Expanding occupational therapy’s role in CMS’s ACCESS and MAHA ELEVATE models
The Centers for Medicare & Medicaid Services (CMS) recently introduced two new models of care that provide exciting opportunities for occupational therapy practitioners (OTPs) to demonstrate our unique value in functional well-being, behavior change, and chronic disease management. These initiatives, run through the Centers for Medicare and Medicaid Innovation (CMMI), reflect a potential shift toward whole person, prevention centered care. The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model and the MAHA (Make America Healthy Again) ELEVATE (Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) model both aim to improve health outcomes for individuals with chronic conditions while building new evidence to guide future Medicare reimbursement.
MAHA ELEVATE Model: Whole-Person, Prevention-Focused Care
CMS’s MAHA ELEVATE model is a first step in promoting whole-person care focused on lifestyle medicine interventions that are not currently covered by Medicare. CMS will invest approximately $100 million over a 3-year period to support up to 30 cooperative agreements. The model emphasizes lifestyle-based approaches such as healthy eating, regular physical activity, restorative sleep, stress management, and social connection.
The overall goal of MAHA ELEVATE is to create an evidence base that shows the cost and quality impacts of non-pharmacologic, non-procedural interventions. This emphasis aligns closely with occupational therapy, as the model reinforces principles that are at the core of occupational therapy practice, such as helping individuals to adopt sustainable health behaviors and establish daily routines that support wellness. MAHA ELEVATE provides OTPs the opportunity to demonstrate their expertise in habit formation, environmental modification, and self-management to address lifestyle and impact health and social engagement.
MAHA ELEVATE is an exciting opportunity to show the effectiveness of occupational therapy in chronic disease management, and to develop evidence for these interventions that could lead to reimbursement under Medicare. Eligible applicants for the program include private practices, health systems, academic organizations, community-based groups, senior living communities, and state or local governments, with demonstrated experience regarding data collection. At press time the first Notice of Funding Opportunity was expected to be released in early 2026, but a second one will be released later in the year for funding in early 2027. Visit the CMS website to find the most current information on this opportunity (https://bit.ly/4rdQnhJ).
Technology-Enabled Chronic Care: Opportunities in the ACCESS Model
The Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) model is a new, voluntary, Medicare Part B payment initiative designed to use digital- and technology-enabled care to better support individuals with chronic conditions. The model seeks to bridge the gap between traditional fee-for-service systems and modern approaches by leveraging remote tools. These include telehealth platforms that connect patients to clinicians from home; wearable devices that track movement, sleep, heart rate, and blood sugar; and mobile apps that guide lifestyle changes.
ACCESS focuses on a wide range of chronic conditions such as hypertension, high cholesterol, obesity, diabetes, chronic kidney disease, heart disease, chronic musculoskeletal pain, and depression and anxiety. The model’s integrated approach requires participating organizations to deliver care in person, virtually, asynchronously, or through other technology-supported methods. They will receive Outcome-Aligned Payments (OAPs) tied to measurable improvements or validated patient-reported outcomes on pain. By integrating OTPs' expertise in functional, behavioral, and environmental factors that influence how individuals manage chronic conditions, ACCESS organizations can improve patient engagement, better support adherence to treatment plans, and help achieve CMS’s performance thresholds for the program.
Participating organizations, which could include occupational therapy private practices with the infrastructure necessary to meet participation requirements, must be accepted into the model by CMS, be enrolled in Medicare Part B, and have a designated Medical Director overseeing care coordination. Beneficiaries can enroll in an ACESS program directly, or through referral from their primary care providers. For more information about participating in the ACESS Model, visit the AOTA website (https://bit.ly/46uFb7U).
A Strategic Moment for Occupational Therapy
Together, the MAHA ELEVATE and ACCESS models demonstrate a shift in thinking about health that we hope will be a powerful moment for occupational therapy. Both initiatives recognize that chronic disease management and prevention depend on behavior change and functional support—areas where occupational therapy excels. While participation is not the central message of these new models, they offer clear avenues for OTPs and organizations to play a larger role in shaping patient outcomes and contribute to emerging Medicare
reimbursement policies.
Kim Karr, OTR/L, is AOTA’s Coding and Payment Policy Manager.
Heather Parsons, MSOT, is AOTA’s Vice President of Federal Affairs.