CMS Launches Models for Chronic Care Administration and Lifestyle Interventions

The Centers for Medicare & Medicaid Services just lately launched two Alternative Payment Models that current a possibility to showcase the advantages of bodily therapist providers for each sufferers and different clinicians.  

The ACCESS Model

The Advancing Chronic Care with Effective, Scalable Solutions, or ACCESSS, mannequin pays suppliers for measurable outcomes by technology-enabled look after sufferers in conventional Medicare with qualifying situations. There are 4 tracks that ACCESS will give attention to, representing lots of the most typical power well being situations, together with: 1) early cardio-kidney-metabolic situations, 2) cardio-kidney-metabolic situations, 3) musculoskeletal situations, and 4) behavioral well being situations. Care could also be offered in particular person or by numerous technology-based approaches, together with digital and asynchronous strategies. 

Physical therapists are well-positioned to help with all of the tracks, particularly musculoskeletal situations. Participation in ACCESS requires a doctor medical director to be chargeable for medical and compliance oversight. APTA is encouraging CMS to permit PTs to serve within the lead medical director position given PTs’ capability to function main care suppliers for musculoskeletal situations and that sufferers in all 50 states and Washington, D.C., have some degree of direct entry to PT providers with out referral.  

At the invitation of CMS, APTA attended the Department of Health and Human Services occasion asserting the mannequin’s launch together with senior HHS policymakers and affiliation and technology-enabled group leaders. 

The MAHA ELEVATE Model

The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence, or MAHA ELEVATE, mannequin offers roughly $100 million to fund cooperative agreements for as much as 30 proposals that promote well being and illness prevention for conventional Medicare beneficiaries. The areas of focus embrace vitamin, bodily exercise, sleep, stress administration, dangerous substance avoidance, and social connection.  

Proposals ought to embrace providers not already coated by conventional Medicare however ought to show scientific proof of the security of the intervention. Each proposal can be required to incorporate a bodily exercise or vitamin part. CMS will launch a Notice of Funding Opportunity in early 2026 for the mannequin’s first cohort to start on Sept. 1, 2026. The second cohort will start a yr later. 

In the 2026 Medicare Physician Fee Schedule proposed rule, CMS requested suggestions on the prevention and administration of power illness. APTA offered a sturdy response describing the numerous ways in which bodily therapist providers help with each stopping and managing power illness, together with stopping falls, enhancing cardiovascular well being, and treating diabetes and neurological illnesses.  

APTA continues to advocate to leverage the documented capability of bodily remedy to assist drive the core objectives of value-based care in different fee fashions. Members concerned about or engaged with these fashions are inspired to affix the APTA Alternative Payment Models Community.