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The Centers for Medicare and Medicaid Services (CMS) expanded the Medicare ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model to include substance use disorder (SUD) and tobacco cessation.
- Why it’s important: The model aims to expand access to quality care through payments dependent on outcomes and adoption of digital technologies.
The details:
- The ACCESS model, first announced last year, pays approved companies to manage certain chronic conditions, including diabetes, high blood pressure, chronic musculoskeletal pain, depression, and anxiety.
- It introduces outcome-aligned payments, in which providers are paid more if their patients’ conditions improve.
- The model aims to boost the adoption of digital technology, which officials hope can help lower health care costs. Payment amounts for ACCESS providers were set low in an effort to encourage innovation that reduces reliance on clinicians.
- Last week, regulators announced that they would expand the chronic conditions eligible for the model to include conditions including SUD and nicotine dependence. The new conditions track will start in spring 2027.
- 160 organizations are participating in the ACCESS model, and CMS published a directory last week of participating organizations and covered conditions.
- But: Some of the most prominent health tech companies targeting chronic disease chose not to enroll in the program, saying the model’s payment amounts do not support their clinician-heavy models. The model’s maximum yearly payments range from $180 per patient for behavioral health conditions to $420 for cardiovascular, kidney, or metabolic conditions.
Read more: Medicare to expand its pilot that pays for technology to manage chronic diseases
Published
September 2026