UnitedHealthcare’s New Remote Monitoring Policy

UnitedHealthcare (UHC), one of the nation’s largest health insurers, has announced an updated policy change regarding coverage for remote patient monitoring services. As of the latest update, UHC will end coverage for most remote patient monitoring (RPM) when it is determined to be “unproven and not medically necessary,” specifically targeting standard cases of Type 2 diabetes and hypertension. This decision has broad implications for healthcare professionals, patients, and those tracking healthcare policy developments.

Details of the Policy Change

UHC’s new policy discontinues coverage for remote patient monitoring in cases where the service is considered unproven or not medically necessary, focusing chiefly on routine management of Type 2 diabetes and most hypertension cases. However, there are notable exceptions:

• Heart Failure: Remote monitoring will continue to be covered for patients diagnosed with heart failure, reflecting evidence supporting improved outcomes in this population.
• Hypertensive Disorders of Pregnancy: Coverage remains in place for pregnant individuals with hypertensive disorders, a group for whom remote management has shown benefit and can mitigate risks to both mother and child.

These exceptions underscore UHC’s commitment to supporting RPM where research demonstrates clear clinical value. The policy applies to new and existing patients as of the effective date, which is detailed in UHC’s provider communications.

Impact on Members: Who Is Affected?

The policy affects UHC members across several plan types, including those enrolled in Medicare Advantage, commercial employer-sponsored insurance, individual exchange (Marketplace) plans, and Medicaid. For most individuals with Type 2 diabetes or standard hypertension, remote monitoring devices and associated services will no longer be reimbursed unless a specific exception applies. Providers and patients should carefully review plan details to understand ongoing eligibility and coverage for RPM.

CMS Rule Changes: Upcoming Service Rate Adjustments

The Centers for Medicare & Medicaid Services (CMS) is expected to implement new rules that adjust payment rates for remote patient monitoring services in 2025. These changes may influence how payers and providers structure RPM programs and could impact future coverage decisions. Stakeholders are watching closely to understand how these federal updates will interact with insurer policies like UHC’s.

Implications for Patients and Providers

UnitedHealthcare’s revised remote patient monitoring policy marks a notable shift in coverage for chronic disease management. While the decision narrows access for many with Type 2 diabetes and hypertension, it maintains support for populations where RPM has proven benefits. As CMS finalizes new rules and advocacy groups push for policy reconsideration, patients and providers should stay informed about coverage updates and seek guidance to ensure continuity of care where remote monitoring remains essential.

What Healthcare Professionals Need to Know About the Latest Medicare Flexibility Extensions

The federal government has officially reopened following the recent shutdown, bringing relief and important updates for healthcare professionals and policy watchers. As part of the reopening, significant developments regarding telehealth billing and Medicare flexibilities have been enacted that are crucial for providers to understand.

Legislative Update: Passage and Signing of H.R. 5371

On November 2025, Congress passed and the President signed H.R. 5371, a Continuing Resolution that ended the government shutdown. This legislation not only funds the government but also extends several Medicare telehealth flexibilities that were set to expire, ensuring continuity of care and operational stability for providers across the country.

Medicare Telehealth Flexibilities Extended Through January 2026

H.R. 5371 extends select Medicare telehealth flexibilities through January 30, 2026. This extension allows providers to continue delivering vital services remotely, supporting patient access and practice sustainability.

Detailed Flexibilities Extended

• Home as an Originating Site: Patients can receive telehealth services from their home, maintaining convenience and access.
• No Geographic Restrictions: The requirement that patients be located in rural or certain geographic areas to receive telehealth services is suspended, broadening eligibility nationwide.
• FQHCs and RHCs as Distant-Site Providers: Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) may continue to serve as distant-site telehealth providers, expanding care delivery options.
• Audio-Only Visits: Providers can bill for eligible audio-only telehealth visits, supporting patients who may lack video access.
• Telehealth for Hospice Recertification: Telehealth remains available for conducting hospice recertification assessments, streamlining care for seriously ill patients.
• Expanded Provider Eligibility: A wider range of practitioners, including therapists and allied health professionals, can continue to furnish telehealth services under Medicare.
• Acute Hospital Care at Home Program: The program allowing hospitals to provide inpatient-level care at home is extended, sustaining hospital capacity and patient-centered care.

Behavioral Health In-Person Visit Requirement Aligned

The requirement for an in-person visit prior to and during ongoing behavioral health telehealth services is also delayed until January 30, 2026. This alignment offers continuity for behavioral telehealth care without disrupting established patient relationships.

Looking Ahead: Pending CMS Guidance

While these extensions provide immediate clarity, further guidance from the Centers for Medicare & Medicaid Services (CMS) is expected. Upcoming updates will cover operational details, billing instructions, and any additional compliance requirements. Providers should stay tuned for future announcements to ensure continued adherence with federal policies.

