The Centers for Medicare & Medicaid Services announced it will expand the ACCESS Model beginning in spring 2027 on Sept. 15, offering new care management options for Original Medicare beneficiaries with substance use disorder and heart failure.
The expansion adds two of Medicare’s most prevalent and costly conditions to a model designed to provide ongoing, coordinated care outside the traditional fee-for-service episodic payment structure, CMS said.
Heart failure affects approximately 6.7 million American adults and is one of the leading causes of hospitalization among Medicare beneficiaries. Substance use disorder has surged as a driver of Medicare costs and mortality, particularly amid the nation’s ongoing opioid crisis.
Under the expanded ACCESS Model, Medicare beneficiaries with these conditions will have access to care coordination services that connect primary care, specialty treatment, behavioral health and social services, according to CMS. The approach aims to reduce emergency visits, hospitalizations and gaps in treatment.
Traditional fee-for-service Medicare pays providers for individual visits and procedures but does not reimburse for many care coordination activities that are central to managing chronic conditions. The ACCESS Model creates a payment framework for those services.
The structural shift is significant. Millions of Original Medicare beneficiaries with substance use disorder or heart failure currently navigate fragmented care systems, often cycling through emergency departments and hospitals without consistent follow-up or coordination between providers.
CMS said the model will be implemented through participating providers who meet the agency’s quality and operational standards. Beneficiary enrollment will be voluntary.
The expansion builds on earlier phases of the ACCESS Model, which CMS has been testing as part of its broader effort to move Medicare toward value-based care delivery. Congressional oversight committees will monitor the model’s performance and cost outcomes.