Sponsors (2)
This bill expands and clarifies Medicare coverage for diabetes technologies, education, and related services—improving access and lowering out‑of‑pocket costs for many people with diabetes—but does so at higher projected cost to taxpayers, with added administrative complexity, potential short‑term coverage gaps, and equity risks for digitally underserved beneficiaries.
Medicare beneficiaries with insulin‑dependent diabetes will gain clearer and expanded coverage for insulin pumps, continuous glucose monitors (CGMs), and automated insulin delivery (AID) software/algorithms (including a statutory DME classification and separate reimbursement), lowering out‑of‑pocket costs and improving access to essential diabetes technologies.
Medicare beneficiaries with diabetes will face lower direct costs and better self‑management support because DSMES (diabetes self‑management education and support) and medical nutrition therapy are covered without Part B deductible/coinsurance and include an initial 10 hours plus annual follow‑up.
People newly enrolled in Part B can get faster access to Part B‑covered diabetes technologies when a qualified provider certifies use within the first 12 months, and providers may use an initial preventive visit to certify, reducing extra visits and paperwork.
Taxpayers and the Medicare program will likely face materially higher spending from expanded coverage and new reimbursable services (DME classification for pumps/CGMs, separate payment for software, broader DSMES and training, virtual program reimbursements).
Some beneficiaries may face coverage gaps or delays—devices and rules may not take effect until Jan 1, 2031, and national coverage determinations or rulemaking could create interim uncertainty or denials, leaving patients without needed technology in the near term.
The bill adds administrative and billing complexity—new codes, separate Part B/Part D interactions, certification requirements for virtual programs, and potential procurement/bidding complications—raising compliance costs and burdening providers and suppliers.
Based on analysis of 18 sections of legislative text.
Expands Medicare coverage and payment rules for diabetes technologies, software, and education; creates billing codes and a CMMI virtual DSMES model; and reclassifies CGMs/pumps as DME in 2031.
Introduced March 10, 2026 by Jeanne Shaheen · Last progress March 10, 2026
Expands Medicare coverage, payment, billing, and program testing for diabetes technologies and education. It directs HHS/CMS to recognize software/algorithms used in automated insulin delivery as payable, creates a fast certification pathway to establish Part B coverage for diabetes devices and supplies, eliminates cost‑sharing for outpatient diabetes self‑management training (DSMES), requires new billing codes and a pilot for virtual DSMES, directs a national coverage determination process for insulin pumps, and schedules continuous glucose monitors and insulin pumps to be treated as durable medical equipment beginning January 1, 2031. The bill also requires a GAO report on barriers to access and sets timelines (many changes effective January 1, 2027) to increase access, standardize payments, and reduce administrative barriers that currently limit patient use of diabetes technologies and education services.