UHC Seems to Realize Its Pending Restrictions on Remote Patient Monitoring Payment Won’t Fly

Modern Healthcare reported that UnitedHealthcare (UHC) says that starting Jan. 1, it will only pay for remote patient monitoring for heart failure or hypertensive disorders of pregnancy.

Apparently, this was published in a September update to physicians, but I just learned of it thanks to the Nov. 10 Modern Healthcare article. The bulletin asserts that for conditions like chronic obstructive pulmonary disease (COPD), diabetes, and hypertension that are unrelated to pregnancy, remote monitoring is unproven, and not medically necessary. As a result, UHC will not cover it.

I have read the bulletin, and I will admit that I am a bit confused about exactly what UHC’s current position is with respect to the scope of patients to which the new policy will apply. The original reporting I saw indicated that this policy would apply to all patients insured by UHC, including Medicare Advantage (MA) patients. I am pretty certain that I saw a news story featuring a comment from UHC that the new policy was legal, but I can’t find that article now. 

There are two reasons I want to mention this policy. The first is that this is a big deal. Remote monitoring is widely used. This change will affect patients and healthcare organizations. The second reason is that I don’t think there is a plausible argument that an MA plan can refuse to cover remote monitoring. I feel a little guilty covering this again, because we’ve seen many stories on the topic, but since it appears that major MA plans struggle to grasp the fact that MA plans have to cover everything that traditional Medicare covers, it bears repeating.  

There is a federal regulation, 42 CFR § 422.101, that says with a few very limited exceptions that apply to some hospital care and hospice, every MA organization has to provide coverage by furnishing, arranging for, or making payment for “all services that are covered by Part A and Part B of Medicare and that are available to beneficiaries residing in the plan’s service area.” The regulation goes on to state that plans must comply with general coverage and benefit conditions included in traditional Medicare, unless superseded by laws applicable to MA plans.   

The language is straightforward and clear. If traditional Medicare covers a service, MA plans must cover it as well. Traditional Medicare covers remote patient monitoring, so I am at a complete loss as to how UHC could think that they can apply this policy to their MA enrollees. But it appears that UHC may already recognize this reality. 

The online version of the UHC policy has three different headings: one for commercial plans, one for individual exchange policies, and one for Medicare Advantage. When I click on the MA policy, I get a “404 page not found” error. It’s possible that someone within UHC recognized this relatively clear violation of MA regulations, and the company will only apply the policy on the commercial side. Ideally, there would be a direct statement on the website making this point, rather than a 404 error. But I suspect that is what is going on. 

The bottom line is that while MA plans can be more generous than Medicare, under the law, they don’t have the ability to unilaterally limit coverage of service covered by traditional Medicare. Any limit on remote patient monitoring should not apply to MA patients unless Medicare adopts a limitation.