Behavioral Health Law Ledger | September 2026

The September 2026 issue of Greenberg Traurig’s quarterly Behavioral Health Law Ledger covers the CMS ACCESS Model’s implications for behavioral health providers and Colorado’s new licensing framework for applied behavior analysis services.

CMS ACCESS Model: Key Takeaways for Behavioral Health Providers

The Centers for Medicare and Medicaid Services’ (CMS) Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a 10-year voluntary Innovation Center model intended to expand technology-supported care for Medicare beneficiaries with common chronic conditions, including depression and anxiety. The model launched July 5, 2026, with rolling participation dates, including Aug. 17 and Oct. 1, 2026.

Although ACCESS principally targets primary care practitioners and referring clinicians, it may create partnership opportunities for behavioral health providers. Below are 10 key takeaways from the current ACCESS Model behavioral health providers should keep top of mind:

1. The initial behavioral health track is limited to depression and anxiety. A beneficiary qualifies for the behavioral health track if they have one or both of those conditions. A provider participating in the behavioral health track must manage all qualifying behavioral health conditions the enrolled beneficiary has within that track — not selectively treat only anxiety or only depression. CMS plans to add a separate substance-use-disorder track beginning April 1, 2027.
2. It applies to Original Medicare, not Medicare Advantage. Eligible beneficiaries must have Original Medicare Parts A and B, with Medicare as primary payer. Medicare Advantage enrollees, PACE participants, and hospice beneficiaries are excluded. Dual-eligible Medicare-Medicaid beneficiaries may participate if otherwise eligible.
3. The model replaces usual Medicare Fee-for-Service (FFS) billing for an aligned patient by the participant and its affiliates. For a beneficiary aligned to a behavioral health ACCESS participant, the participant and affiliated entities generally may bill only the model-specific ACCESS G-codes during the active care period; they cannot also submit Medicare FFS claims for other services they furnish to that beneficiary, including indirectly through certain contracted arrangements.
4. Payment is fixed and recurring, but ultimately contingent on outcomes. ACCESS uses Outcome-Aligned Payments (OAPs) for a 12-month care period. CMS pays participants to manage the qualifying condition rather than provide a prescribed menu of visits, minutes, or devices. Payment includes a higher initial care tier and a lower continuation/maintenance tier and is subject to clinical outcome and substitute spend adjustments.
5. Performance will be measured with PHQ-9, GAD-7, and functional-status reporting. The behavioral-health OAP measures require minimum symptom improvement as measured by the PHQ-9 for depression and the GAD-7 for anxiety. CMS’s current technical FAQ also identifies submission of the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 as a required validated patient-reported measure of overall function, while the February 2026 Request for Applications (RFA) described WHODAS submission as optional, so participants may wish to follow current CMS implementation guidance and their respective contracts.
6. Performance is evaluated at the organization’s population level, not as an all-or-nothing patient-by-patient payment. CMS compares the organization’s percentage of aligned beneficiaries who achieve all applicable targets with the applicable Outcome Attainment Threshold (OAT). For the first model year, CMS states the OAT is 50%, meaning an organization with 40% of patients meeting the targets would receive 80% of the full payment, subject to a maximum 50% reduction in gross payment.
7. Participation is organizational, and Medicare enrollment structure matters. The participant must be a Medicare Part B-enrolled provider or supplier under a single taxpayer identification number (TIN) and eligible to bill under the Physician Fee Schedule. It must designate a Medicare-enrolled physician medical director. Physicians and non-physician practitioners furnishing or supervising care must be individually Medicare-enrolled, have reassigned billing rights to the participating TIN, and appear on a maintained practitioner roster.
8. Technology is permitted — and often central — but it carries HIPAA, licensure, and FDA obligations. The model contemplates care delivered in person, virtually, asynchronously, or through other technology-enabled methods. Potential components include telehealth, digital therapeutics, apps, symptom tracking, clinician-supported therapy and counseling, and medication management. Participants must be HIPAA covered entities, satisfy applicable state licensure and scope of practice rules, and ensure that any regulated software or devices are legally marketed for their intended use, unless FDA enforcement discretion applies.
9. Care coordination must be real, electronic, and workflow integrated. Participants must make reasonable efforts to identify the beneficiary’s primary care provider (PCP) and referring clinician and provide standardized clinical updates at initiation, completion, and key clinical milestones in a manner that actually makes the update accessible to the coordinating clinician. Participants also must integrate with a health information exchange or similar trusted network and report measures through CMS-hosted standards-based Application Programming Interfaces (APIs).
10.  Referring clinicians have a new co-management payment, and patient cost-sharing is an elective design choice. PCPs and other referring clinicians may bill a separate ACCESS co-management service for documented review of care updates and related coordination, such as medication reconciliation, medication changes, problem list updates, monitoring instructions, or referral activity. CMS estimates approximately $30 per service, with a roughly $10 first-time onboarding/setup increment when the required modifier applies; billing is limited to once every four months per beneficiary per track, up to about $100 annually, and has no beneficiary cost-sharing. Separately, ACCESS participants may elect to waive OAP beneficiary cost-sharing under the CMS-sponsored model patient incentive safe harbor, but must apply the policy uniformly and disclose anticipated costs before enrollment if they collect cost-sharing.



