The CMS Innovation Center has debuted a new model to encourage the use of technology to treat chronic diseases, which could be a boon for health tech companies that have struggled with reimbursement.
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model is a 10-year payment program that would offer stable, recurring payments for technology used to treat diabetes, hypertension, chronic kidney disease, obesity, depression and anxiety.
Certain software-based health technologies, such as prescription digital therapeutics, have not traditionally been covered by Medicare due to limitations in the Medicare statute. Under the ACCESS Model, novel technologies cleared by the Food and Drug Administration could prove themselves based on the outcomes they produce.
The model is another step by President Donald Trump's health department to put health technology in the hands of Medicare beneficiaries. It took its first step in this direction over the summer, when it announced the Health Tech Ecosystem Initiative.
Health technology companies are set to meet again in D.C. on Thursday to discuss the ACCESS Model, sources close to the issue told Fierce Healthcare.
The Center for Medicare and Medicaid Innovation (CMMI) plans to use outcomes-aligned payments to cover the cost of technology for Medicare providers if a patient with a qualifying chronic condition achieves clinically significant results, like lowering their blood pressure.
“Rather than paying for a specific set of services, the model rewards results—giving care teams flexibility to use technology, clinical tools, and care approaches that best support each patient’s needs,” a frequently asked questions page on the Centers for Medicare & Medicaid Services' (CMS') website says.
The CMS will also waive the co-payment for the services, a recurring ask of the agency from remote monitoring providers.
Referring providers could also boost their payments by co-managing the patients they referred to the ACCESS program. The referring provider could gain up to $100 a year per patient on the model.
After a patient achieves control of their condition, the CMS says it will pay a lower rate for services on most tracks. The tracks include early Cardio-Kidney-Metabolic (Hypertension, dyslipidemia, obesity, and prediabetes); Cardio-Kidney-Metabolic (diabetes, chronic kidney disease, atherosclerotic cardiovascular disease); Musculoskeletal (chronic musculoskeletal pain); and Behavioral Health (depression and anxiety).
The CMS will maintain a public directory listing ACCESS Model providers and help organizations identify optional tools like “data exchange and interoperability solutions, identity verification systems, optional connected clinical devices like blood pressure cuffs, and tools that support HIPAA compliance.”
The ACCESS Tools Directory will include the application portal, CMS resources and outcomes from ACCESS providers. Technology providers can offer special discounts to ACCESS providers, the CMS said.
“Medicare beneficiaries increasingly expect the same innovation and flexibility in their care that they experience in other parts of their lives,” Access for Health said in a statement. “Today, CMS is signaling that Medicare must evolve to meet those expectations. By testing an outcome-aligned, technology-enabled care model, CMS is helping ensure that prevention, chronic disease management, and patient engagement can happen wherever patients are.”
Provider organizations must be enrolled in Medicare Part B to participate in the model. The CMMI is accepting applications on a rolling basis from 2026 to 2033.