The Centers for Medicare & Medicaid Services recently introduced two Alternative Payment Models that present an opportunity to showcase the benefits of physical therapist services for both patients and other clinicians.
The ACCESS Model
The Advancing Chronic Care with Effective, Scalable Solutions, or ACCESSS, model pays providers for measurable outcomes through technology-enabled care for patients in traditional Medicare with qualifying conditions. There are four tracks that ACCESS will focus on, representing many of the most common chronic health conditions, including: 1) early cardio-kidney-metabolic conditions, 2) cardio-kidney-metabolic conditions, 3) musculoskeletal conditions, and 4) behavioral health conditions. Care may be provided in person or through various technology-based approaches, including virtual and asynchronous methods.
Physical therapists are well-positioned to assist with all of the tracks, especially musculoskeletal conditions. Participation in ACCESS requires a physician clinical director to be responsible for clinical and compliance oversight. APTA is encouraging CMS to allow PTs to serve in the lead clinical director role given PTs’ ability to serve as primary care providers for musculoskeletal conditions and that patients in all 50 states and Washington, D.C., have some level of direct access to PT services without referral.
At the invitation of CMS, APTA attended the Department of Health and Human Services event announcing the model’s launch along with senior HHS policymakers and association and technology-enabled organization leaders.
The MAHA ELEVATE Model
The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence, or MAHA ELEVATE, model provides approximately $100 million to fund cooperative agreements for up to 30 proposals that promote health and disease prevention for traditional Medicare beneficiaries. The areas of focus include nutrition, physical activity, sleep, stress management, harmful substance avoidance, and social connection.
Proposals should include services not already covered by traditional Medicare but should demonstrate scientific evidence of the safety of the intervention. Each proposal is also required to include a physical activity or nutrition component. CMS will release a Notice of Funding Opportunity in early 2026 for the model’s first cohort to begin on Sept. 1, 2026. The second cohort will begin a year later.
In the 2026 Medicare Physician Fee Schedule proposed rule, CMS requested feedback on the prevention and management of chronic disease. APTA provided a robust response describing the many ways that physical therapist services assist with both preventing and managing chronic disease, including preventing falls, improving cardiovascular health, and treating diabetes and neurological diseases.
APTA continues to advocate to leverage the documented ability of physical therapy to help drive the core goals of value-based care in alternative payment models. Members interested in or engaged with these models are encouraged to join the APTA Alternative Payment Models Community.