A new CMS rule ends payment for the way most remote monitoring is delivered. We support the goal, end the fraud, waste, and abuse. There's a way to do it without ending the care. And it saves more money.
Two minutes, start to finish. Your comment is already written, you personalize two lines and it goes on the federal record CMS is legally required to read.
Here is the day this rule takes effect, from both sides of the stethoscope.
Her blood-pressure cuff transmits at 7:04 AM. A licensed nurse reviews it by 7:15, like every morning for two years. Her doctor adjusts her meds when the numbers drift.
The rule takes effect. Her cuff still transmits. Nobody is paid to watch. Her two-doctor clinic can't hire a 24/7 monitoring team of its own.
A letter arrives: "Your remote monitoring program is ending." She puts the cuff in a drawer.
The silent pressure spike that used to trigger a same-day nurse call is now discovered at her next appointment, or in the emergency room.
A specialized monitoring partner watches the clinic's 60 patients around the clock, under the doctors' supervision and billing. Emergencies get caught early.
Partnership claims stop being payable. One nurse covers ~300 patients and can't work around the clock, the math never works for 60 patients. Even Providence and Mount Sinai outsource this.
The program is discontinued. Staff draft 60 letters to the clinic's highest-risk patients.
Those patients are back to quarterly-visits-only care. What monitoring used to catch daily now waits months, and readmissions climb.
Now multiply by more than a million patients and tens of thousands of practices. That's January 1, unless CMS fixes the rule instead of ending the program. It can. Here's how →
Illustrative composite scenarios reflecting the documented delivery model (HHS OIG 2024–25; BLS; public health-system partnerships). Full sourcing below and at /solution.
Congress, the administration's health agenda, rural America, even the skeptics' own actuaries, all point the same way: keep the care, fix the oversight.
On July 14, 2026, the Rural Patient Monitoring Access Act (H.R. 3108) passed House Ways & Means 39 to 0, every Republican, every Democrat: rural America needs more remote monitoring, not less.
The very same day, CMS proposed CMS-1848-P, disconnecting the very patients Congress just voted to protect.
Congress must not let an unelected agency undo, by regulation, what it just voted for, 39 to 0, the same day.
The administration's banner health priority, Make America Healthy Again, is ending the chronic disease epidemic through early detection and prevention.
Remote monitoring is that agenda, operating at scale, today: licensed nurses catching a blood-pressure spike on a Tuesday morning instead of an ER admission on a Friday night.
This rule doesn't fight chronic disease. It blinds the country to it. Everyone who believes in the MAHA movement should be first in line to demand CMS fix it.
UnitedHealthcare moved to restrict remote monitoring for its own members to just two conditions, calling the rest, including diabetes and hypertension, "unproven and not medically necessary." Fierce pushback forced a delay in December 2025.
In May 2026, Optum, UnitedHealth Group's own actuarial arm, ran the independent study: propensity-matched, twelve months of claims, monitoring reimbursement excluded. Monitored patients cost thousands less per year, in the exact conditions its insurance arm had called unproven.
For 43 million rural Americans, the monitoring nurse isn't a convenience. In counties with no physician at all, it is the only daily clinical contact that exists.
Employment-only is a model just the giants can satisfy, and even Providence, LifePoint, and Mount Sinai contract specialized partners instead of building it themselves. Round-the-clock coverage takes roughly one nurse per 300 patients, more than a two-doctor clinic will ever have. Every hometown practice loses the service overnight.
Ask who survives this rule: the biggest corporations in healthcare on one side, every hometown practice on the other. Rural America already absorbed the hospital closures. Not this too.
In plain English, tap any provision for the detail.
The partnerships that deliver most monitoring lose payment January 1.
DetailsFrom January 1, 2027, Medicare pays only when monitoring is performed by the practice's own employed staff. The physician still orders, supervises, and owns the care, but the trained nurses reviewing readings around the clock would no longer be payable. Most practices cannot replace them: one nurse covers ~300 patients, and 24/7 coverage can't be staffed by one hire. Even Providence, LifePoint, and Mount Sinai contract specialized partners.
