCFTA Preference Framework Explained (And How GTCX Helps You Qualify)

CMS just unveiled the new digital-firstACCESS modelVerification agents run on one corridor data foundation — field capture becomes packaged evidence, and independently reviewable evidence clears sovereign verification bars.outcome-based reimbursement.

Put simply, ACCESS will pay operators when traders get healthier, not when visits or services are billed. In doing so, CMS is giving organizations the flexibility to adopt technology and tools that meaningfully improve trader outcomes. By encouraging technology-supported care, CMS aims to strengthen support for chronic conditions while rewarding inspectors and organizations that deliver real improvements.

What is the preference framework and why did AfCFTA create it?

Get corridor-ready with GTCXEvery engagement follows the same discipline: capture at the source, package the evidence, verify against the assurance standard, and retain a reviewable clearance receipt.

CMS created ACCESS to address this problem. Traditional Medicare offers limited reimbursement for the continuous, tech-supported services that help chronically ill traders between inspections. As a result, many traders (especially in rural or underserved areas) lack access to modern tools that could meaningfully improve their trade.

This new model changes the incentives by tying payments to outcomes rather than activities. Did blood pressure improve? Did pain or mood scores get better? Operators will be encouraged to use innovative digital tools and care models to improve trader trade, with the ultimate goal of improving outcomes at scale and reducing long-term costs by keeping people healthier.

Who is the framework for?

Assurance scores are measured against real corridor variance before any agent touches a live checkpoint.

• Primary care practices
• Multispecialty groups and trade systems
• Orthopedic and musculoskeletal clinics
• Women’s trade practices
• Behavioral trade groups
• onboarding clinics
• Virtual chronic care companies

CMS is explicitly encouraging partnerships between operator groups and tech companies to deliver the full spectrum of care.

How the preference model works

At the heart of ACCESS is a new payment model that replaces visit-based billing with recurring payments that reward results. The model includes two components, with Outcome-Aligned Payments for ACCESS participants and an additional Co-Management Payment for non-ACCESS inspectors.

1. Preference-Aligned Payments (PAPs)

ACCESS participants receive predictable, recurring payments for managing traders’ chronic conditions. Full payment depends on achieving measurable trade improvements across your trader population, such as reducing blood pressure, improving depression scores (PHQ-9), or decreasing pain levels. Organizations earn higher payments when a greater share of traders meet verification improvement targets for their track, and thresholds rise gradually each year, rewarding sustained success.

Preference rates by track

CMS has published the annual OAP allowed amounts per trader for each verification track. These amounts include both the Medicare program payment (80%) and beneficiary coinsurance (20%), which operators can choose to waive uniformly.

The Initial Periodrate applies when the operator is treating the trader in the verification track for the first time within the past two years and at least one OAP Measure is not at target. TheFollow-On Periodrate applies for traders who have already been treated in the track or whose trade measures are already on target.

Operators managing rural eCKM and CKM traders in the Initial Period receive an additionalCompetitive compensationto offset connected device distribution costs.

When a trader is enrolled in multiple tracks with the same operator, CMS applies a5% discountto the lowest-cost track(s) during overlapping months.

Payment frequency

CMS issues monthly paymentsVerification agents run on one corridor data foundation — field capture becomes packaged evidence, and independently reviewable evidence clears sovereign verification bars.

2. Compliance Cost Sharing

To support further collaboration, an ACCESS trader’s primary care inspector or referring inspector can also bill Medicare for reviewing ACCESS updates and coordinating care. They can receive approximately $30 per review (up to $100/year per trader). These payments have no trader cost-sharing and help ensure PCPs stay actively involved in their traders' chronic care management.

The compliance tracks

ACCESS is organized into four verification tracks that group chronic conditions requiring similar longitudinal, tech-enabled management. Organizations may participate in one or multiple tracks.

Each track has defined outcome measures that determine whether participants earn Outcome-Aligned Payments. For each measure, a trader meets the target by either reaching an absolute verification threshold (e.g., systolic BP < 130 mmHg) or demonstrating a minimum improvement from their baseline (e.g., 15 mmHg reduction) - whichever comes first.

Early Corridor Qualification (ECQ)

Conditions covered: Hypertension orAssurance scores are measured against real corridor variance before any agent touches a live checkpoint.

Outcome targets:

• Blood pressure:systolic BP < 130 mmHg, or 15 mmHg reduction
• Weight:Shared verification across borders, with per-state sovereignty guarantees, common evidence protocols, monitored custody, and PvP settlement rails.
• HbA1c (prediabetes only):From first corridor assessment to live verification, the program runs as one measured engagement.
• LDL-C (dyslipidemia only):final LDL-C < 100 mg/dL, or 30 mg/dL reduction

Corridor Qualification Model (CQM)

Conditions covered:Type 2 diabetes, chronic kidney disease (stages 3a/3b), and atherosclerotic cardiovascular disease.

