CMS Adds Heart Failure, COPD and Substance Use Tracks to ACCESS Payment Model

The Centers for Medicare & Medicaid Services said on Tuesday that it will expand its ACCESS Model, an outcome-based payment test for technology-supported chronic care, to cover heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders and tobacco cessation starting in spring 2027.

According to the CMS announcement, the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model lets participating organizations provide virtual care, health coaching, remote monitoring, and connected devices and wearables between regular doctor visits. CMS said the model ties payments directly to measurable improvements in patient health instead of paying solely for individual services.

The new tracks

CMS described the additions as follows:

• Heart failure: continuous monitoring focused on measurable gains in function, symptom management and quality of life.
• COPD: support to maintain or improve lung function, ease symptoms and support day-to-day activities.
• Substance use disorders: care for opioid, alcohol and other substance use disorders, including support for co-occurring depression and anxiety.
• Tobacco cessation.
• Musculoskeletal pain: continued support for certain specified conditions beyond the initial 12-month care period.

The ACCESS Model page lists April 1, 2027 as the start date for the new condition tracks and says current participants and applicants will not need to reapply to join them.

"We built ACCESS because too many people with chronic conditions were falling through the cracks between appointments," CMS Administrator Dr. Mehmet Oz said in the announcement. He described the model as giving patients and providers greater access to AI-enabled technologies, remote monitoring and connected devices.

How the payment model works

The model page says ACCESS began on July 5, 2026 and runs for 10 years. Its initial tracks cover early cardio-kidney-metabolic conditions such as hypertension and prediabetes; cardio-kidney-metabolic conditions including diabetes, chronic kidney disease and atherosclerotic cardiovascular disease; chronic musculoskeletal pain; and behavioral health conditions, namely depression and anxiety.

Participating organizations receive recurring Outcome-Aligned Payments for managing a patient's qualifying conditions, with full payment tied to achieving measurable outcomes such as improvement in blood pressure, HbA1c, lipids or weight, or in validated patient-reported measures of pain, mood and function. CMS bases payment on the overall share of an organization's patients who meet their targets. Care may include the use or monitoring of FDA-authorized devices and software, or devices subject to FDA enforcement discretion, according to the page. Primary care clinicians who refer patients can bill a new co-management payment for reviewing updates from ACCESS organizations.

CMS said 160 organizations are participating at launch and that it will keep adding to the list over the model's 10 years. The agency said three out of four people with Medicare qualify for at least one ACCESS track. The model is limited to Original Medicare; Medicare Advantage enrollees are not eligible, though their plans may offer similar programs.

CMS also said payers representing 165 million people with Medicare Advantage, Medicaid and private insurance have pledged to adopt an outcomes-based payment structure aligned to ACCESS, and that 18 clinical and patient societies have expressed support.

As MedCity News reported, participating providers take on responsibility for quality and the total cost of care, and the program is designed to test whether outcome-based payments encourage more consistent use of remote monitoring and virtual care for chronic conditions. CMS has said it will publish risk-adjusted outcomes for participating organizations.