Sponsors (2)
The bill significantly expands and clarifies Medicare coverage for diabetes technologies and education—reducing out‑of‑pocket costs and improving access for many beneficiaries—while increasing federal spending and creating implementation, administrative, and equity risks during rollout.
Medicare beneficiaries with diabetes will gain clearer and expanded coverage and reimbursement for modern diabetes technologies (automatic insulin delivery algorithms/software, insulin pumps, and continuous glucose monitors), improving access and likely better glycemic control.
Medicare beneficiaries will pay less and get guaranteed diabetes self‑management training (DSMST/DSMES) — initial 10 hours plus 2 hours annually, exempt from the Part B deductible and paid at 100% — with clinicians able to authorize additional medically necessary training.
Coverage of virtual/web‑based DSMST is authorized and encouraged, increasing access for beneficiaries in rural and underserved areas who cannot reach in‑person programs.
Taxpayers and Medicare trust funds could face substantial higher costs because expanded coverage, separate reimbursement for software/devices, deductible exemptions, and new billing will increase Part B spending.
Some beneficiaries could still face limited supplier choice or reduced access if competitive bidding, a narrowed national coverage determination, or supplier network effects constrain available suppliers for CGMs, pumps, or associated services.
Implementation and administrative burdens — rulemaking deadlines, new HCPCS codes, system updates, and oversight requirements — will strain CMS, federal staff, and providers and could divert resources from other priorities or cause rushed rollouts.
Based on analysis of 18 sections of legislative text.
Expands Medicare coverage and payment rules for CGMs, insulin pumps, and AID software; strengthens diabetes education coverage; creates billing codes; pilots virtual education; and orders reviews and an NCD.
Introduced March 10, 2026 by Jeanne Shaheen · Last progress March 10, 2026
Expands Medicare coverage, payment, and administrative rules to improve access to diabetes technologies (continuous glucose monitors, insulin pumps, and automated insulin delivery software) and diabetes outpatient self‑management training. It directs HHS/CMS to recognize AID algorithms/software as separately payable, strengthen payment and deductible protections for education services, create new billing codes, run a virtual education pilot, issue a proposed national coverage determination for infusion pumps, and require a government report on access barriers.