Sponsors (16)
The bill expands and subsidizes access to diabetes self‑management education (including a virtual pilot), which should improve access and outcomes for Medicare beneficiaries with diabetes but increases Medicare spending and administrative/provider burdens and may constrain CMS flexibility or risk variable virtual program quality.
Medicare beneficiaries with diabetes will no longer owe coinsurance or deductibles for diabetes self-management training (DSMT) and medical nutrition therapy (MNT), lowering out-of-pocket costs and improving access to covered services.
Medicare beneficiaries with diabetes gain guaranteed DSMT access (an initial 10 hours plus 2 hours annually thereafter), supporting better self-management and likely improving glycemic control and related health outcomes.
More clinicians (physicians and qualified nonphysician practitioners) may order DSMT, expanding referral pathways and making it easier for patients to receive needed education.
Eliminating beneficiary cost‑sharing for DSMT and MNT will increase Medicare program spending, which could raise fiscal pressure on taxpayers or necessitate offsets elsewhere in the program over time.
Broader no‑limit access and expanded coverage (including virtual pilots) will likely raise demand and create administrative and operational burdens for certified providers, Medicare claims processing, and digital vendors, requiring capacity or systems investments.
Altering statutory phrasing to be more prescriptive ('consistent with' rather than 'after consideration of') may narrow CMS discretion, reducing its flexibility to manage costs or tailor coverage rules in response to program changes.
Based on analysis of 3 sections of legislative text.
Guarantees Medicare coverage and no cost‑sharing for expanded DSMT (initial 10 hours + 2 hours/yr) and requires a CMI model testing virtual DSMT by 2026; payment changes effective 2027.
Official title: To amend title XVIII of the Social Security Act to improve access to diabetes outpatient self-management training services, to require the Center for Medicare and Medicaid Innovation to test the provision of virtual diabetes outpatient self-management training services, and for other purposes.
Introduced June 6, 2025 by Kim Schrier · Last progress June 6, 2025
Expands Medicare coverage and payment rules for diabetes outpatient self‑management training (DSMT) and medical nutrition therapy (MNT), eliminates beneficiary cost‑sharing for DSMT, and requires a CMS Innovation Center model to test virtual DSMT. It guarantees an initial 10 hours of DSMT (individual or group), allows 2 additional hours each subsequent year, bars the Secretary from limiting medically necessary amounts when certified providers and clinicians agree, and directs Medicare to pay 100% of the lesser of actual charge or fee schedule amount for DSMT for services on or after January 1, 2027. Directs the Secretary to launch, by January 1, 2026, a Center for Medicare & Medicaid Innovation (CMI) model testing Medicare coverage of virtual diabetes outpatient self‑management training for eligible beneficiaries, with evaluations on clinical outcomes, utilization (including rural and underserved uptake), medication adherence, and Medicare spending. The model must include stakeholder consultation and define qualified web‑based programs and virtual service standards.