The Pushback on CMS's Proposed 2027 Changes to RPM

 ***CMS is expected to release 2027 changes to remote care management by November. Learn how to keep your RPM program compliant with 2027 rules. Register for our complimentary, expert-led webinar, "Understanding Medicare's 2027 Changes to Remote Care Management," on November 19, 2026, at 2:00 PM ET / 11:00 AM PT. Reserve your seat here → *** 

On July 14, CMS released the CY 2027 Physician Fee Schedule proposed rule. For remote patient monitoring (RPM) and remote therapeutic monitoring (RTM), it reverses the direction of last year's rule, which expanded billing options. The 2027 proposal would narrow who can furnish billable services, add enrollment requirements, and cut the value of several codes. We covered the full proposal in our post, "Medicare's 2027 PFS Proposed Rule: What It Means for RPM." The provisions that matter most here:

• Employed clinical staff only. Medicare would pay for RPM and RTM only when clinical staff employed by the billing practice perform the services. Work performed by contracted or outsourced clinical staff would no longer qualify.
• A required initiating visit. Practitioners would need to furnish a separately reportable visit before billing either RPM or RTM.
• Lower code values. CMS would revalue the device supply codes by cross walking them to the self-measured blood pressure codes, citing limited invoice and pricing data on RPM devices. It would also remove clinical staff practice expense inputs from the treatment management codes.

CMS also requested information on replacing the RPM and RTM code sets with bundled, all-or-nothing monthly G-codes.

The pushback has been fast and broad. Since CMS released the proposal, we have tracked comment letters, congressional pushback, and public statements from provider groups, lawmakers, and even insurers, nearly all asking CMS to reconsider its remote monitoring proposals. Prevounce submitted its own comments, and I made the case against the device revaluation and the ban on contracted staff in Medical Economics. This post rounds up that response and what it means for the final rule.

The Proposal Comes at a Time of RPM Expansion

The timing is also out of step with the rest of the federal government and with the states.

Congress Is Moving in the Opposite Direction

The Rural Patient Monitoring Access Act (H.R. 3108) has bipartisan sponsorship. Reps. David Kustoff (R-Tenn.), Don Davis (D-N.C.), Troy Balderson (R-Ohio), and Mark Pocan (D-Wis.) introduced it in April 2025, and it has a Senate companion (S. 1535). The bill would set a five-year floor on the geographic cost indices used to pay for RPM, so Medicare no longer pays rural practices a fraction of what it pays urban practices for the same service. It also adds quality requirements, including that practitioners be available in real time to respond to data anomalies. On July 15, one day after CMS released the proposed rule, the House Ways and Means Committee advanced the bill. Committee Chairman Jason Smith (R-Mo.) noted that rural communities use remote monitoring at a 33% lower rate and framed the bill as a way to close that gap. Congress wants more RPM in rural America at the same moment CMS proposes rules that would make it harder to deliver.

States Are Investing Billions in RPM

The Rural Health Transformation Program (RHTP), created by H.R. 1 in July 2025, directs $50 billion to states over five years, and CMS administers it. The Alliance for Connected Care's September 2026 analysis of Year 1 state plans and procurement activity found:

• 22 states have announced or awarded approximately $240 million in funding opportunities dedicated specifically to RPM infrastructure.
• 35 states have announced funding opportunities totaling more than $2.4 billion that identify RPM as an allowable use of funds alongside other technology and care investments.
• Nearly all 50 states have written some form of remote monitoring into their RHTP plans.

According to the Alliance, most rural providers lack the capacity to build RPM programs in-house and are counting on vendor partnerships. If the employment restriction takes effect, Medicare would stop paying for services delivered through those partnerships. The Alliance warns that the resulting shortfalls could make state RPM investments unsustainable, jeopardize the outcome goals attached to states' RHTP awards, and expose them to clawbacks.

Outpouring of Comments and a Consistent Message

CMS's proposed rule drew more than 44,000 comments before the comment period closed on September 14, more than double last year's total. Opposition to the remote monitoring provisions came from well beyond the RPM industry, including physician and hospital associations, rural clinics, and an office inside the federal government.

The Alliance for Connected Care Coalition Letter

More than 230 organizations, including over 30 major health systems and more than 50 national patient and provider groups, signed a letter to CMS Administrator Dr. Mehmet Oz urging CMS not to finalize the RPM and RTM provisions. The coalition estimates the proposal would disrupt care for more than 1 million beneficiaries and push Medicare back toward emergency visits, hospitalizations, and institutional care. The letter states: "A policy intended to strengthen oversight should not increase costs to taxpayers." The signers ask CMS to delay the policies and work with stakeholders on proportionate, evidence-based guardrails.

The AMA and the RUC

The AMA's 171-page comment letter names remote monitoring among its chief concerns. The RUC, the valuation body CMS normally relies on, moved its re-review of the remote monitoring codes up a year from January 2028 to January 2027, and urged CMS to postpone the payment reductions and G-codes until that data exists. CMS's own valuation source is calling the revaluation premature.

The American Hospital Association

The AHA urged CMS not to finalize the remote monitoring changes and identified a structural flaw in the employment test. At academic medical centers, the billing physician is often employed by a faculty practice plan while the nurses who perform monitoring are hospital employees. Those arrangements would fail the employment test even though no vendor is involved.

