Medicare Expands ACCESS Chronic Care Pay Test Early

The Centers for Medicare & Medicaid Services will add five chronic-care tracks in 2027 to ACCESS, its Original Medicare experiment in paying for tech-supported disease management. Officials announced the change on September 15, 2026, 72 days after the 10-year model began on July 5, 2026.

With the new tracks, three out of four people with Medicare will qualify for at least one ACCESS option, CMS said. Full payment still depends on measured results such as a 15 mmHg drop in blood pressure, and CMS has not posted whether the first cohorts hit those marks.

Five New Tracks Start Next April

ACCESS is the Advancing Chronic Care with Effective, Scalable Solutions Model, run by the CMS Innovation Center. It pays enrolled care groups a set yearly amount to manage qualifying chronic conditions with video visits, coaching, remote monitoring, and FDA-authorized devices, and it holds back the full check until enough patients meet a target.

The first design covered more than two-thirds of people with Medicare through four tracks: early cardio-kidney-metabolic care (high blood pressure, abnormal lipids, obesity or overweight with central obesity, and prediabetes); cardio-kidney-metabolic care (diabetes, stage 3a or 3b chronic kidney disease, and atherosclerotic heart disease); chronic musculoskeletal pain; and depression or anxiety.

On September 15 CMS said it would grow that list. New tracks for heart failure, chronic obstructive pulmonary disease, substance use disorder, and tobacco cessation, plus a follow-on period for chronic musculoskeletal pain, start on April 1, 2027. Current participants do not have to reapply.

TRACKS STARTING APRIL 1, 2027

• Heart failure: Continuous monitoring aimed at function, symptoms, and quality of life.
• COPD: Support meant to hold or improve lung function and ease day-to-day limits.
• Substance use disorder: Care for opioid, alcohol, and other substance use, including depression and anxiety that travel with those diagnoses, tied to the White House Great American Recovery initiative.
• Tobacco cessation: Help for people trying to quit tobacco and nicotine.
• Pain follow-on: Ongoing support for chronic musculoskeletal pain after the first 12-month period, which until now had no follow-on rate.

Participation stays voluntary. CMS says joining does not cut Medicare benefits, coverage, or the right to see any Medicare clinician. Care can be in person, on video, or asynchronous. Groups must share electronic updates with the patient’s regular doctor, who may bill a separate co-management fee with no patient cost-sharing.

CMS Is Scaling a Test That Just Started

ACCESS is still a Center for Medicare and Medicaid Innovation test under Section 1115A of the Social Security Act. It runs through June 30, 2036. CMS can add tracks inside that test. Turning ACCESS into a standing Medicare benefit would still require an evaluation that quality rose without raising costs, or that costs fell without harming quality, plus certification by the CMS Office of the Actuary.

The agency’s own technical FAQ, still posted as the public rulebook, says a small share of people who try to enroll in a given track may be randomly assigned to a control group so CMS can measure the model’s effect. Those people keep ordinary Medicare. That design is how a test is supposed to work. It is an odd backdrop for a coverage map that now reaches three out of four people with Medicare.

THE ACCESS CALENDAR

1. December 2025: CMS announces ACCESS as a nationwide, voluntary 10-year model for Original Medicare.
2. January 12, 2026: Applications open; the first-cohort deadline is later extended to May 15, 2026.
3. July 5, 2026: The first performance period begins.
4. September 15, 2026: CMS adds five tracks, says 160 groups are in, and points patients to a live directory.
5. April 1, 2027: Heart failure, COPD, substance use, tobacco cessation, and pain follow-on tracks start.
6. January 1, 2028: Health plans that signed the ACCESS payer pledge are supposed to offer aligned payment deals.
7. June 30, 2036: The model performance period ends.

CMS Administrator Dr. Mehmet Oz, a former cardiac surgeon, framed the expansion as a way to catch problems between office visits and to pay for results rather than activity.

We built ACCESS because too many people with chronic conditions were falling through the cracks between appointments. 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.

Dr. Mehmet Oz, CMS Administrator, September 15, 2026 press statement

Health and Human Services leaders repeated that pitch at a Washington event the same day. The CMS Innovation Center posted the new-track notice as patients were being told to search the new directory.

ACCESS is here with new tracks announced — paving a way for people with Original Medicare to get personalized support from the comfort of home for additional health conditions like heart failure and tobacco cessation. Search ACCESS organizations: https://t.co/BpTkOzlzhj pic.twitter.com/JwMjQqg9zW

— CMS Innovation Center (@CMSinnovates) September 15, 2026

What Medicare Pays for Each ACCESS Track?

