CMS Expands The ACCESS Model: New Tracks For Heart Failure, COPD, Substance Use Disorders, Tobacco Cessation, And Extended MSK Support

Key Takeaways:

• CMS is expanding the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model in spring 2027 to add five new tracks: heart failure, Chronic Obstructive Pulmonary Disease (COPD,) substance use disorders (SUD), and tobacco cessation, as well as extended support for musculoskeletal (MSK) conditions.
• The expansion is especially significant for palliative care: the new tracks emphasize symptom management, quality of life, functional improvement and technology-enabled care for individuals with serious or chronic conditions.
• The Model now includes 160 participating organizations, and three out of four people with Medicare qualify for at least one ACCESS track.
• Although Medicare Advantage (MA) enrollees are not eligible for ACCESS tracks, major health payers representing 165 million Americans with MA, Medicaid, and private health insurance plans have pledged to adopt outcomes-based payment aligned to ACCESS, signaling potential for broader systemic adoption beyond Original Medicare.

Background: The Original ACCESS Model

As discussed in our December 4, 2025, client alert, CMS launched the ACCESS Model on July 1, 2026, to expand access to technology-enabled chronic care and introduce an outcome-aligned payment (OAP) approach for organizations serving Original Medicare beneficiaries.

The original model included four clinical tracks:

1. Early Cardio-Kidney Metabolic (eCKM): hypertension, dyslipidemia, obesity/overweight with central adiposity, prediabetes
2. Cardio-Kidney Metabolic (CKM): diabetes, chronic kidney disease, atherosclerotic cardiovascular disease
3. Musculoskeletal (MSK): chronic musculoskeletal pain
4. Behavioral Health (BH): depression or anxiety

Under the OAP structure, participating organizations receive recurring payments for providing technology-supported care to beneficiaries with qualifying conditions. Payment is tied to defined health outcomes relative to each patient’s baseline. The model is designed to support improved patient outcomes through services such as health coaching, care coordination, education, medication management, and remote monitoring (using FDA-authorized devices or software).

September 2026 Expansion

On September 15, 2026, CMS announced a significant expansion of the ACCESS Model. CMS Administrator Dr. Mehmet Oz stated: “We built ACCESS because too many people with chronic conditions were falling through the cracks between appointments . . . . This latest expansion of the program will help more Americans get the care they need and reward providers who deliver actual results.”

Beginning in spring 2027, CMS will offer five new condition tracks:

1. Heart Failure: Continuous monitoring focused on measurable gains in function, symptom management, and quality of life.
2. COPD: Targeted support to maintain or improve lung function, ease symptoms, and support daily activities.
3. SUDs: Comprehensive care for opioid, alcohol, and other substance use disorders, including integrated support for co-occurring depression and anxiety.
4. Tobacco Cessation: Assisting individuals with tobacco cessation through technology-supported interventions.
5. Expanded MSK Support: Ongoing support for chronic musculoskeletal pain beyond the initial 12-month care period, recognizing that chronic pain management is an ongoing need.

The expanded model continues to use virtual care, health coaching, remote monitoring, connected devices, and wearable technology to support beneficiaries outside traditional clinical settings. CMS has stated that participating organizations may provide integrated services, including behavioral health support, therapy, counseling, patient education, care coordination, and chronic disease management.

Participation remains voluntary and does not alter Medicare coverage or payment rules outside the model. CMS has also launched a directory at Medicare.gov/ACCESS to help beneficiaries locate participating organizations. CMS is currently accepting applications for the spring 2027 cohort on a rolling basis.

Significance for Palliative Care

The ACCESS expansion is especially meaningful for individuals with serious or chronic illnesses who need palliative care. Several features of the new tracks support palliative care’s focus on comfort, quality of life, and patient-centered treatment.

• Focus on Heart Failure and COPD. These tracks emphasize symptom management, quality of life, and functional improvement – key goals for palliative care. This approach creates a meaningful new pathway for palliative-style care focused on holistic, patient-centered care, rather than exclusively curative treatment and traditional clinical outcomes.
• Technology-Supported, Home-Based Care. Remote monitoring, virtual care, connected devices, and wearable technology allow patients to receive ongoing support at home. This may improve access to care for individuals with limited mobility or serious chronic conditions.
• Whole-Person Care for Substance Use Disorders. The SUD track addresses co-occurring depression and anxiety alongside substance use. This integrated approach recognizes the physical, behavioral, and psychological needs of patients, consistent with palliative care principles.
• Extended MSK Support Reflects Palliative Care Philosophy. Extending MSK care beyond the initial 12-month period recognizes that chronic pain may require ongoing management, in alignment with palliative care’s commitment to long-term symptom relief and patient comfort.
• Outcome Measures Aligned with Patient-Centered Values. The ACCESS Model measures success through symptom reduction, quality of life, and functional improvement, rather than relying solely on traditional clinical outcomes.

Who Can Participate

ACCESS participants must be Medicare Part B–enrolled organizations (excluding DME and lab suppliers) and must designate a Medicare-enrolled Clinical Director. Although MA plans are not eligible for payment under the ACCESS Model, MA payers may, at their discretion, provide similar services. As of the September 2026 announcement, 160 organizations are participating in the ACCESS Model.

Key Unknowns

• Payment rates and benchmarks. CMS has not yet published OAP rates or outcome benchmarks for the new condition tracks.
• 2027 application process. CMS has not yet detailed the application timeline or process for the spring 2027 cohort.
• Private-payer implementation. It remains to be seen how payer commitments will translate into specific contractual arrangements and whether private payers will adopt CMS’s OAP models.
• Interaction with existing benefits. The relationship between the new ACCESS tracks and existing Medicare palliative care and hospice benefits remains unclear. Providers should monitor potential overlap and billing conflicts.
• Outcome measurement. CMS has not yet explained how it will measure outcomes for conditions such as substance use disorders and tobacco cessation.

Quick Take

• The expansion of the ACCESS Model to address additional chronic conditions, including heart failure, COPD, and substance use disorders, expands opportunities for chronic care reimbursement within traditional Medicare. The ACCESS expansion represents a continued and accelerating commitment by CMMI to coupling novel technologies with Medicare payment flexibility.
• The addition of heart failure and COPD tracks creates a meaningful new pathway for Medicare-reimbursed care focused on symptom management and quality of life, rather than exclusively curative treatment.
• The substance use disorder track incorporates whole-person care, including behavioral health support for co-occurring conditions, consistent with an integrated approach to patient treatment.
• Organizations providing palliative care, chronic disease management, or technology-enabled home care should consider ACCESS as a potential way to broaden their Medicare reach and reimbursement. For the spring 2027 cohort, track CMS’s application timeline and requirements and assess eligibility, operational readiness, payment terms, and fit with providers’ services and patient populations.