The U.S. Centers for Medicare & Medicaid Services (CMS) has added new options in its Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model. The provisions are designed to strengthen symptom management among patients with chronic conditions.
The agency unveiled the 10-year voluntary payment model at the end of last year, which began on July 1, 2026. The ACCESS model was introduced to expand access to new technology-enabled care options for patients with conditions such as chronic kidney disease, depression, diabetes, high blood pressure and musculoskeletal pain.
CMS recently expanded the ACCESS model with Medicare reimbursement options that will take effect in spring 2027. The new options are for patients with chronic obstructive pulmonary disease (COPD), heart failure, nicotine dependence and substance abuse disorders. The updates are designed to improve chronically ill patients’ overall health and help them remain in the home, according to CMS Administrator Dr. Mehmet Oz.
“We built ACCESS because too many people with chronic conditions were falling through the cracks between appointments,” Oz said in a recent statement. “This latest expansion of the program will help more Americans get the care they need and reward providers who deliver actual results.”
The Center for Medicare and Medicaid Innovation (CMMI), a component of CMS, developed the ACCESS model. The model is designed to provide an avenue of Medicare reimbursement for care organizations that develop technology-supported services. These payment options have lacked adequate funding in the fee-for-service realm, according to CMS.
The model’s recently expanded options cover continuous monitoring of heart failure conditions, as well as targeted support for patients with COPD. The payment demonstration will focus on measuring the impacts on improved symptom management and quality of life.
Prior to the newly added payment options, patients receiving hospice or palliative care were “explicitly excluded” from being included in the ACCESS model, according to Brynn Bowman, CEO of the Center to Advance Palliative Care (CAPC), and Allison Silvers, the center’s chief healthcare transformation officer.
To date, CMS has not updated its Request for Assistance (RFA) documentation to accommodate new patient populations under the expanded ACCESS model options, Bowman and Silvers stated.
The ACCESS model’s expanded coverage is meant to integrate appropriate technology solutions into chronic care management, they said. However, clinicians need meaningful avenues of support to provide quality advanced disease management, according to Bowman and Silvers.
“Reimbursement changes that would support more intensive management for advanced disease and unstable patients are still up in the air,” they told Hospice News in an email. “While integration of technology into this complex, intensive patient population can be useful, technology is at most a supplemental resource in the setting of palliative care, which requires meaningful clinician access and truly human interactions that clarify circumstances, options, and goals.”
The payment demonstration may have minimal impacts for palliative care programs, according to Bowman and Silvers. Participants in the ACCESS model receive monthly payments to coordinate care delivery for patients receiving technology-enabled services.
About 160 organizations are currently participating in ACCESS model, CMS reported. The demonstration is available to Original Medicare and Medicare Advantage beneficiaries.
The ACCESS model could help fill gaps of care when patients are discharged from facility-based settings into the home, according to CAPC. Palliative care provider participants need to closely monitor beneficiaries’ enrollment in the model. Patients with intensifying needs should be disenrolled and provided more in-person care, Silvers and Bowman indicated.
Chronically ill patients can benefit from expanded clinical approaches that balance technology-enabled and human-centered support, they said. Reimbursement that incentivizes this blended approach should carefully consider eligible patient populations and examine impacts on quality and cost outcomes, according to Silvers and Bowman.
“On whether patients receiving palliative care should be allowed in the [ACCESS] model, we would be fully supportive, but only for a sub-set of patients,” Silvers and Bowman told Hospice News. “Almost all programs are much more intensive, with regular visits with palliative care team members. The practice of electronic symptom monitoring has been shown to improve patient quality of life and reduce avoidable spending in patients with cancer … While it hasn’t yet been fully tested in heart failure or COPD, it is worthwhile to include remote symptom monitoring in such a model designed to test patient outcomes.”
