CMS expands ACCESS to heart failure, COPD, substance use disorder, nicotine dependence, and extended musculoskeletal care in spring 2027

What happened

CMS’s September 15 announcement expands ACCESS in spring 2027 to heart failure, COPD, substance use disorders and nicotine dependence, with extended support for specified chronic musculoskeletal conditions beyond the initial 12-month care period. The voluntary Original Medicare model ties payment to measurable health outcomes rather than only individual services. Participants may offer virtual care, coaching, remote monitoring and connected devices between regular visits, coordinated with the broader care team. The new tracks are announced future options at this September coverage cutoff, rather than evidence that all such services are already available through the expansion.

CMS says participation does not negatively alter a beneficiary’s benefits, coverage or provider choice, and primary care clinicians can refer eligible people to participating organizations. Medicare Advantage enrollees are not eligible for ACCESS itself, though plans may offer similar programs; the announcement separately describes payer pledges to align outcome-based payment. CMS reported 160 participating organizations at launch and a directory of organizations and conditions. Service-line readiness therefore depends on the actual participant, track and beneficiary eligibility, together with clinical coordination and outcome measurement, not simply the presence of a chronic diagnosis or a wearable device.

Why it matters

Potential referrals and participation require coordinated clinical, device and outcomes-data workflows, with Original Medicare eligibility distinguished from similar payer programs.

Implementation playbook

1. Internal target: Assign service-line owners for the five added ACCESS tracks. Clinical Operations · Due 2026-10-04
2. Internal target: Assess referral, consent, remote-monitoring, device, and outcomes-data readiness. IT · Due 2026-10-18
3. Internal target: Prepare a participation or referral recommendation when CMS posts track specifications. Managed Care · Due 2026-11-01

Sources

• CMS Adds Medicare Options to Help People Manage Substance Use Disorder, Heart Failure, and Other Common Chronic ConditionsOfficial · Centers for Medicare and Medicaid Services · 2026-09-15 · Source review 2026-09-20