Starting in spring 2027, people with Original Medicare who live with heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, or nicotine dependence will be able to get technology-supported care between doctor visits through an expanded federal payment model, the Centers for Medicare & Medicaid Services announced on Tuesday.
The expansion adds four condition tracks to the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. It also extends support for certain bone, joint, and mobility conditions beyond the initial 12-month care period. CMS says three out of four people with Medicare now qualify for at least one track.
For families caring for an older parent with heart failure or COPD, the change could bring more remote monitoring and coaching at home. But the program is voluntary, is limited to Original Medicare, and does not change anyone's existing benefits, so households will need to seek it out rather than expect it automatically.
New Tracks and the Care They Cover
According to CMS, the heart failure track will offer continuous monitoring aimed at improving function, symptom management, and quality of life. The COPD track will provide targeted support to maintain or improve lung function, ease symptoms, and support daily activities. The substance use track covers opioid, alcohol, and other substance use disorders, with integrated support for depression and anxiety that occur alongside them. A separate track will help people quit tobacco.
These conditions join existing tracks that cover high blood pressure, diabetes, chronic musculoskeletal pain, and depression, among related conditions. The 10-year model launched in July, and CMS says 160 organizations are participating. A directory of participants and the conditions they treat is available on Medicare.gov.
"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 agency's announcement.
Payment Tied to Results, Not Visits
ACCESS pays participating organizations recurring amounts for managing a patient's condition, but full payment depends on measurable improvements, such as better blood pressure control. Participants can use virtual care, health coaching, remote monitoring, connected devices, and wearables. Primary care doctors and other clinicians can refer patients and bill for co-managing their care.
For the model's existing tracks, maximum annual amounts for the first year of care range from $180 to $420 per patient, with lower amounts for an optional follow-on year, according to CMS's payment schedule. Those amounts include both Medicare's 80% share and the patient's 20% coinsurance, although participating organizations may choose to waive the coinsurance. Patients should ask whether an organization will bill them for that portion. CMS has not yet listed payment amounts for the new tracks.
Some digital health companies have warned that the rates may be too low to sustain the services, Healthcare Dive reported, although more than 150 providers and technology companies joined the model.
Jacob Shiff, chief AI and technology officer at the CMS Innovation Center, said at a Tuesday event that ACCESS was designed from the start to reach Medicaid, Medicare Advantage, and commercial plans, Fierce Healthcare reported. CMS says health payers covering 165 million Americans have pledged to adopt a similar outcomes-based payment approach. The agency also plans to publish a voluntary reference design for a maternal track that includes high blood pressure disorders of pregnancy, which Medicaid plans could use.
HHS Secretary Robert F. Kennedy Jr. argued at the same event that traditional fee-for-service payment rewards volume. "When we pay for activity instead of outcomes, we get more activity," he said. Oz warned that the program depends on keeping public trust. "We don't get two chances at this," he said.
Who Stands to Benefit and Open Questions
People in rural areas, those with limited mobility, and caregivers who juggle frequent appointments may gain the most from care delivered at home. According to Shiff, primary care providers, specialists, rural and federally qualified health centers, and pharmacies can all refer patients and receive updates on their care. Eighteen clinical and patient societies have voiced support for the approach.
The model's value is still unproven. It is a federal test, not a permanent benefit, and CMS has not released outcome data from its first months. In a Health Affairs Scholar commentary, researchers Aditya Narayan and Bob Kocher called ACCESS a novel approach but said it leaves many questions unanswered, including payment levels and how quality will be measured and adjusted for patient risk. The commentary also cites a 2023 Congressional Budget Office analysis that found the CMS Innovation Center increased federal spending during its first decade.
Those open questions matter for older adults with limited digital skills, hearing or vision problems, or several chronic illnesses at once. Families may need to push for clear answers before signing up.
Medicare Advantage members are not eligible, although CMS says their plans may offer similar programs. People with only Medicaid, private insurance, or no insurance cannot join ACCESS.
Steps for Patients and Caregivers
Beneficiaries interested in ACCESS can ask their primary care doctor about a referral, search the Medicare.gov directory, or call 1-800-MEDICARE. Before enrolling, patients should ask whether the organization coordinates with their current doctors, which devices are required, who pays for internet or phone service, and whether any out-of-pocket costs apply.
A technology-based program should not replace urgent care, and a wearable alert is not a diagnosis. People with heart failure who notice sudden weight gain, worsening shortness of breath, or new leg swelling, and people with COPD who have rising breathlessness, chest pain, or bluish lips, should contact their clinician promptly or seek emergency care.
Patients should not stop or change medications based on an app or device reading without talking to their care team. People struggling with opioid or alcohol use can call SAMHSA's free National Helpline at 1-800-662-4357 for treatment referrals.
CMS will keep adding participants over the model's 10-year run, and the new tracks are scheduled to start April 1, 2027. Details are posted on the CMS ACCESS Model page. MedicalDaily will track enrollment rules and any early results the agency releases.
Key Questions Answered
What did Medicare announce?
CMS announced on Sept. 15 that its ACCESS Model will add tracks for heart failure, COPD, substance use disorders, and tobacco cessation starting in spring 2027, along with extended support for certain musculoskeletal conditions.
Who can join ACCESS?
People with Original Medicare who have a qualifying condition. Medicare Advantage members are not eligible, though their plans may offer similar programs.
Does ACCESS change my Medicare benefits?
No. Participation is voluntary and does not reduce existing benefits, coverage, or choice of providers, according to CMS.
How do I find a participating organization?
Search the ACCESS directory on Medicare.gov, ask your primary care doctor for a referral, or call 1-800-MEDICARE.
Will I pay anything to participate?
Possibly. CMS's payment amounts include a 20% patient coinsurance share, which some organizations may waive. Ask the organization whether it bills that portion and about any device or internet costs before enrolling.
Is the program proven to work?
Not yet. ACCESS is a 10-year federal test, and CMS has not published outcome results from its early months.