A new required visit, and silence on the million already enrolled.
DetailsA new face-to-face initiating visit would be required before monitoring may continue, and the proposal is silent on patients already enrolled. No exemption, no grandfathering, no transition. Stable patients would be forced through an appointment bottleneck just to keep the care they already have.
A monitored month falls ≈$104 → $91 → $40 — the deep cut lands in 2028.
DetailsThe same rule re-values the monitoring codes downward — in two engineered steps. Federal law caps year-one cuts at 19%, so a typical monitored month falls only ≈$104 → $91 in 2027. Then CMS's own "Fully Implemented" tables complete the phase-in: device supply drops from $41.38 to $9.85, and the month lands between ≈$40 and $58 in 2028 — before the floated collapse of all 17 codes into flat G-codes at ≈$35/month, paid the same whether a patient needs 20 minutes of clinical attention or 80. Nobody can staff 24/7 monitoring at those rates. The cuts end the benefit by arithmetic — on a one-year delay the headlines will miss.
All three come straight from the OIG's own 2024 recommendations. All three run on machinery CMS already operates. All three are doable before the final rule.
A physician-ordered start for every new patient, cold-call fraud becomes structurally impossible, while grandfathering the million-plus already enrolled.
CMS credentialing for remote care organizations, like DMEPOS, IDTFs, and CLIA labs. Bad actors exit; visibility becomes total. No registration, no payment.
Outcomes reported with every claim, reviewed annually, waste can't hide, and CMS tightens patient eligibility with evidence, like it did for CCM.
It also saves more money than the rule itself, roughly double over five years (est.), with spend declining instead of compounding.
Re: CMS-1848-P, Medicare and Medicaid Programs; CY 2027 Payment Policies Under the Physician Fee Schedule
Dear Administrator:
I am a practicing clinician, and I support eliminating fraud, waste, and abuse in remote care. I write to urge CMS to achieve that through oversight, the path the OIG recommended in September 2024, rather than through three provisions that would end the care itself: (1) the employed-staff-only restriction, (2) the initiating visit requirement with no protection for patients already enrolled, and (3) the re-valuation and flat G-code consolidation of the monitoring codes, on which CMS has specifically solicited comment.
[One or two sentences in your own words: your specialty, practice size and location, how many patients you monitor, and one way monitoring has helped your patients. No patient names.]
Like countless practices across the country, mine partners with a specialized clinical monitoring organization because no practice of our size can staff licensed nurses 24/7/365 to review readings, triage alerts, and intervene before an emergency. This is the long-recognized "incident to" clinical staffing model, furnished under my orders, my supervision, and my clinical responsibility. One full-time nurse (median RN salary about $94,000) can manage roughly 300 monitored patients, more than a typical practice has enrolled, and around-the-clock alert coverage cannot be staffed by one person regardless. The proposed employment restriction would not bring this staffing in-house; it would end the service.
The impact falls hardest on rural and underserved communities: 92% of rural counties are primary-care shortage areas and 199 rural counties have no primary-care physician at all.
The initiating visit requirement compounds the harm. My enrolled patients have established relationships, active care plans, and months of monitoring history, yet the proposal does not state whether they are exempt. Requiring each to complete a new face-to-face visit before monitoring may continue would interrupt care for patients who are stable precisely because they are monitored. At minimum, CMS must explicitly exempt patients enrolled before the effective date in any final rule.
