CMS 2026–2027 Updates: ACCESS Model, MAHA ELEVATE & Rural Health | Ash

CMS 2026–2027 Regulatory Outlook: Accelerating the Shift to Outcomes-Based Care

The first quarter of 2026 has brought a wave of definitive updates from the Centers for Medicare & Medicaid Services (CMS). From the $50 billion injection into rural healthcare to the long-awaited launch of the outcome-aligned ACCESS model, the mandate is clear: reimbursement is no longer about the volume of services, but the validity of results.

For clinical leaders and payer executives, these updates aren't just administrative changes—they are the new blueprints for strategic growth. Below, we break down the three major shifts and how Ash helps you navigate them.

1. The ACCESS Model: Paying for Results, Not Phone Calls

Starting July 5, 2026, the ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model will begin a 10-year test of Outcome-Aligned Payments (OAPs). Unlike traditional fee-for-service, OAPs reward clinicians only when patients meet specific clinical targets—such as a 10 mmHg reduction in blood pressure or a stabilized HbA1c.

The Ash Advantage: The ACCESS model focuses on four tracks: Early Cardiovascular-kidney-metabolic (CKM) (hypertension/obesity), CKM (diabetes/CKD), Musculoskeletal, and Behavioral Health. To earn full payment, organizations need a technology-first infrastructure. Ash provides the engine for this by:

• Decentralizing Diagnostics: Our at-home lab test kits, blood test at home options, and other home health solutions remove the lab visit friction that often tanks member compliance.
• Real-Time Data Streams: We provide the home health tests and remote monitoring tools necessary to capture the baseline and improvement data required for OAP reconciliation.

2. MAHA ELEVATE: Lifestyle Medicine as a Reimbursable Asset

The MAHA ELEVATE Model is a $100 million initiative launching October 2026. It is designed to evaluate whole-person interventions—nutrition, sleep, and stress management—that were previously excluded from Original Medicare coverage.

The Ash Advantage: CMS is looking for evidence that lifestyle changes actually move the needle on metabolic risks like high BMI and fasting plasma glucose. Ash supports your application and implementation by:

• Biomarker Validation: Before and after your lifestyle program begins, Ash can deploy at home lab test panels to prove clinical efficacy.
• White-Label Integration: Our platform integrates into your digital health app or other platform, allowing you to track things like food as medicine outcomes and lifestyle interventions through high-fidelity clinical data.

3. Rural Health Transformation: The Race to Implement

The application phase for the $50 billion Rural Health Transformation (RHT) Program is over, and as of early 2026, states are now in the critical monitoring and implementation phase. States are receiving first-year awards averaging $200 million to modernize facilities and expand remote patient monitoring.

The Ash Advantage: The challenge now is proving that these funds are closing care gaps. States are prioritizing healthcare deserts where 121 million Americans lack facility access. Ash bridges this gap by:

• Closing Gaps in Care Deserts: Our home health testing infrastructure allows rural residents to complete kidney health evaluations, colorectal cancer screenings (FIT), hba1c testing, cholesterol panels, cervical cancer screenings, STI testing, and more without traveling hours to a clinic. 
• Scalable Compliance: We help plans meet HEDIS and Star Ratings benchmarks in rural populations, ensuring the data is linkable to meet the stricter 2027 risk adjustment requirements.

Moving Forward

The 2027 Advance Notice already signals a crackdown on unlinked data and audio-only diagnoses. The future belongs to those who can capture high-quality, clinical-grade data from the member’s home.

If you’d like to learn more about Ash, our powerful gap closure solutions, or how we can help your organization collect valuable member data - we’d love to chat.

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References

1. _{https://www.cms.gov/}
2. _{https://www.ncqa.org/hedis/}
3. _{https://www.cms.gov/newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states}
4. _{https://www.cms.gov/priorities/innovation/innovation-models/access}
5. _{https://www.cms.gov/priorities/innovation/access-technical-frequently-asked-questions}
6. _{https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate}
7. _{https://www.nccih.nih.gov/health/whole-person-health-what-it-is-and-why-its-important}
8. _{https://www.medicare.gov/providers-services/original-medicare}
9. _{https://www.cms.gov/priorities/rural-health-transformation-rht-program/overview}
10. _{https://pmc.ncbi.nlm.nih.gov/articles/PMC10567127/}
11. _{https://www.cms.gov/files/document/2026-star-ratings-fact-sheet.pdf}
12. _{https://www.cms.gov/newsroom/fact-sheets/2027-medicare-advantage-part-d-advance-notice}

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