ACCESS update: CMS boosts coverage for heart failure technologies
In an effort to combat the increasing costs of care associated with heart failure, the Centers of Medicare and Medicaid Services (CMS) is expanding coverage for technology that monitors patients at home through the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model.
Starting in the spring of 2027, CMS will expand the existing ACCESS initiative to offer technology to better monitor Medicare beneficiaries and keep them out of hospitals and attempt to lower healthcare expenditures by managing conditions at home. In addition to heart failure, ACCESS is also focused on improving care for chronic obstructive pulmonary disease (COPD), substance use disorders and nicotine dependence.
For heart failure, the program will use continuous monitoring to try and attain measurable improvements in function, symptom management and quality of life. Heart failure management and readmissions are both associated with a significant amount of Medicare spending. This is among several efforts to try and reduce those costs.
The ACCESS model is designed to modernize CMS and create a digital health ecosystem that allows Medicare beneficiaries greater access to innovative health technologies. ACCESS uses a new payment approach that emphasizes achieving specified health outcomes and value-based medicine over paying for individual services.
The ACCESS model began July 5, 2026, offering new care options for people with chronic conditions affecting more than two-thirds of people with Medicare. These include high blood pressure, diabetes, chronic musculoskeletal pain and depression. Three out of four people with Medicare qualify for at least one ACCESS track. The program is scheduled to run for 10 years.
ACCESS was created because people with Original Medicare historically lacked a payment option to adequately support novel technology-supported care. Instead, it focused on fee-for-service payments for a defined set of activities. ACCESS removes these Medicare payment barriers for patients who qualify.
CMS said ACCESS will test a new outcome-aligned payment (OAP) option for Medicare-enrolled care organizations. It emphasizes outcomes over volume of care episodes, enabling clinicians to offer innovative technology-supported care that improves patient health.
Participating organizations will receive recurring payments for managing patients’ conditions, and full payment amounts will be tied to achieving measurable health outcomes. The model focuses on clinical improvement or control of a condition determined by each patient's baseline and measurements at specified periods of time that should show improvements.
“We built ACCESS because too many people with chronic conditions were falling through the cracks between appointments,” CMS Administrator Mehmet Oz, MD, a former cardiac surgeon, said in a statement. “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.”
Current cardio-kidney metabolic coverage
As of July 5 in cardiology, ACCESS began coverage for qualifying conditions of cardio-kidney metabolic (CKM) disorders. Under early CKM (eCKM) this includes hypertension, or two or more of the following: dyslipidemia, overweight with central obesity and prediabetes. Outcome measures include lowering blood pressure, LDL-C, HbA1c and weight. Patients either receive the benefit free from CMS or with a $6 monthly payment.
CKM patients include those with diabetes mellitus, chronic kidney disease (stage 3a/3b), and atherosclerotic cardiovascular disease (ASCVD). Outcome measures monitored include blood pressure, LDL-C, HbA1c, weight, uACR, and eGFR. Patients either get the services for free or with a $7 per month fee.
For physicians, the CMS annual payment allowed for eCKM is $360 during the initial period and $180 for a follow-on period. For CKM, it is $420 during the initial period and $210 for follow-on period. For beneficiaries residing in rural areas, CMS will provide an additional fixed payment of $15 to offset higher operational costs related to connected device distribution and support.
However, CMS said in its ACCESS guidance that these allowed amounts do not reflect potential downward payment adjustments resulting from the clinical outcome adjustment or substitute spend adjustment applied to the Medicare paid amount.
Find more detailed information on the payment model.
CMS ACCESS heart failure monitoring coverage begins in 2027
Starting April 1, 2027, CMS will expand ACCESS coverage for heart failure remote monitoring technologies. According to the CMS ACCESS website, these include telehealth software to help patients interact with their healthcare providers from anywhere and wearable devices to continuously monitor sleep, heart rate, movement, blood sugar and other functions. Also covered are apps that coach people to make lifestyle changes that can benefit both their behavioral and physical health.
CMS said these services will be especially valuable for people in communities with limited local care options, like those residing in rural areas.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]