2027 Medicare outlook · Heart failure care
Heart failure care is changing in 2027.
New Medicare models are placing greater emphasis on upstream disease management, measurable outcomes and coordination outside the hospital. Here is what health-system leaders and cardiology teams should know about ASM, ACCESS and emerging remote-monitoring policy.
Reviewed October 24, 2026 · Based on published CMS guidance and proposals
Key dates for 2027
January 1, 2027
ASM begins its first performance year; LEAD ACO starts.
April 1, 2027
ACCESS adds a heart-failure-specific clinical track.
2027 — proposed
Medicare RPM/RTM billing and staffing changes remain subject to final rulemaking.
Four developments to watch
The policy changes take different approaches. Two create or expand care-delivery models, one affects ACO accountability, and one concerns proposed rules for fee-for-service remote monitoring. Understanding the distinction matters when planning a heart failure program.
Mandatory for selected cardiologists · Jan 2027
Ambulatory Specialty Model
Performance-based accountability for heart failure quality, episode costs, care coordination, and interoperability.
How ASM works →Voluntary participating organizations · Apr 2027
ACCESS heart failure track
An outcome-aligned payment approach for technology-supported chronic care, with a new track dedicated to heart failure.
How ACCESS works →Proposed policy · 2027
RPM and RTM payment changes
Proposals involving initiating visits, staffing rules and reimbursement valuation could affect remote-monitoring programs.
What CMS proposed →Voluntary ACO model · Jan 2027
LEAD ACO Model
A longer-term accountable-care model emphasizing coordinated management of high-needs Medicare populations.
Where LEAD fits →01 · Specialty accountability
The Ambulatory Specialty Model (ASM)
Beginning January 1, 2027, CMS will require selected cardiologists treating people with heart failure in Original Medicare to participate in the Ambulatory Specialty Model. ASM is not a nationwide mandate for every cardiologist: selection depends on Medicare heart failure episode volume, specialty type and designated geographic areas. CMS has released the final participant list for the first performance year.
Participants will be evaluated on four areas: clinical quality, episode-based costs, improvement activities and interoperability. CMS seeks better upstream chronic-disease management, stronger collaboration with primary care and fewer avoidable hospitalizations. The model runs for five performance years (2027–2031), and a 2027 performance score can influence Medicare Part B payment adjustments beginning in 2029.
Why this matters for heart failure monitoring
Programs accountable for outcomes and avoidable utilization have an incentive to recognize deterioration between visits, coordinate follow-up and document care decisions. Longitudinal fluid-status trends may be useful inputs to those workflows.
Source: CMS — Ambulatory Specialty Model ↗ and CMS — ASM FAQs ↗.
02 · Technology-supported chronic care
ACCESS: a new heart failure track in April 2027
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model began in July 2026. CMS announced that a heart failure track will start on April 1, 2027, alongside additional tracks for other chronic conditions. ACCESS is voluntary and is designed for participating Medicare-enrolled care organizations, not a requirement for all practices.
ACCESS tests recurring Outcome-Aligned Payments (OAPs) for qualifying, clinician-guided care, rather than paying solely for a predetermined set of activities. CMS describes technology-supported interventions including remote monitoring, connected devices, virtual care, medication management and coordination with referring clinicians.
For the upcoming heart failure track, CMS has highlighted patient function, symptoms and quality of life. Program designers should verify the final heart-failure-specific outcome targets, payment amounts and eligibility instructions as CMS releases further materials, rather than treating the measures for existing ACCESS tracks as definitive for HF.
What this could mean for remote monitoring partners
An ACCESS participant may use connected measurements to support management between visits, provided the approach meets the participant's clinical and model obligations. A technology supplier is not automatically an ACCESS participant merely because its device can collect useful data. ACCESS also includes restrictions intended to prevent duplicative fee-for-service billing for aligned beneficiaries during active care periods.
Sources: CMS — ACCESS Model ↗ and CMS — September 2026 HF expansion announcement ↗.
03 · Proposed fee-for-service changes
2027 Medicare remote-monitoring proposals
Separate from CMS Innovation Center models, the proposed CY 2027 Medicare Physician Fee Schedule addresses remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM). As of October 24, 2026, these are proposals, not final reimbursement requirements.
Among other provisions, CMS has proposed that RPM/RTM practitioners furnish a separately reportable initiating visit when services begin; that monitoring services billed under the relevant codes be delivered by clinical staff employed by the billing practice rather than contracted staff; and changes to practice-expense valuations. CMS has also requested comment on alternative coding and payment structures.
Why the final rule matters
Organizations should review their clinical staffing, contracted monitoring arrangements, patient onboarding, billing compliance and program economics against the final rule when published. The proposed restrictions may change before becoming effective. Nothing on this page should be used as a claim that a particular device or workflow is reimbursable.
Source: CMS — CY 2027 Physician Fee Schedule proposed rule ↗.
04 · Accountable care
LEAD: a broader accountable-care pathway
The Long-term Enhanced ACO Design (LEAD) Model is a voluntary accountable-care model scheduled to run from January 1, 2027 through December 31, 2036. It follows ACO REACH and seeks to support coordinated, financially accountable care, including for high-needs patients and people who are homebound or home-limited.
LEAD is not a heart-failure-specific program. Its relevance to HF comes from the broader opportunity to improve continuity of care, manage chronic disease outside the hospital and avoid unnecessary emergency and inpatient utilization. The business case for a particular monitoring service depends on the ACO's population, care design and contractual arrangements.
Source: CMS — LEAD Model ↗.
Frequently asked questions
Is the 2027 Ambulatory Specialty Model mandatory for every cardiologist?
No. ASM is mandatory for physicians selected under CMS criteria, including cardiology specialty, historical attributed heart failure episode volume and selected geographic areas. CMS has published the final 2027 participant list.
Is the ACCESS heart failure track already active?
No. ACCESS began in July 2026 for other chronic conditions; the new heart failure track is scheduled to start April 1, 2027. Organizations should consult CMS for the definitive HF track requirements.
Are the 2027 Medicare remote-monitoring rules finalized?
Not as of this page's October 24, 2026 review date. The RPM/RTM changes described here come from the proposed 2027 Physician Fee Schedule and are subject to final rulemaking.
Does use of a remote-monitoring device automatically qualify an organization for these payments?
No. Model participation, beneficiary eligibility, covered services, operational requirements and applicable billing rules govern payment. A device can be one component of a qualifying care program, but is not itself evidence of program eligibility or reimbursement.
Official sources and further reading
The links below point to CMS, which is the source of record for rules, model participation, dates, eligibility and future updates.
Updated October 24, 2026. This educational overview summarizes publicly available CMS information. It is not legal, clinical, coding or reimbursement advice; policies and proposed rules may change. Consult CMS and your compliance and reimbursement teams before acting.
Connect with Bodyport
Building a heart failure monitoring program for 2027?
Explore how a simple daily Cardiac Scale measurement, longitudinal fluid-status trends and clinical workflow integration may support your heart failure care strategy.
Start a conversation →