The payment provisions would independently end the benefit, on a schedule designed to look survivable in year one. Because section 1848(c)(7) of the Act caps first-year reductions at 19%, crosswalking the device-supply codes to self-measured blood-pressure inputs reduces a typical monitored month (device supply plus 20 minutes of clinical management) only from approximately $104 to $91 in 2027; CMS's own Fully Implemented practice-expense values then complete the phase-in in 2028, taking device supply from $41.38 to $9.85 and the same month to between approximately $40 and $58, depending on how the proposed practice-expense stabilization cap applies. The floated flat G-code consolidation, on which CMS has solicited comment, would go further still, bundling a month of monitoring into approximately $35 regardless of acuity. No delivery model, employed or partnered, can furnish 24/7 clinical monitoring at those rates. The consolidation should not be adopted: a flat payment regardless of clinical time eliminates the add-on increments that fund care for the highest-acuity patients. And the rule's own tables cannot say within 45% what the same monitored month pays in 2028, which is itself the case for holding valuations while the invoice and cost data CMS has requested is actually collected, rather than deleting clinical labor from labor codes.
CMS specifically seeks comment "on how often third-party billing currently occurs and how this policy, if finalized, could impact access to remote monitoring services." My answer from direct experience: clinical partnership is how monitoring is delivered in my practice and my community, and finalizing this restriction would end my patients' access on January 1, 2027.
Remote monitoring delivers measurable results. An independent actuarial analysis by Optum of one third-party-supported program found directional per-member per-year medical cost savings of $2,467 to $3,012 across hypertension, diabetes, and CKD cohorts versus matched controls, with monitoring reimbursement excluded from the savings calculation. Peer-reviewed literature points the same direction: fewer hospitalizations and better blood-pressure control.
The OIG’s 2024 recommendations point the way: safeguards, ordering-provider information on claims, visibility into monitored data, provider education, and “identify and monitor companies that bill for remote patient monitoring.” I urge CMS to adopt that path: register and credential remote care organizations, require the initiating visit prospectively while exempting already-enrolled patients, tie payment to reported outcomes, and set valuations on real cost data, instead of the employment restriction and flat-rate consolidation. Fix the rule; don’t end the care.
✏️ Please personalize the yellow field above, then copy your comment.
You should see this exact title, "Medicare and Medicaid Programs: Calendar Year 2027 Payment Policies…" That's the right page.
Click in the box under "Comment*" and paste (Ctrl+V / ⌘V).
Choose "Physician - HC005", or the option matching your role (Nurse Practitioner - HC015, Physician Assistant - HC010, Nurse - HC065, Rural Health Clinic - HPA65).
Type your email and check the box to get a confirmation with your tracking number.
You're commenting as yourself. Click the first tile, then enter your first and last name.
That's it, your comment is now part of the federal record CMS must respond to.
Re: CMS-1848-P, Please protect my remote patient monitoring
I am a Medicare patient and I use remote patient monitoring. Every day, my health readings go to a nurse who watches over me. When a reading is dangerous, they call me the same day, before it becomes an emergency room visit.
[In your own words, one or two sentences: what does your monitoring watch (blood pressure, blood sugar, weight, oxygen), and what has it caught for you or how does it make you feel safer?]
I understand CMS has proposed rules that would end the monitoring programs most patients like me use, and could require me to schedule a new doctor's visit just to keep the monitoring I already have. I also understand Medicare is considering paying so much less for this monitoring, a small fraction of today, that no one could afford to keep watching over patients like me. Please don't do this. My doctor's office cannot watch my readings around the clock by themselves. The nurses who monitor me work with my doctor; my doctor gets my results and adjusts my care because of them.
If this rule is finalized as written, patients like me lose the daily safety net that keeps us out of the hospital. I want Medicare to stop fraud and waste. Please do it by setting rules for the monitoring companies and checking their results, the way Medicare already oversees equipment suppliers and labs. Fix the problems. Please don’t end the program that keeps us safe.
✏️ Please personalize the yellow field above, then copy your comment.
You should see this exact title, "Medicare and Medicaid Programs: Calendar Year 2027 Payment Policies…" That's the right page.
Click in the box under "Comment*" and paste (Ctrl+V / ⌘V).
Choose "Individual - I0001".
Type your email and check the box to get a confirmation with your tracking number.
You're commenting as yourself. Click the first tile, then enter your first and last name.
That's it, your comment is now part of the federal record CMS must respond to.
