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Expands Medicare coverage for diabetes outpatient self-management training by increasing baseline education hours, allowing orders from qualified nonphysician practitioners, and waiving Part B coinsurance and the Part B deductible for these services. Requires the Center for Medicare & Medicaid Innovation to test a virtual diabetes self-management training model by January 1, 2026, to evaluate clinical outcomes, access (including rural and underserved areas), utilization, medication adherence, and Medicare spending. Changes to coverage, provider rules, and cost-sharing for in-person and virtual services take effect for items and services furnished on or after January 1, 2027, while the CMMI virtual model must be implemented by January 1, 2026.
The bill expands and subsidizes diabetes self‑management training (including virtual options) to improve access and outcomes for Medicare beneficiaries, but it raises near‑term Medicare costs and creates equity and implementation challenges that could limit benefits for some populations.
Medicare beneficiaries with diabetes will face no coinsurance and gain expanded covered outpatient self‑management training (initial 10 hours plus 2 hours/year), now available in-person and through virtual delivery pathways.
Medicare beneficiaries in rural and underserved areas will have greater access to diabetes self‑management services through virtual delivery, improving reach where local programs are scarce.
People with diabetes may experience better clinical outcomes (e.g., lower A1c, fewer diabetes‑related hospitalizations) and potential long‑term Medicare savings if expanded and virtual models improve adherence and self‑management.
Expanding covered hours, waiving coinsurance, and implementing virtual models will likely increase Medicare spending in the short term, putting pressure on program budgets and potentially requiring offsets.
Beneficiaries without reliable internet access or sufficient digital literacy—often low‑income or rural seniors—may be unable to use virtual services, worsening equitable access.
Higher utilization could strain certified provider capacity in some areas, producing longer waits or access bottlenecks, particularly in rural and underserved communities.
Introduced June 6, 2025 by Kim Schrier · Last progress June 6, 2025