Policy Watch
A structural inequity built into Medicare’s reimbursement formulas penalizes remote patient monitoring in the places where chronic disease burden is highest and specialist access is lowest. The geographic payment index used to calculate RPM reimbursement means providers in Mississippi and Arkansas receive approximately $84–$85 per enrolled patient per month, while the national average is $96 — an $11 monthly gap in states where hypertension, heart failure, and diabetes prevalence far exceeds national averages.
The geography of chronic disease and the geography of payment
Three out of five federally designated health professional shortage areas (HPSAs) are in rural regions. Approximately 21 million Americans lack sufficient broadband access to support video-enabled telehealth — with rural areas disproportionately affected. And yet Medicare’s geographic payment index applies wage-area adjustments designed for facility-based care to remote monitoring services — a payment model in which geographic labor costs have minimal bearing on program delivery. The result is that the providers most likely to serve the Medicare patients who benefit most from RPM receive the least payment for doing so.
The Rural Patient Monitoring Access Act
To address this, Senators Marsha Blackburn (R-TN) and Mark Warner (D-VA) introduced the bipartisan Rural Patient Monitoring Access Act (S.1535 / H.R.3108) in April 2025. The bill would floor the geographic payment index at 1.00 for RPM services, so no rural provider receives below-national-average reimbursement. It also mandates a cost-savings study and requires enrolled RPM providers to demonstrate they can respond clinically to detected data anomalies — a program integrity provision that addresses one of OIG’s core oversight recommendations. The bill currently sits in committee.
The access-equity argument
Forty-one states currently provide some Medicaid RPM reimbursement, reflecting broad recognition of the modality’s value across payer lines. The $10 billion Rural Health Transformation Program enacted in July 2025 lists telehealth investment as a stated priority. But neither Medicaid parity nor the Transformation Program addresses the Medicare-specific structural disadvantage that the Blackburn-Warner bill targets. For advocates of equitable Medicare coverage, passage of S.1535 represents one of the most concrete near-term policy wins available on remote care access — bipartisan in sponsorship, modest in cost, and directly corrective of a documented disparity.