A bipartisan group of 32 House lawmakers is pressing CMS Administrator Mehmet Oz to roll back proposed Medicare payment changes that would bar remote patient monitoring programs from using third-party clinical staff.
The lawmakers argue the proposal could significantly reduce access to remote monitoring for Medicare beneficiaries, particularly rural patients and those served by small, independent physician practices and hospitals.
Representatives David Kustoff, R-Tenn., and Troy Balderson, R-Ohio, drafted the bipartisan letter, signed by 30 other members of Congress, calling out a CMS proposal that would block third-party vendors from remote patient monitoring.
In July, the Centers for Medicare and Medicaid Services (CMS) proposed changes to remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) reimbursement that stakeholders say would make many programs difficult to sustain. The policy change, tucked inside a hefty Medicare physician pay draft rule, marks a shift with far-reaching implications for RPM companies, primary care physicians, hospitals and health systems by eliminating third-party vendors.
Under the draft rule, Medicare will only allow payment for RPM and RTM services when furnished by clinical staff employed by the practice, effective January 1, 2027.
If finalized, for the purposes of billing Medicare, the RPM and RTM codes could not be billed in cases where the service is not performed by clinical staff of the billing practitioner and will not allow contracting out to third-party companies, regulators wrote in the draft rule.
CMS said the change was necessary to address concerns about program integrity and vendors offering low-quality care. Payments for remote patient monitoring jumped 31% from $408 million in 2023 to $536 million in 2024, according to a 2025 report. In 2024, nearly 1 million enrollees received these services, up 27% from 2023.
The proposed rule received more than 43,000 public comments.
According to HHS, nearly 1 million Medicare enrollees utilized remote monitoring services to manage their conditions in 2024. In rural communities, beneficiaries often face long travel distances, transportation barriers, clinician shortages, and limited access to timely follow-up care. Remote monitoring allows clinicians to monitor health metrics in real time between visits, identify worsening conditions earlier and intervene before a patient requires an emergency department visit or hospitalization, the lawmakers wrote in the letter.
Many rural, small, and independent practices, as well as both urban and rural health systems, rely on partners for remote monitoring. Nearly 70% of rural health clinics who reported offering RPM relied on specialized clinical and technology partners to make remote monitoring services available to their patients, according to a National Association of Rural Health Clinics survey.
The bipartisan House letter also highlights a policy disconnect between the CMS proposal and congressional efforts to expand access to care in rural areas. States are investing heavily in RPM-enabled care through the $50 billion Rural Health Transformation Program (RHTP). According to an Alliance for Connected Care analysis, 22 states have announced roughly $240 million in RPM-specific funding and 35 states have identified more than $2.4 billion in broader technology investments that could support remote monitoring.
"We are concerned that a blanket prohibition on partnering clinical staff could inadvertently disrupt the care delivery models that CMS and the states are working to build, and both small and rural practices and hospitals often lack the internal workforce to manage these programs entirely in-house," the lawmakers wrote. "Restricting clinically integrated partnerships, which help to fill this gap through a remote monitoring and care team, would leave rural providers with fewer tools to serve their patients and could push care back toward more costly emergency departments and institutional settings."
"We applaud this bipartisan group of 32 congressional leaders for standing up to protect crucial remote monitoring services that seniors across America – particularly those in rural communities – rely on for high-quality, coordinated care in the home. Our members look forward to working with Congress and CMS to ensure these services remain accessible while strengthening quality, accountability, and meaningful cost savings for the Medicare program," Chris Adamec, executive director of the Alliance for Connected Care, said in a statement.
The letter from House lawmakers echoes similar concerns raised by Senator Mark Warner (D-VA) and Marsha Blackburn (R-TN). In a letter (PDF) sent to Dr. Oz in September, they urged CMS to reconsider the proposed RPM restrictions, warning that requiring RPM clinical staff to be directly employed by a billing practice could make it harder for rural and smaller providers to offer these services.
"Many hospitals and rural, small, and independent practices rely on specialized clinical and technology partners to make remote monitoring available. However, these vendors are not mere middlemen; they are specialized to partner with health care practitioners to help provide these services to medically complicated patients," Warner and Blackburn wrote.
These arrangements help practices manage patient onboarding, device support, data review, alert management, documentation and clinical escalation under the oversight of the treating practitioner.
"Because both hospitals as well as small and rural practices often lack the internal workforce to manage these programs entirely in-house, we urge CMS to develop a regulatory framework that protects against waste while preserving flexible staffing models," the senators wrote.
Warner and Blackburn also called for CMS to develop targeted program integrity guardrails that reach bad actors while preserving access for beneficiaries who need remote monitoring services.