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Since the year 2000, states have been required to provide alternate assessments for students with the most significant cognitive disabilities who cannot access the general assessment, even with accommodations. The development of these alternate assessments based on alternate academic achievement standards (AA-AAAS) included innovative approaches that addressed the need for accessibility and accommodations. This paper presents the findings of two studies that examined what the research literature and states’ policies reveal about accommodations on AA-AAAS. The paper highlights critical gaps in the current landscape and discusses implications for future research and policy development to enhance the validity and accessibility of AA-AAAS for students with significant cognitive disabilities.