CMS Proposal Could Narrow Medicare Access to Home Monitoring Tools
For Dianne Williams, a blood pressure cuff is more than a device. It is part of a care routine that connects her rural Georgia home to her clinic, her nurse, and a steady stream of feedback about what is working and what is not.
Her experience captures why remote patient monitoring has become so attractive for patients with chronic illness and for clinicians trying to manage those patients outside the exam room. Williams measures her blood pressure at home, and the reading is transmitted to her care team. A nurse calls monthly, checks in on her progress, and reinforces medication adherence, diet changes, and exercise. In practical terms, the program turns scattered data into a usable clinical conversation.
A proposed federal rule could sharply limit that model for many people enrolled in traditional Medicare.
Why the Payment Change Would Hit Rural Care Hardest
The Centers for Medicare & Medicaid Services is proposing to stop reimbursing providers who rely on health technology companies to run remote monitoring programs. Under the rule, Medicare would pay clinicians only when the service is delivered by someone at the facility where they work. That matters because many rural clinics and health centers do not have the staffing or infrastructure to manage these programs entirely on their own.
Caroline Pearson, executive director of the Peterson Center on Healthcare, said the proposal could virtually eliminate or dramatically reduce use of remote monitoring for many Medicare patients. Her concern is especially acute in rural communities, where travel barriers make in-person follow-up harder and where staffing shortages already limit what small practices can offer. Edward Vance, chief medical officer of Albany Area Primary Health Care, said his system could not provide remote monitoring without an outside vendor. He described a setting already operating with borderline staffing and shoestring budgets.
In that environment, a remote cuff, scale, glucose monitor, or fitness band can function as a clinical extension of the practice. Data arrive between office visits. Nurses and other staff can respond when readings drift in the wrong direction. When vital signs suggest danger, patients can be told to seek emergency care. For a patient with hypertension, diabetes, or heart disease, that kind of daily visibility can prevent deterioration before it becomes an emergency department visit or hospitalization.
The biology is straightforward. Blood pressure, glucose, and weight trends are not just numbers on a screen; they are early indicators of whether a treatment plan is controlling physiologic risk. If clinicians can adjust medication, reinforce adherence, or intervene when values worsen, the program can alter the trajectory of disease rather than merely record it.
Fraud Concerns Drove the Rule, but the Response Is Broader Than CMS Wants
CMS says the proposal responds to reports from the Department of Health and Human Services’ Office of Inspector General. Those reports raised concerns about fraud, inadequate data collection, and patients not actually receiving care from the clinician who prescribed the device. The agency also argues that outside vendors may have little established relationship with patients or clinicians, which it says can fragment care.
CMS spokesperson Timothy Foster said the agency recognizes the value of technology-enabled care, including in rural settings, but believes stronger safeguards are needed.
The problem is not that critics reject oversight. Pearson, vendors, and other health policy experts agree that remote monitoring needs tighter rules. The dispute centers on how far CMS is going and whether the agency is throwing out a clinically useful model to address misuse.
Andrew Van Ostrand, senior vice president at the Alliance for Connected Care, said the proposal arrived as a surprise. He argued that many vendors had already made changes in response to the inspector general’s recommendations and expected CMS to adopt those recommendations more directly. Instead, the proposed rule would effectively bar a large share of Medicare remote monitoring arrangements that rely on third-party support.
One sentence captures the tension: a payment rule designed to restrain abuse could also dismantle legitimate care pathways.
Traditional Medicare Is the Immediate Target, but the Spillover Could Be Wider
The proposal applies only to traditional Medicare, not to Medicare Advantage plans, which cover more than half of Medicare participants. Even so, the policy could travel well beyond that population. Pearson and Van Ostrand said Medicaid programs, private insurers, and Medicare Advantage plans could follow the same direction if CMS sets the standard for reimbursement.
That possibility matters because the remote monitoring market has grown quickly. Traditional Medicare use remains limited overall, at about 1% of beneficiaries for the more common physiologic monitoring programs, but enrollment has climbed rapidly. Between 2019 and 2023, enrollment in such programs increased tenfold, while spending rose from just under $7 million to more than $194 million, according to a Peterson Center on Healthcare report. Average duration of use also increased, from 1.7 months to 5.2 months.
Those numbers help explain why policymakers are uneasy. A service intended to support short-term stabilization can drift into longer-term billing without clear evidence that the patient still needs it. Pearson said Medicare should limit the length of time a patient can stay in monitoring unless there is proof the service remains clinically necessary. She also wants more reporting on outcomes and a reimbursement structure tied to patient health rather than volume.
Rural Health Dollars and Remote Monitoring Are Moving in Opposite Directions
The proposed CMS rule also sits uneasily beside the administration’s broader rural health agenda. Van Ostrand pointed to the five-year, $50 billion Rural Health Transformation Program, which encourages states to adopt technology solutions to improve care in rural areas. States have already earmarked at least $240 million from their first-year rural health funding for remote monitoring, according to an Alliance for Connected Care report.
More than 230 health tech vendors, healthcare systems, and patient and medical advocacy groups had signed an opposition letter by Sept. 14. The list reflects a wide belief that remote monitoring is one of the few scalable tools available to small and understaffed systems trying to manage chronic disease outside the hospital.
At the same time, not everyone in healthcare wants the current payment model preserved. Humana, Blue Cross Blue Shield Association, and Sutter Health supported the proposed rule in their comments. Sutter Health operates its own remote monitoring program, a reminder that large systems with internal infrastructure may be less dependent on vendors than smaller rural clinics.
Williams’ own experience shows why patients worry about losing access. She said she was frustrated when medication alone did not lower her blood pressure. A nurse encouraged her to exercise and improve her diet, and the coaching helped her walk regularly and shift from fried to baked fish. The monthly calls were not an accessory to care; they were part of the treatment itself.
The central question is not whether remote monitoring can be abused. It can. The harder question is whether Medicare will keep paying for a model that has already become integral to chronic disease management in places where the nearest clinic may be a long drive away. CMS has not answered that in a way rural patients, and many clinicians, are likely to accept.