Sponsors (11)
This bill expands and standardizes access to diabetes self-management services (including testing virtual delivery) and eliminates beneficiary cost-sharing to increase access and equity, while shifting costs to Medicare and creating provider, administrative, and program-quality/flexibility risks that must be managed.
Medicare beneficiaries with diabetes will face no coinsurance or deductible for diabetes self-management training (DSMT) and medical nutrition therapy (MNT), reducing out-of-pocket costs and financial barriers to care.
Medicare beneficiaries with diabetes will have guaranteed access to an initial 10 hours of DSMT (available until used) plus 2 hours annually thereafter, with clinicians (physicians and qualified nonphysician practitioners) able to order services and certified DSMT providers able to deliver medically necessary care without arbitrary CMS quantity/duration limits — improving access and supporting day
Medicare will test coverage of virtual DSMT through a model that can expand access — especially in rural and underserved areas — and potentially reach beneficiaries who otherwise lack in-person options.
Eliminating beneficiary cost-sharing for DSMT and MNT will increase Medicare spending and could place greater fiscal pressure on the program and taxpayers.
Broader no-limit access and expected higher utilization could create significant demand and administrative burden for certified providers and Medicare claims processing, straining provider capacity and program operations if capacity is not expanded.
If virtual DSMT is approved or scaled without strong, enforced quality controls, beneficiaries may receive lower-quality or inconsistent education compared with in-person services, potentially undermining health benefits.
Based on analysis of 3 sections of legislative text.
Expands Medicare coverage and payment for outpatient DSMT and MNT, eliminates Part B cost‑sharing for DSMT, and pilots virtual DSMT under a Medicare Innovation model.
Introduced June 6, 2025 by Kim Schrier · Last progress June 6, 2025
Expands Medicare coverage and payment for outpatient diabetes self‑management training (DSMT) and medical nutrition therapy (MNT), guarantees an initial 10 hours of DSMT and 2 hours each year thereafter, and removes Medicare Part B cost‑sharing for these services. It requires Medicare to pay the lesser of the actual charge or the applicable fee schedule amount in full for DSMT, and prevents the Secretary from imposing quantity/duration limits when a certified provider and clinician deem additional services medically necessary. Requires the Medicare Innovation Center to test a model that covers virtual diabetes outpatient self‑management training for eligible Medicare beneficiaries, to be implemented by January 1, 2026, and sets evaluation goals (A1c reduction, fewer diabetes‑related hospitalizations, increased utilization including in rural/underserved areas, improved medication adherence, and Medicare savings). The coverage and payment rule changes apply to services furnished on or after January 1, 2027.