Sponsors (7)
Last progress June 6, 2025 (8 months ago)
Introduced on June 6, 2025 by Kim Schrier
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Expands Medicare coverage for outpatient diabetes self-management training by defining covered hours (an initial 10 hours that remain available until used, plus 2 hours per year thereafter), allowing additional medically necessary hours with clinician approval, updating medical nutrition therapy rules, and eliminating the Medicare deductible for these diabetes training services effective for services furnished on or after January 1, 2027. Creates a Medicare model test to evaluate covering virtual diabetes outpatient self-management training, requiring the Department to implement the model by January 1, 2026, measure health and cost outcomes (e.g., A1c, hospitalizations, medication adherence), and consult stakeholders shortly after enactment.
Amends section 1861(qq) of the Social Security Act by replacing the phrase "the Secretary determines appropriate" with "specified in paragraph (3)" in paragraph (1).
Amends section 1861(qq)(1) to change the approved certifying provider from "the physician who is managing the individual's diabetic condition" to "a physician or qualified nonphysician practitioner."
In section 1861(qq), changes wording in paragraph (2)(B) by striking "paragraph" and inserting "subparagraph" (technical conforming change).
Adds a new paragraph (3)(A)(i) providing an initial 10 hours of individual or group educational and training services; these 10 hours remain available until used.
Adds a new paragraph (3)(A)(ii) providing an additional 2 hours of individual or group educational and training services each year, beginning with the year in which the initial 10 hours are completed.
Who is affected and how:
Medicare beneficiaries with diabetes: Directly benefit from clearer coverage rules, reduced out-of-pocket costs (deductible removed), and increased access to structured self-management and nutrition education. The defined hours (10 initial; 2/year) create a predictable benefit, while clinician authorization for extra hours allows individualized care for complex cases.
Health care providers and diabetes educators: See clearer billing and authorization rules, potential increased demand for DSMT and nutrition therapy services, and new operational requirements if providing virtual programs that must meet the statute's definitions and model criteria.
Virtual program/platform vendors and telehealth infrastructure: May gain market opportunities if virtual DSMT is covered through the model; must meet qualification standards and participate in outcome measurement. Broadband and telehealth access barriers in some areas could remain a challenge for reach and equity.
Medicare program budget and administrators: Short-term costs may increase because of broadened coverage and removed deductible; the Section 1115A model is designed to measure whether virtual delivery reduces downstream costs (fewer hospitalizations, better glycemic control) that could offset program spending.
Patients in rural or underserved areas: Likely to see improved access if virtual DSMT is proven effective, though disparities in broadband access could limit benefits without parallel investments.
Implementation considerations and tradeoffs:
1 meeting related to this legislation
Updated 4 days ago
Last progress June 2, 2025 (8 months ago)