Outcome-aligned payments are yearly allowed amounts for managing a person in a track. CMS publishes annual allowed amounts for each track that include the 80% Medicare share and the 20% coinsurance. Groups may waive that coinsurance. If they collect it, they have to disclose the expected bill before a person enrolls.

The first-year rate is higher because onboarding and early improvement take more work. A follow-on year, when one exists, pays half as much. Musculoskeletal pain had no follow-on rate in the original table; that is the gap the 2027 pain track is meant to fill. CMS has not posted dollar figures for heart failure, COPD, substance use, or tobacco cessation.

ACCESS PAYMENT ALLOWED AMOUNTS

The top first-year figure is $420 for cardio-kidney-metabolic care. Rural patients in the eCKM or CKM initial period get an extra $15, which CMS describes as help with the cost of shipping and supporting a connected blood pressure cuff. If the same group manages more than one track for the same person, CMS applies a 5% discount to the lower-priced track for overlapping months.

Monthly billing uses set allowed amounts of $30 for eCKM, $35 for CKM, and $15 each for pain and behavioral health, which multiply to the yearly figures. Full payment still hinges on the share of a group’s patients who meet track targets, against a floor that rises in later years. For blood pressure, CMS’s example is a 15 mmHg drop in systolic pressure, or control below 130 mmHg. Diabetes care looks at A1c. Pain and mood use validated patient questionnaires, including PHQ-9 and GAD-7.

Those sums are modest next to a hospital stay for heart failure or a year of specialty visits. They are also the entire federal price tag for a year of app-and-device management unless a group bills ordinary Medicare for something else. The bet is that a few hundred dollars of continuous support can prevent much larger bills. Two months into the first performance period, CMS has not published risk-adjusted results that would show whether that bet is paying off.

Most of the 160 Groups Never Billed Medicare

CMS said the number of organizations participating at launch is now 160, and that Medicare will keep adding names across the 10 years. The participant roster updated on September 15 lists brands that will be familiar to anyone who follows consumer health gadgets and apps, including Headspace, Withings, WHOOP Physician Services, Welldoc, Lark Medical Group, Cadence Health, SonderMind, Kardia Medical Group, and DocGo, mixed in with kidney clinics, telehealth groups, and primary-care companies such as Aledade and Devoted Medical.

CMS also said most of those organizations have not previously served people with Medicare. That is the point of the model, in the agency’s telling: Original Medicare had no clean way to pay for continuous, tech-supported chronic care, so the groups that built that care never enrolled. It is also the operational risk. Groups new to Part B still have to enroll, name a physician clinical director, meet HIPAA and FDA rules (or sit under FDA enforcement discretion), report through CMS APIs, and survive program-integrity review.

ACCESS AT THE SEPTEMBER 15 UPDATE

• Participating groups: CMS puts the count at 160, with rolling entry through 2033.
• Live directory: HHS said nearly 40 organizations were available for patients to find that day.
• Early enrollment: HHS said thousands of people with Medicare had already signed up.
• Reach after expansion: Three out of four people with Medicare will qualify for at least one track.

Pure software vendors and device makers cannot join on their own. CMS bars durable medical equipment suppliers and labs from being the billed participant. A company that only sells a cuff or an app has to partner with, or become, a Part B provider that will own the outcomes.

A Directory That Lists About 40 Names

CMS told patients and referring clinicians to use a public directory of ACCESS organizations on Medicare.gov, searchable by condition and location. At the September 15 event, HHS said that directory was live with nearly 40 organizations “available today,” with more to be added, while 160 groups were participating.

Those are different lists. One is the Innovation Center’s accepted-participant roster. The other is the consumer catalog. The gap matters because ACCESS is built on choice: people may sign up on their own or after a referral, and they may join more than one track, even with different groups. A catalog that shows about a quarter of the accepted names is a thin menu for a model that now claims three out of four people with Medicare as potential users.

CMS says it will publish risk-adjusted outcomes in that directory so patients and doctors can compare groups. No such scores exist yet, because the first performance period is weeks old. Until those numbers appear, the directory is a phone book, not a report card.

