RPM Access Act
- Sponsor
- Rep. Kustoff, David [R-TN-8]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jul 15, 2026
Bottom line
The bill seeks to expand access to and improve the quality of remote patient monitoring for Medicare beneficiaries, especially in rural and underserved areas, by adjusting reimbursement rates and mandating quality safeguards.
What it actually does
This bill aims to increase Medicare reimbursement for remote patient monitoring (RPM) services, particularly in rural areas, by setting a floor of 1.00 for geographic practice expense and malpractice indices (GPCIs) where they would otherwise be lower. It also establishes quality standards for RPM services to ensure real-time response capability, electronic health record (EHR) compatibility, and data reporting for cost-savings evaluation.
Proponents argue
Proponents argue that the bill will address disparities in healthcare access and quality for rural Medicare beneficiaries by ensuring adequate reimbursement for RPM services, which are crucial for managing chronic conditions and preventing costly hospitalizations. They emphasize that RPM improves patient outcomes, supports coordinated care, and can ultimately lower overall Medicare costs, despite an initial increase in practice expense payments.
Opponents contend
Opponents might raise concerns about the non-budget neutral nature of the GPCI floor, arguing that it could lead to increased Medicare spending without clear accountability for the promised cost savings. They may also question the administrative burden of new data collection and reporting requirements on providers, particularly smaller practices, and whether the mandated quality standards are sufficient or overly prescriptive.
The bill is concise and clearly written, allowing for a quick and thorough understanding of its provisions.
Section 3, amending Section 1848(e)(1) of the Social Security Act.
Establishment of a Floor for Geographic Practice Expense and Malpractice Indices for Remote Patient Monitoring
This provision mandates that for remote patient monitoring services provided to Medicare beneficiaries starting January 1, 2026, the geographic practice expense and malpractice indices (GPCIs) used to adjust reimbursement rates will be set at a minimum of 1.00. If an area's calculated index would naturally be below 1.00, it will be increased to 1.00, effectively boosting reimbursement in those areas. Crucially, this adjustment will not be offset by cuts elsewhere in the Medicare budget.
Supporters argue
Supporters argue this provision is essential to ensure equitable access to RPM, particularly in rural and underserved areas where lower GPCIs currently disincentivize providers. By setting a floor, it recognizes that the costs of delivering RPM (like technology and malpractice) do not significantly vary by geography, thus stabilizing and increasing reimbursement to reflect actual expenses and encourage broader adoption.
Critics contend
Critics might contend that while the goal of equitable access is laudable, making this adjustment non-budget neutral could lead to an unchecked increase in Medicare spending. They may argue that a more comprehensive reform of the GPCI system or targeted subsidies might be more fiscally responsible than a blanket floor that could benefit some areas disproportionately.
Tradeoffs
The provision balances the goal of improving healthcare access in underserved areas with concerns about increasing federal healthcare expenditures. It addresses the perceived inequity of GPCIs for RPM but does so in a way that directly adds to Medicare costs without requiring offsets.
Section 4(a), adding new subsection (aa) to Section 1834 of the Social Security Act.
Conditions for Medicare Payment for Remote Patient Monitoring
This provision establishes three mandatory conditions for Medicare payment for RPM services furnished on or after January 1, 2026. First, a qualified healthcare professional (physician, nurse practitioner, clinical nurse specialist, or physician assistant) must be available in real-time to respond to any detected physiological anomalies. Second, the monitoring system must be capable of transmitting data in a format compatible with electronic health records (EHRs). Third, providers must collect and report data to the Secretary of HHS to evaluate cost savings, though the Secretary can grant exemptions for undue hardship.
Section 4(b)
Mandated Report on Cost Savings and Practice Expenses of Remote Patient Monitoring
This provision requires the Secretary of Health and Human Services to submit a report to Congress within five years of the bill's enactment. The report must analyze the estimated savings to the Medicare program resulting from RPM, specifically from earlier interventions, fewer hospitalizations, and increased medication adherence among beneficiaries. It also requires an analysis of practice expenses related to RPM, including costs for cellular connectivity and technology platform maintenance, for the four-year period beginning January 1, 2026.
The clause "The preceding sentence shall not be applied in a budget neutral manner" specifies that the increase in geographic indices for RPM will not be offset by reductions in other Medicare payments.
Section 3, amending Section 1848(e)(1)(J) of the Social Security Act.
Why it matters:While technically precise, placing this fiscal implication within a technical amendment to the Social Security Act's payment formula might make its broader budgetary impact less immediately apparent to a non-expert. It's standard legislative drafting to place such clauses where they apply.
Case for: Supporters argue this ensures the intended increase in RPM reimbursement is fully realized, providing the necessary financial incentive for providers without forcing cuts to other essential Medicare services. It directly addresses the problem of under-reimbursement in certain areas.
Case against: Critics would argue this is a significant fiscal decision that should be more prominently highlighted. They might contend that avoiding budget neutrality could set a precedent for increasing spending without accountability or lead to an unsustainable growth in Medicare outlays.
Estimated impact: This clause directly contributes to an increase in federal Medicare spending, the exact amount of which would depend on the number of providers and services affected.