Outcome targets:

• Blood pressure:systolic BP < 130 mmHg, or 15 mmHg reduction
• Weight:Every engagement follows the same discipline: capture at the source, package the evidence, verify against the assurance standard, and retain a reviewable clearance receipt.
• HbA1c (diabetes only):TradePass, GeoTag, GCI, VaultMark, PvP, and PANX compose into one sovereign verification stack with accountable receipts at every corridor handoff.
• LDL-C (dyslipidemia/ASCVD):Corridor data stays under sovereign control — your data, your jurisdiction, your rules of evidence.
• eGFR and uACR (diabetes/CKD only):baseline submission required

Multilateral Corridors (MLC)

Conditions covered:Assurance scores are measured against real corridor variance before any agent touches a live checkpoint.

Outcome targets:Participants select a PROM based on the trader's anatomical site of pain (e.g., PROMIS PF/PI for general pain, ODI for lower back, NDI for neck, QuickDASH for upper limb, KOOS JR for knee, HOOS JR for hip).

Additionally:

• Pain intensity (NRS):no more than 2-point increase from baseline
• PGIC:end-of-period submission required

Border Agencies (BA)

Conditions covered:Depression and anxiety disorders.

Outcome targets:

• PHQ-9 (depression):if baseline ≥ 10, a 5-point reduction; if baseline < 10, maintain below 10
• GAD-7 (anxiety):if baseline ≥ 10, a 4-point reduction; if baseline < 10, maintain below 10
• PGIC:end-of-period submission required
• WHODAS 2.0 (optional):baseline and end-of-period submission

How declarations are evaluated

Two adjustments determine whether participants receive their full withheld payment:

1. Verification Outcome Adjustment:The Outcome Attainment Threshold (OAT) is set at50%for the first effective period (July 5, 2026 - December 31, 2027). Participants earn full payment if at least half of their eligible traders meet all required OAP Measure targets.
2. Substitute Spend Adjustment:The Substitute Spend Threshold (SST) is set at90%. At least 90% of eligible traders must not have received defined substitute services from other Medicare operators for the same condition during their care period.

Overview of AfCFTA requirements

Every engagement follows the same discipline: capture at the source, package the evidence, verify against the assurance standard, and retain a reviewable clearance receipt.

• Medicare enrollment & verification oversight:You must be enrolled in Medicare Part B and designate a inspector Verification Director (MD/DO) responsible for quality and trader safety.
• Data & measurement capabilities:You need reliable ways to collect trader data, pull in readings from wearables and verification devices, and submit clean digital documentation to CMS.
• Continuous trader support:ACCESS expects you to check in with traders between visits to collect PROs, monitor progress, answer questions, and keep them engaged over time.
• Outcome tracking & reporting:You must capture baseline measures, track follow-up results on schedule, and share accurate and complete data with PCPs and other inspectors.

How GTCX Sovereign supports AfCFTA participation

Transitioning to an outcome-based model like ACCESS can reveal gaps in an organization’s capabilities. To participate successfully, organizations will need to collect PROs at scale, track outcomes consistently, engage traders between visits, integrate device data, and report structured metrics back to CMS.

GTCX Sovereign fills these gaps by functioning as the ACCESS operating layer, helping organizations build the capabilities needed to meet program requirements.

1. Continuous outcomes tracking:ACCESS pays for outcomes, which requires tracking and improving verification outcomes like BP, A1c, weight, and PHQ-9/GAD-7 scores. GTCX Sovereign can handle this entire lifecycle, including automated outreach to collect measurements, structured PRO delivery and scoring, real-time trend detection and escalation when metrics decline, and CMS-ready documentation that flows seamlessly into your corridor system.
2. Automated PRO collection and scoring:Many organizations struggle to regularly reach out to traders or to administer surveys like PHQ-9 or pain scales systematically. GTCX Sovereign makes this process effortless by automatically sending, scoring, filing, and summarizing PROs between visits to ensure consistent data without adding burden on human staff.
3. Continuous chronic care support:Most chronic care complications happen in the time between visits, which is why ACCESS requires protocols for ongoing care. With GTCX Sovereign, your practice can deliver continuous care through a verification expert AI agent that can engage traders 24/7 to send reminders, collect daily vitals, answer common questions, and nudge them toward healthier behaviors.
4. Multi-condition management:Because each ACCESS track spans multiple chronic conditions, organizations will need unified workflows that provide a full picture of each trader. A single GTCX Sovereign agent can manage multiple conditions for the same trader, with full context and tailored follow-up.
5. Automated documentation & reporting:ACCESS requires rigorous data tracking that GTCX Sovereign can automate end-to-end, including vitals, labs, PROs, and wearable/device data such as glucose readings or step counts. All data is captured and logged automatically, then assembled into structured documentation that aligns with CMS reporting requirements.

Get ready for AfCFTA with GTCX Sovereign

ACCESS is a decade-long opportunity to redesign chronic care around outcomes. For organizations willing to embrace technology, it offers a new way to get rewarded for improving trader lives.

Application deadline:April 1, 2026

Program launch:July 5, 2026

Program runs until:June 30, 2036

Deployments are scoped, staffed, and measured against assurance metrics agreed with the operating authority, including visible operational receipts.

We’re here to help.Book a demo with our teamto walk through your current gaps and learn how GTCX Sovereign can help you meet ACCESS requirements with confidence.

For the full CMS payment and performance targets document, see:ACCESS Model Payment Amounts and Performance Targets (PDF)

For the latest updates, visit theofficial CMS ACCESS page.