HR-3108-119
Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 39 - 0.
Sponsored by David Kustoff (R-TN)
What it does
This bill would set a minimum payment floor for Medicare reimbursements for remote patient monitoring (RPM) services, ensuring that geographic payment indices for practice expenses and malpractice costs cannot fall below 1.00 — effectively raising payments in lower-reimbursement areas, primarily rural regions. It would also establish quality standards that providers must meet to receive RPM payments, including real-time clinician availability, electronic health record compatibility, and data reporting. The bill would take effect January 1, 2026, and would not be applied in a budget-neutral manner, meaning it would add to Medicare spending rather than offset costs elsewhere. HHS would be required to submit a report to Congress within five years analyzing cost savings and practice expenses generated by RPM use.
Who benefits
Rural Medicare beneficiaries — particularly those with chronic conditions like heart failure, hypertension, and diabetes — who would gain greater access to remote monitoring services. Rural healthcare providers and clinics that currently receive below-average Medicare reimbursements for RPM and may have limited financial incentive to offer it. RPM technology companies and device manufacturers that would see expanded demand. Nurse practitioners, clinical nurse specialists, and physician assistants, who are explicitly recognized as eligible real-time responders, potentially expanding their role in RPM delivery. Patients in federally designated health professional shortage areas who face long travel distances to in-person care.
Who is hurt
Medicare's general fund, which would absorb higher RPM payments without budget-neutral offsets — a cost ultimately borne by taxpayers and future beneficiaries. Urban and suburban providers who already receive higher geographic payment rates and would not benefit from the floor provision. Competing telehealth service models that do not qualify under the new quality standards. Smaller or under-resourced rural providers who may struggle to meet the new technical requirements — such as real-time clinician availability and EHR-compatible data transmission — and could lose RPM reimbursement eligibility entirely. Providers who find the data reporting requirements burdensome, even with the hardship exemption.
Supporters argue
Supporters argue that the current Medicare geographic payment formula creates a perverse outcome: reimbursements for RPM are lowest in the rural states where chronic disease rates are highest and in-person care is hardest to access, with three out of five federally designated health professional shortage areas located in rural regions. They contend that because RPM practice and malpractice expenses do not actually vary significantly by geography, the existing payment disparity is not grounded in cost differences and actively discourages rural providers from offering a service that can reduce hospitalizations and improve medication adherence — generating downstream savings for Medicare that may offset the increased reimbursement costs.
Opponents argue
Opponents argue that bypassing the budget-neutral requirement sets a costly precedent, adding to Medicare spending without a corresponding offset at a time when the program faces long-term solvency concerns. They contend that the quality standards — particularly the real-time clinician availability requirement — may be difficult for small rural practices to meet consistently, potentially excluding the very providers the bill aims to help. Critics may also argue that the bill's projected savings from reduced hospitalizations and better medication adherence are speculative, and that Congress should await more rigorous evidence before permanently raising payment floors and expanding program spending.