The Centers for Medicare & Medicaid Services is expanding a 10-year Original Medicare experiment in paying for technology-supported chronic-care management, adding tracks for heart failure, chronic obstructive pulmonary disease, substance use disorder, tobacco cessation and continued care for chronic musculoskeletal pain. The new tracks are scheduled to begin April 1, 2027.
The change broadens the conditions addressed by the voluntary ACCESS model, which is designed to test payments linked to patient outcomes rather than reimbursement for each individual clinical service. It could make participating organizations more able to combine office visits with virtual, asynchronous and other clinically appropriate approaches to managing long-term illness. But the expansion is a policy test, not evidence that any particular app, remote-monitoring tool or digital health device improves patients’ health.
Five tracks broaden an existing Medicare model
On its ACCESS model page, CMS describes the initiative as Advancing Chronic Care with Effective, Scalable Solutions. It is aimed at helping people prevent and manage chronic disease through technology-supported care under an outcome-aligned payment structure. The agency says the model began July 5, 2026, and will run for 10 years, with organizations able to enter on rolling start dates.
The model had already included cardio-kidney-metabolic conditions, chronic musculoskeletal pain and behavioral-health conditions. CMS identifies high blood pressure, diabetes, depression and chronic pain among the conditions within its current focus. The additions create separate tracks for heart failure, COPD, substance use disorder and tobacco cessation, as well as a follow-on period for people receiving support for chronic musculoskeletal pain.
The pain follow-on track is distinct from simply adding pain as a new diagnosis. Chronic musculoskeletal pain was already part of ACCESS; the new element concerns longer-term support after the initial period of pain-related care. CMS has not publicly detailed, on the available program page, how eligibility, participating organizations, patient enrollment or technology requirements will work for each new track.
STAT reported that officials estimated roughly three in four people enrolled in Medicare could be eligible for at least one ACCESS track after the expansion. That is an estimate attributed to officials, rather than a participation projection. Eligibility does not mean that every beneficiary will be offered services: actual reach will depend on which organizations join, which patients enroll and how the model is implemented.
Payment experiment is separate from FDA device pilot
ACCESS is sometimes discussed alongside a Food and Drug Administration program called TEMPO, but the two initiatives perform different functions. CMS is testing a Medicare payment and care-delivery model. FDA’s Technology-Enabled Meaningful Patient Outcomes, or TEMPO, pilot concerns the agency’s oversight of certain digital health devices used in collaboration with ACCESS.
In an April 2026 announcement, FDA said TEMPO could allow selected device manufacturers, in specified circumstances, to request enforcement discretion while they collect and report real-world performance data. FDA said it expected to select up to about 10 manufacturers in each of four clinical-use areas.
Enforcement discretion is not the same as FDA clearance, authorization or approval of a product. It describes an agency decision about how it may exercise regulatory enforcement in defined circumstances. The pilot is intended to give FDA and CMS information on how technologies perform in real-world use, not to make a blanket determination that digital devices are safe, effective or appropriate for all people with chronic disease.
What the expansion can, and cannot, show
Outcome-aligned payment models seek to move incentives away from the volume of billable encounters and toward measures of patient health or care performance. In principle, that can give a participating care organization more flexibility to use a mix of clinicians, digital tools and communication methods. Whether that flexibility produces better outcomes, lowers spending or reduces hospital use is a question ACCESS is intended to examine over time.
No clinical findings from the new condition tracks have been reported. The available federal materials do not provide patient enrollment targets, a study sample size, outcome benchmarks or results comparing ACCESS participants with similar Medicare beneficiaries receiving usual care. Those omissions mean it is not yet possible to conclude that participation causes better disease control, fewer symptoms or improved access.
The distinction is particularly important for conditions such as heart failure and COPD, where people can have changing symptoms and frequent need for care, and for substance use disorder and tobacco cessation, where treatment engagement and outcomes can be shaped by social, behavioral and medical factors beyond a technology platform. A payment model may support new ways of delivering care, but it does not establish the effectiveness of any one intervention.
The American Medical Association welcomed the original ACCESS launch in a December 2025 statement, saying the approach could provide clinicians greater flexibility and reinforce care teams. That is a stakeholder assessment of the model’s potential, not an outcome evaluation.
For Medicare beneficiaries, the practical significance will emerge gradually. The next major date is April 1, 2027, when the five added tracks are scheduled to open. CMS’s 10-year evaluation and FDA’s separate real-world data effort may eventually clarify which care arrangements and technologies work well, for whom, and under what conditions.