Sponsors (8)
The bill expands and pays for more diabetes self-management training (including virtual options), improving access and likely health outcomes for many Medicare beneficiaries while lowering their out-of-pocket costs — but it raises near-term Medicare/taxpayer costs, may burden providers, and could produce uneven access for those without reliable internet or digital skills.
Medicare beneficiaries with diabetes gain guaranteed training availability: an initial 10 hours of outpatient self-management training (individual or group) plus 2 additional hours per year thereafter, and clinicians can authorize additional medically necessary education without arbitrary federal limits.
Medicare will cover these diabetes self-management training services with no Part B deductible and pay 100% of the lesser of actual charge or fee schedule, substantially lowering out-of-pocket costs for beneficiaries.
The bill broadens who can order diabetes training to 'physician or qualified nonphysician practitioner,' enabling more clinicians to refer patients and improving access and care coordination.
Expanding covered services and paying 100% of allowable charges could increase overall Medicare spending and put upward pressure on premiums or taxpayer costs in the short to medium term.
Relying on virtual delivery risks leaving beneficiaries without reliable internet access or digital literacy—particularly rural residents and some people with disabilities—unable to benefit equally from the program.
Providers may face higher administrative and staffing burdens to deliver expanded training, document medical necessity, and meet program requirements; stringent standards could also exclude smaller providers, limiting options for beneficiaries.
Based on analysis of 3 sections of legislative text.
Expands Medicare coverage and payment for diabetes outpatient self-management training, exempts it from the Part B deductible, and requires a CMMI test model for virtual delivery.
Introduced June 6, 2025 by Kim Schrier · Last progress June 6, 2025
Expands Medicare coverage and payment rules for outpatient diabetes self-management training (including virtual delivery) by guaranteeing an initial 10 hours of training and 2 follow-up hours per year, allowing physicians or qualified nonphysician practitioners to authorize additional medically necessary hours, and requiring Medicare to pay 100% of the lesser of actual charge or fee-schedule amount while exempting these services from the Part B deductible. It also directs HHS to implement a CMMI test model to evaluate virtual diabetes self-management training for Medicare beneficiaries, with a focus on clinical outcomes, utilization in rural and underserved areas, medication adherence, and program costs. Changes to payment and coverage take effect for items and services furnished on or after January 1, 2027; the CMMI virtual-care test model must be implemented by January 1, 2026, and will include stakeholder consultation and defined quality requirements for web-based programs.