In Short:

The extension of Medicare telehealth flexibilities following the government shutdown offers critical support for healthcare delivery through January 2026. Providers are encouraged to review these changes on the CMS website, maintain compliance, and monitor for further CMS guidance. 

As North Carolina moves into data-driven, value-based health care, the N.C. Health Information Exchange Authority is working to modernize the state-designated health information exchange, NC HealthConnex. This valuable tool can help your practice close important care gaps through information  exchange between health care provider and patient. The N.C. Health Information Exchange Authority is offering valuable training on the features of NC HealthConnex.

• Module 1: NC HealthConnex Overview — Watch this module.
  
  To access the rest of the training modules, please fill out the training request form.
• Module 2: Unpacking the NC HealthConnex Welcome Packet (12 minutes)
• Module 3: Participant Account Administrator Roles & Responsibilities (10 minutes)
• Module 4: Clinical Portal Overview (20 minutes)
• Module 5: Direct Secure Messaging
• Module 6: Patient Education (26 minutes)
• Module 7: NC*Notify (13 minutes)
  

   

In honor of Health Literacy Month, the ADL is highlighting an article about how the concept of health literacy has expanded to address different ways that patients interact with health systems.

The updated definition of health literacy in Healthy People 2030 points out the ways that health organizations are responsible for making their information accessible and understandable, as an essential part of health literacy.

To learn more, check out the ADL’s October 15 Highlighted Resource: Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health

From the CMS QPP Updates Newsletter:

From MLN Connects Newsletter, Special Edition: October 1, 2025:

What’s Changing with Medicare Telehealth?

1. Fewer Services Will Be Covered
   Many telehealth services that were allowed during the COVID-19 emergency will no longer be covered unless Congress acts. This mostly affects non-mental health services.

2. As prior to COVID -19 Flexibilities, Where the Patient Is Matters
   Patients must be in rural areas or certain medical facilities to get Medicare-covered telehealth (except for mental health care).
   Services from home will not be covered for most types of care.

3. Mental Health Services Are Still Covered
   Telehealth for mental and behavioral health can still be done from home.
   However, patients must have an in-person visit at least once every year to keep using telehealth for these services. 

4. Advance Notice May Be Needed
   If a provider offers a telehealth service that Medicare won’t pay for, they may need to give the patient an Advance Beneficiary Notice to explain the cost.

5. Some Providers Can Still Use Telehealth Freely
   Providers in Medicare Shared Savings Program ACOs can continue offering telehealth without location limits, even after October 1.

    

   Source: https://www.cms.gov/medicare/payment/fee-for-service-providers 

This edition of the newsletter was sent to subscribers on October 1.  You are encouraged to subscribe to updates from CMS. Archived editions of the newsletter are available here.

North Carolina Medicaid provider reimbursement rate reductions go into effect October 1, 2025.

The reduction percentages vary from 3%,  8% or 10% and apply to procedure codes.

NC Medicaid plans to publish detailed updated fee schedules to the NC Medicaid Covered Codes and Fee Schedules Portal. You are advised to check back frequently for these updated documents. 

North Carolina Division of Health Benefits officially notified Vaya Health of upcoming changes to the NC Medicaid fee schedule rates effective October 1, 2025. The new detailed fee schedule changes have not yet been provided.

Vaya Health notified network providers in their recent bulletin that it will update their systems to implement the fee schedule changes no earlier than November 1, 2025.  If there is no legislative agreement by October 31, Vaya will implement the rate cuts on November 1, retroactive to the effective date of October 1.  On that date they plan to update their systems to pay at the newly published rates, and will take steps to recoup the difference in reimbursement for services provided back to October 1.

Vaya indicated they will issue more detailed communications soon, and provided links to email them with questions as well as a link to join the Vaya Provider Touchpoint webinar on October 3rd.

Source: https://providers.vayahealth.com/bulletins/

NC Medicaid, in collaboration with the five NC Medicaid Managed Care Standard Plans, hosts the...

Fifth Annual Virtual Statewide Quality Forum

Wednesday, October 8 from noon-1:30 p.m.

Topics will include:

• Administrative Simplification Workgroup Updates
• Early Intervention and EPSDT: Proven Strategies for Success – Feedback from Providers 
  and Standard Plans
• Key Updates from NC Medicaid

The forum is designed for providers, practice managers, and quality managers to engage in 
focused discussion about how to successfully apply Medicaid Managed Care quality initiatives to 
generate positive outcomes.

Please register to participate in this valuable and informative forum that will offer practical 
applications to enhance and improve your services to NC Medicaid members.