ACCESS to Add Substance Use Disorder, Heart Failure, and More

CMS said on Sept. 15 that starting in the spring of 2027 it will expand the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model to Medicare beneficiaries who have heart failure, chronic obstructive pulmonary disease (COPD), substance use disorders, and nicotine dependence.

CMS said with these additions more people with common chronic conditions and Original Medicare can receive ongoing care designed to help them improve their health and stay independent.

ACCESS supports CMS’s work on modernizing the nation’s digital health ecosystem and empowering Medicare beneficiaries through greater access to innovative health technologies, the agency said.

The model uses a new payment approach that emphasizes achieving specified health outcomes. Instead of paying solely for individual services, CMS said it ties payments directly to measurable improvements in patient health.

Virtual Care

CMS said ACCESS 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 agency said.

Right now, ACCESS offers care options for people with high blood pressure, diabetes, chronic musculoskeletal pain, and depression. Three out of four people with Medicare qualify for at least one ACCESS track.

CMS’s expansion for the ACCESS Model cuts across several areas:

• Heart failure: Supporting eligible patients with continuous monitoring focused on measurable gains in function, symptom management, and quality of life.

• COPD: 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.

• 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.

  
  

CMS said 160 organizations are participating in ACCESS, 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.

Read a primer on the ACCESS Model by Anne Tumlinson, founder and CEO of ATI Advisory, by clicking here.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.