CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic Conditions
ACCESS Model Now Available to People with Original Medicare
Starting in Spring 2027, the Centers for Medicare & Medicaid Services (CMS) will expand an existing initiative to offer technology-supported care options to Medicare beneficiaries who have heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, and nicotine dependence. With these additions, CMS will enable more people with common chronic conditions and Original Medicare to receive ongoing care, designed to help them improve their health and stay independent, from the comfort of their homes.
This disease management support is made possible by the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model. The model supports CMS’s work on modernizing the nation’s digital health ecosystem and empowering Medicare beneficiaries through greater access to innovative health technologies. ACCESS uses a new payment approach that emphasizes achieving specified health outcomes. Instead of paying solely for individual services, CMS ties payments directly to measurable improvements in patient health.
“We built ACCESS because too many people with chronic conditions were falling through the cracks between appointments,” said CMS Administrator Dr. Mehmet Oz. “ACCESS is one of the tools we are using to bring healthcare into the digital age, giving patients and their providers greater access to AI-enabled technologies, remote monitoring, connected devices, and other innovative tools that can help identify problems earlier and improve care. This latest expansion of the program will help more Americans get the care they need and reward providers who deliver actual results.”
The ACCESS Model enables participating organizations to potentially provide virtual care, health coaching, remote monitoring, and connected devices and wearables between regular doctor visits. It is designed to integrate with the broader healthcare system, enabling healthcare professionals, such as those in primary care, to refer people with Medicare to ACCESS participants who will work with their care team. Participation is completely voluntary and does not negatively alter a beneficiary’s Medicare benefits, coverage, or provider choice.
The ACCESS Model currently offers care options for people with chronic conditions, including high blood pressure, diabetes, chronic musculoskeletal pain, and depression. Three out of four people with Medicare qualify for at least one ACCESS track.
CMS will grow the ACCESS Model across several areas:
- Heart failure: Supporting eligible patients with continuous monitoring focused on measurable gains in function, symptom management, and quality of life.
- Chronic obstructive pulmonary disease: Offering targeted support to help maintain or improve lung function, ease symptoms, and support day-to-day activities.
- Substance use disorders: Providing comprehensive care for opioid, alcohol, and other substance use disorders, including integrated support for co-occurring depression and anxiety, consistent with President Trump’s Great American Recovery initiative.
- Tobacco cessation: Assisting individuals with tobacco cessation.
- Expanded support for bone, joint and mobility conditions: Providing ongoing support for chronic musculoskeletal pain for certain specified conditions beyond the initial 12-month care period.
The new condition tracks will start in spring 2027.
The number of organizations participating in ACCESS at launch is now 160, and Medicare will continue to add to this list throughout the model’s 10 years. CMS is maintaining a directory at Medicare.gov/ACCESS of participating organizations and covered conditions in the ACCESS Model to help patients and providers evaluate their options. ACCESS supports people with Original Medicare; Medicare Advantage enrollees are not eligible, though their plans may offer similar programs.
Major health payers representing 165 million Americans with Medicare Advantage, Medicaid, and private health insurance plans have pledged to adopt an outcomes-based payment structure aligned to ACCESS, supported by CMS implementation resources. Eighteen clinical and patient societies have also expressed support for CMS’s efforts to support clinicians in delivering and expanding patient access to effective technology-supported care for chronic conditions.
If Medicare beneficiaries with chronic health conditions have questions about ACCESS, they should visit Medicare.gov/ACCESS or call 1-800-MEDICARE.
To hear from CMS and HHS leaders about ACCESS and the future of chronic care, view the Sept. 15 HHS event at HHS.gov/live or the HHS YouTube page.
For more information, visit the ACCESS Model webpage on CMS.gov.
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