The National Association of Rural Health Clinics

NARHC told CMS that many rural health clinics would stop offering RPM if the rule is finalized. Its survey found nearly 70% of RHCs that offer RPM rely on specialized clinical and technology partners to deliver it.

ATA Action

The American Telemedicine Association's advocacy arm submitted comments on August 31 urging CMS not to finalize its RPM proposals and to pursue a targeted, data-driven approach, including further CMS and OIG analysis of claims data. ATA Action had already called the proposal a direct contradiction of bipartisan congressional support for RPM.

The SBA Office of Advocacy

On September 14, the Small Business Administration's Office of Advocacy filed its own comment letter. It carries weight a trade association letter does not: Advocacy is an independent voice for small entities within the federal government, and under the Small Business Jobs Act of 2010, CMS must respond to its comments in the final rule. After nearly 100 Red Tape Hotline inquiries, the office held a September 1 roundtable with about 100 stakeholders and the CMS Ombudsman's office. Its letter reports that small practices lack the volume to justify full-time monitoring staff, that staffing shortages make recruiting impractical, and that CMS has implemented only one of OIG's five 2024 recommendations. Advocacy asked CMS to implement the rest and consider alternatives such as a registration and certification process for RPM organizations.

Bipartisan Pushback From Congress

On October 6, Fierce Healthcare reported that 32 House members sent a bipartisan letter to CMS Administrator Dr. Oz urging the agency to reconsider the RPM and RTM restrictions. Reps. Kustoff and Balderson, lead sponsors of the Rural Patient Monitoring Access Act, drafted the letter.

The lawmakers support CMS's efforts against fraud, waste, and abuse but call the restriction overly broad. Their argument rests on access. Nearly 1 million Medicare enrollees received remote monitoring in 2024, according to HHS data, and the letter cites the NARHC survey finding above. Rural beneficiaries already face long travel distances, clinician shortages, and limited follow-up care. The letter warns the restriction would reduce access to care for Medicare beneficiaries, with the most severe consequences for rural communities and for patients served by small and independent practices and hospitals.

The members also name the disconnect between CMS and the states, writing that "a blanket prohibition on partnering clinical staff could inadvertently disrupt the care delivery models" CMS and the states are building through RHTP. They ask CMS to work with providers, patient advocates, and remote monitoring companies on targeted program integrity safeguards that reach bad actors without cutting off access.

The House letter follows a September 23 letter from Sens. Mark Warner (D-Va.) and Marsha Blackburn (R-Tenn.) making the same request. The senators describe RPM partners as specialized clinical and technology organizations rather than middlemen. They note that these partners handle onboarding, device support, data review, alert management, documentation, and clinical escalation under the treating practitioner's oversight, and they ask CMS for a framework that protects against waste while preserving flexible staffing models.

An Unexpected Twist: Insurers Oppose the Employment Restrictions

The most surprising entries in the comment record came from the insurers. On September 23, STAT reported that UnitedHealth Group, CVS Health, and Kaiser Permanente each wrote to CMS opposing the direct-employment requirement and calling for focused guardrails rather than a ban on vendors. All three operate both health plans and care delivery organizations.

UnitedHealth's position stands out because of its own recent history with RPM. In the fall of 2025, UnitedHealthcare quietly published a coverage policy that would have limited RPM reimbursement to two conditions, chronic heart failure and hypertensive disorders of pregnancy, across its Medicare Advantage, commercial, and Medicaid plans, effective January 1, 2026. The insurer called RPM unproven and not medically necessary for every other indication, including hypertension, diabetes, and COPD.

The response was immediate. Clinicians, medical societies, and health policy researchers challenged the evidence review, and Medicare Advantage legal experts questioned whether an MA plan could exclude a service traditional Medicare covers on a diagnosis basis without individual medical necessity review. On December 17, 2025, two weeks before the effective date, UnitedHealthcare postponed the policy until further notice, citing feedback from care providers, medical societies, and other stakeholders.

Nine months later, the same company is on record with CMS defending the contracted-staff model that makes RPM available to most small and rural practices. When the country's largest health insurer, which tried to stop paying for most RPM a year ago, tells CMS the proposed restriction goes too far, the agency should take notice.

Stay Ahead of Regulatory Changes

We are watching closely for the 2027 PFS final rule, which CMS is expected to release by November 1. Any finalized changes would take effect January 1, 2027. Current RPM and RTM billing rules and rates stay in place through December 31, 2026.

We expect significant pieces of this proposal will not survive to the final rule. CMS acknowledged in the proposed rule that it lacked the cost and clinical workflow data it needs to finalize some of these provisions. It now has that data from more than 44,000 comments, including the coalition of more than 230 organizations, the SBA Office of Advocacy, 32 House members, two senators, and the country's largest insurers. The agency also has a track record of narrowing aggressive proposals after a comment period. The open question is how far CMS moves, and whether the final rule replaces the employment restriction with the targeted safeguards these commenters asked for.

For the full breakdown of what CMS finalized, what it dropped, and what your RPM program needs to do before the new year, join our complimentary, expert-led webinar, Understanding Medicare's 2027 Changes to Remote Care Management, on November 19 at 2:00 PM ET / 11:00 AM PT. A Medicare compliance expert will walk through the final rule's RPM and remote care provisions and take your questions. Reserve your seat here.