Colorado Establishes New Licensing Framework for Applied Behavior Analysis Services Under HB 26-1425

On June 2, 2026, Colorado enacted House Bill 26-1425 (HB 26-1425), establishing new requirements for applied behavior analysis (ABA) services in the state, including licensure of behavior analysts and assistant behavior analysts, facility licensing requirements, and changes affecting Colorado Medicaid reimbursement.

Licensure of Behavior Analysts and Assistant Behavior Analysts

Beginning July 1, 2028, individuals generally must be licensed to practice as behavior analysts or assistant behavior analysts in Colorado unless an applicable exemption applies. To administer the new licensing requirements, HB 26-1425 establishes the Colorado Behavior Analyst Licensing Board (the Board) within the Division of Professions and Occupations of the Colorado Department of Regulatory Agencies (DORA).

To qualify for licensure as a behavior analyst or assistant behavior analyst, the applicant must:

• File an application for licensure with the Board;
• Hold a valid certification in good standing with a certifying entity;
• Complete a fingerprint-based criminal history record check;
• Maintain professional liability insurance in an amount established through rulemaking, unless the applicant works as a public employee covered by government immunity; and
• For assistant behavior analysts, practice under the supervision of a licensed behavior analyst and within the scope of practice the Board establishes.

The Board may take disciplinary action for licensing violations, including denying, suspending, or revoking a license and issuing cease-and-desist orders. Practicing as a behavior analyst or assistant behavior analyst without a required license or applicable exemption constitutes a class 2 misdemeanor.

Licensing Requirements for ABA Clinics

HB 26-1425 also establishes facility licensing requirements the Colorado Department of Human Services (CDHS) administers for ABA clinics. CDHS defines an “ABA clinic” to include a facility that provides ABA therapy and at least four hours, but less than 24 hours, of care each business day to at least three individuals who are at least 18 months old but under 21 years old.

Beginning Aug. 1, 2027, ABA clinics will become subject to CDHS’s existing facility licensing framework, which includes requirements concerning sanitation and fire prevention, background checks, and local zoning. HB 26-1425 also requires ABA clinics to comply with applicable licensing fee and employee qualification requirements and directs CDHS to establish additional standards specifically governing ABA clinics through rulemaking.

Colorado Medicaid Reimbursement for ABA Services

HB 26-1425 also addresses Colorado Medicaid reimbursement for ABA services furnished by registered behavior technicians. A “registered behavior technician” is a behavior technician certified by a certifying entity who provides ABA services under the direction and supervision of a licensed behavior analyst or other qualified licensed professional.

The Colorado Department of Health Care Policy and Financing (HCPF) must reimburse an ABA provider for qualifying services furnished by a registered behavior technician to a Medicaid member with autism spectrum disorder or another condition under HCPF policies. Subject to federal approval and applicable statutory requirements, HCPF must also reimburse providers for services furnished during one temporary period of at least 45 days while a behavior technician pursues the required certification.

Preparing for Implementation

ABA providers operating in Colorado may wish to begin preparing for the legislation’s phased implementation by assessing which practitioners may require state licensure, evaluating whether their locations meet the definition of an ABA clinic, and reviewing their credentialing and reimbursement practices for registered behavior technicians. Providers with covered facilities might also evaluate their operations against applicable CDHS facility licensing requirements in advance of Aug. 1, 2027.

Since several aspects of HB 26-1425 will be further developed through rulemaking, providers should monitor DORA, CDHS, and HCPF guidance for additional requirements and implementation details as the applicable compliance dates approach.