Medicare Advantage Stays Outside the Model

ACCESS is for people with Original Medicare Parts A and B when Medicare is the primary payer. Medicare Advantage enrollees cannot join the federal model, CMS said, though their plans may build look-alike programs. That split is easy to miss in the headline that three out of four people with Medicare will qualify, because the qualifier is Original Medicare, not every Medicare card.

The same week CMS locked Advantage members out of the federal test, it again touted a payer pledge first announced in February 2026. Major plans representing 165 million people in Medicare Advantage, Medicaid, and commercial coverage have promised to adopt an outcomes-based payment structure aligned with ACCESS, with CMS implementation help. The pledge date is January 1, 2028. Signers named by CMS include UnitedHealthcare, Humana, Cigna, CVS Health, Centene, Devoted Health, and a string of Blue Cross Blue Shield plans, with later additions including Baylor Scott & White Health Plan, TriWest Healthcare Alliance, and Blue Cross Blue Shield of Rhode Island. Eighteen clinical and patient societies have also backed the effort, CMS said.

PAYERS NAMED ON THE ACCESS PLEDGE

• National carriers: UnitedHealthcare, Humana, Cigna, CVS Health, and Centene.
• Blues plans: Arkansas, California, Minnesota, North Dakota, Tennessee, CareFirst, Horizon of New Jersey, and Rhode Island, among others listed by CMS.
• Deadline: Aligned payment deals are supposed to be on offer by January 1, 2028, two years and nine months after ACCESS launched.

A pledge is not a benefit. Advantage members still cannot enroll in the federal ACCESS tracks, and commercial patients only get a similar deal if their plan actually writes one. Health and Human Services Secretary Robert F. Kennedy Jr. used the September 15 event to argue that the old Medicare habit of paying for volume had left doctors without tools or incentives to keep people well.

Historically, we’ve paid doctors to care for people when they are sick without giving them any of the tools and incentives to keep people healthy. We have rewarded the volume of services delivered rather than improvements in health.

Robert F. Kennedy Jr., Health and Human Services Secretary, September 15, 2026 HHS event

Paying groups a few hundred dollars a year to watch blood pressure or mood is a narrow answer to that complaint. It does not, on its own, change a clinic visit that still runs on a short slot and a prescription pad. The model’s own safeguards assume the ACCESS group will ping the regular doctor, and that the doctor will read the ping. If that loop fails, a patient can end up with two care plans and one shared A1c.

Blank Price Tags on the 2027 Tracks

Heart failure and COPD are the additions most likely to pull in connected scales, oxygen saturation probes, and hospital-at-home style monitoring. Substance use and tobacco cessation pull ACCESS into recovery care, where outcomes are harder to reduce to a single lab number. CMS has described the aims in plain language (function, symptoms, quit support) and has not yet published allowed amounts, outcome formulas, or which of the 160 groups will actually staff those tracks.

WHAT WE KNOW

• Start date: The new tracks begin April 1, 2027, and current ACCESS groups do not need to file a fresh application.
• Who can use them: People with Original Medicare who meet each track’s still-to-be-posted clinical rules; Advantage members remain outside the federal model.
• Pain change: Chronic musculoskeletal pain already had a first-year track at $180 with no follow-on; CMS is adding a follow-on period for specified pain care.

WHAT IS UNCONFIRMED

• New-track prices: CMS has not posted initial or follow-on allowed amounts for heart failure, COPD, substance use, or tobacco cessation.
• Outcome formulas: The agency has not published the exact measures that will release full payment in those tracks.
• Who will offer them: The September 15 participant list is organized by the original four tracks, not the 2027 additions.

Eighteen months of a 10-year clock will already have run when the new tracks open. By then ACCESS will either have a public outcomes directory worth reading, or it will be a large eligibility map with a small live catalog and no posted proof that blood pressure, A1c, or pain scores moved. CMS has chosen not to wait for that proof before drawing the map out to three out of four people with Medicare.

Disclaimer: This article is news reporting and analysis of a federal Medicare payment model. It is for information only and is not medical advice, insurance advice, or a determination of anyone’s benefits. It does not tell readers whether to enroll in ACCESS, switch clinicians, or change treatment for heart failure, diabetes, pain, depression, addiction, or any other condition. People with Medicare should confirm eligibility, costs, and participating groups with CMS, 1-800-MEDICARE, or a qualified clinician or SHIP counselor before acting. Payment amounts, track rules, directory listings, and enrollment status come from CMS and HHS materials dated through September 15, 2026, and can change as the model is updated.