The RPM Access Act aims to improve healthcare access and outcomes in rural areas by setting a minimum reimbursement rate for remote patient monitoring under Medicare and ensuring high-quality monitoring standards.
David Kustoff
Representative
TN-8
The RPM Access Act aims to improve healthcare access and outcomes, especially in rural areas, by adjusting Medicare reimbursement for remote patient monitoring (RPM). It sets a minimum threshold for practice expense and malpractice geographic indices used in calculating Medicare payments for RPM services, ensuring more equitable compensation across different regions. The bill also introduces quality standards for RPM services to be eligible for Medicare reimbursement, including real-time response capabilities and data compatibility with electronic health records. Finally, the Act requires a report to Congress analyzing the cost savings and practice expenses associated with RPM under Medicare.
New RPM Access Act Sets Medicare Payment Floor for Rural Remote Monitoring: Changes Kick In January 2026
The "Rural Patient Monitoring Access Act," or "RPM Access Act," is designed to make it easier for Medicare patients, especially those in rural areas, to access healthcare from home using remote patient monitoring (RPM) technologies. Starting January 1, 2026, the bill changes how Medicare pays for these services by establishing a minimum payment rate (a "floor" of 1.00 for specific geographic cost calculations) for providers in areas where reimbursement is currently lower. This boost in payment, outlined in Section 3, isn't planned to be offset by cuts elsewhere in the Medicare budget, aiming to encourage more doctors and clinics to offer RPM.
Closing the Gap: Fairer Pay for Remote Care
Currently, how much Medicare pays for remote patient monitoring can vary quite a bit depending on where a clinic is located, even though the actual costs to provide the service might not change much. The RPM Access Act, in its findings (Section 2), notes that rural areas, often facing doctor shortages and requiring residents to travel farther for care, see some of the lowest RPM reimbursements despite RPM's potential to improve outcomes and lower costs. To tackle this, Section 3 of the bill steps in: from January 1, 2026, if the calculated geographic adjustment for practice expenses and malpractice costs for RPM services in an area is below a standard benchmark (an index of 1.00), Medicare will bump it up to 1.00. Think of it like a minimum wage for RPM reimbursement in these specific areas. This could mean a small clinic in a rural town that previously couldn't afford to offer RPM might now be able to provide services like at-home heart rate or blood sugar monitoring to its Medicare patients, helping them manage chronic conditions without long drives to the doctor. And importantly, the bill states this pay raise will not be budget neutral, meaning the funds aren't being shifted from other Medicare services.
Smarter Monitoring, Better Care: New Rules for Quality and Data
It's not just about paying more; the RPM Access Act also sets new standards for how these remote services are delivered to ensure Medicare patients get high-quality care. According to Section 4, starting January 1, 2026, for Medicare to cover RPM, a few key things need to be in place. First, a qualified healthcare professional – like a physician, nurse practitioner, clinical nurse specialist, or physician assistant – must be available in real time to respond if the monitoring system detects a significant physiologic anomaly, like a sudden dangerous change in vital signs. Imagine a patient's home monitoring device flags a serious heart rhythm irregularity; this rule means someone qualified needs to be on deck to act on that information promptly. Second, the RPM system itself must be able to transmit physiologic data in a format compatible with electronic health records (EHRs), making it easier for all involved healthcare providers to see a complete picture of a patient's health. Finally, providers will generally need to collect and report data as required by the Secretary of Health and Human Services to evaluate cost savings from RPM. There's a provision for an exemption if this reporting causes "unreasonable hardship," which will be something to watch to ensure enough data is gathered to see how effective the program is.
The Five-Year Check-Up: Tracking RPM's Real-World Impact
To figure out if these changes are truly making a difference, Section 4 of the RPM Access Act requires a detailed report card. Within five years of the bill's enactment, the Secretary of Health and Human Services has to send a report to Congress looking back at the data from January 1, 2026, onwards. This report will dig into whether remote patient monitoring is actually saving Medicare money by, for example, catching health problems earlier to avoid costly hospitalizations or by helping patients stick to their medication plans. It will also examine the real-world practice expenses tied to RPM, like the costs for cellular connectivity to transmit data or for maintaining the technology platforms. This long-term look will be crucial for understanding the true value and operational costs of expanding RPM services under Medicare.