Medicare proposal threatens rural tech access

Dianne Williams straps a cuff to her arm, presses a button, and sends her blood pressure data to a care team in a private company. She does this every day in her rural Georgia home. For Williams, this routine has lowered her blood pressure and changed her diet. But a proposed federal rule could end that access for millions of Medicare beneficiaries.

The Centers for Medicare & Medicaid Services proposed a rule that would stop reimbursements for providers who use health technology companies to administer remote monitoring. Under the new guidelines, Medicare would only pay clinicians when the service is delivered by staff at the facility where they work. This shift would effectively halt the use of third-party vendors that currently manage these programs for many patients.

The move responds to 2024 and 2025 reports from the Department of Health and Human Services Office of Inspector General. Those audits raised concerns about fraud, poor data collection, and a lack of direct clinician involvement. CMS spokesperson Timothy Foster said the agency recognizes the role technology plays in access to care but requires more safeguards. The proposed rule states that outside vendors may have little to no established relationship with patients, potentially fragmenting care.

Caroline Pearson, executive director of the Peterson Center on Healthcare, warned that the rule would virtually eliminate or dramatically reduce remote monitoring services. She noted that rural communities would be hardest hit because many local facilities lack the capacity to run their own programs. Most of these facilities contract with third-party vendors to handle the data and patient check-ins.

Edward Vance, chief medical officer at Albany Area Primary Health Care, said his system could not offer remote monitoring without an outside vendor. Vance noted that many community health centers operate with shoestring budgets and are already understaffed. The Alliance for Connected Care, a group advocating for health tech adoption, said the proposal took them by surprise. Andrew Van Ostrand, the group’s senior vice president, stated that many vendors had already implemented changes based on the OIG recommendations.

The proposed rule applies only to traditional Medicare, not to Medicare Advantage plans. However, experts predict that private insurers and Medicaid programs may adopt similar changes. Van Ostrand argued that the new rules conflict with the Trump administration’s Rural Health Transformation Program. That initiative allocates $50 billion over five years to improve rural healthcare through technology.

According to a report by the Alliance for Connected Care, states have earmarked at least $240 million from their first-year rural health funding for remote monitoring. More than 230 health tech vendors, healthcare systems, and advocacy groups signed a letter opposing the rule change as of Sept. 14. A few organizations, including Humana and Blue Cross Blue Shield Association, largely support the proposed rule.

The Peterson Center on Healthcare reported that enrollment in remote physiologic monitoring for traditional Medicare patients grew tenfold from 2019 to 2023. Spending on these programs rose from just under $7 million to more than $194 million during that period. The average duration of enrollment also increased from 1.7 months to 5.2 months.

Pearson argued that Medicare should limit how long patients are prescribed monitoring unless treatment is still needed. She said the agency should require clinicians to report more data, including patient outcomes. The CMS has begun a new ACCESS program in July that pays both clinicians and vendors, but Pearson said it reimburses less than traditional models. Williams said the government should keep remote monitoring accessible. She described the current approach as cutting off everybody.