Expanding Access to Diabetes Self-Management Training Act of 2025
This bill expands Medicare coverage of diabetes outpatient self-management training.
Specifically, the bill specifies that in addition to physicians, other health care practitioners may also provide such services. It also specifies that coverage includes an initial 10 hours of training until used, as well as an additional 2 hours of training per year. The bill also prohibits the Centers for Medicare & Medicaid Services from limiting training that is deemed medically necessary.
Additionally, the Center for Medicare and Medicaid Innovation must test a model in which such training is provided virtually and evaluate any effects on costs, services, and health outcomes.
[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 1925 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
1st Session
S. 1925
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.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 2, 2025
Mrs. Shaheen (for herself and Ms. Collins) introduced the following
bill; which was read twice and referred to the Committee on Finance
_______________________________________________________________________
A BILL
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.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Expanding Access to Diabetes Self-
Management Training Act of 2025''.
SEC. 2. IMPROVING ACCESS TO DIABETES OUTPATIENT SELF-MANAGEMENT
TRAINING SERVICES.
(a) In General.--Section 1861(qq) of the Social Security Act (42
U.S.C. 1395x(qq)) is amended--
(1) in paragraph (1)--
(A) by striking ``the Secretary determines
appropriate'' and inserting ``specified in paragraph
(3)''; and
(B) by striking ``the physician who is managing the
individual's diabetic condition'' and inserting ``a
physician or qualified nonphysician practitioner'';
(2) in paragraph (2)(B), by striking ``paragraph'' and
inserting ``subparagraph''; and
(3) by adding at the end the following new paragraph:
``(3)(A) For purposes of paragraph (1) and subject to subparagraph
(B), the times specified in this paragraph are the following:
``(i) An initial 10 hours of individual or group
educational and training services to remain available until
used.
``(ii) An additional 2 hours of individual or group
educational and training services each year, beginning with the
year in which the initial 10 hours described in subparagraph
(A) are completed.
``(B) The Secretary shall not limit the quantity or duration of
educational and training services furnished by a certified provider to
an individual with diabetes if such services are deemed medically
necessary by a physician or qualified non-physician practitioner.''.
(b) Medical Nutrition Therapy Services.--Section 1861(s)(2)(V) of
the Social Security Act (42 U.S.C. 1395x(s)(2)(V)) is amended--
(1) by striking clause (i);
(2) by redesignating clauses (ii) and (iii) as clauses (i)
and (ii), respectively; and
(3) in clause (ii), as so redesignated, by striking ``after
consideration of'' and inserting ``consistent with''.
(c) Cost-Sharing.--Section 1833 of the Social Security Act (42
U.S.C. 1395l) is amended--
(1) in subsection (a)(1)--
(A) by striking ``and (HH)'' and inserting
``(HH)''; and
(B) by inserting the following before the semicolon
at the end: ``and (II) with respect to diabetes
outpatient self-management training services (as
defined in section 1861(qq)), the amount paid shall be
100 percent of the lesser of the actual charge for the
services or the amount determined under the fee
schedule that applies to such services under this
part;''; and
(2) in subsection (b), in the first sentence--
(A) by striking ``, and (13)'' and inserting
``(13)''; and
(B) by striking ``1861(n)..''and inserting
``1861(n), and (14) such deductible shall not apply
with respect to diabetes outpatient self-management
training services (as defined in section 1861(qq))''.
(d) Application.--The amendments made by this section shall apply
with respect to items and services furnished on or after January 1,
2027.
SEC. 3. CMI TESTING OF PROVIDING VIRTUAL DIABETES OUTPATIENT SELF-
MANAGEMENT TRAINING SERVICES.
Section 1115A of the Social Security Act (42 U.S.C. 1315a) is
amended--
(1) in subsection (b)(2)(A), by adding at the end the
following new sentence: ``The models selected under this
subparagraph shall include the testing of the model described
in subsection (h).''; and
(2) by adding at the end the following new subsection:
``(h) Testing of Providing Virtual Diabetes Outpatient Self-
Management Training Services.--
``(1) Establishment.--Not later than January 1, 2026, the
Secretary shall implement a model to test the impact of
providing coverage under title XVIII for virtual diabetes
outpatient self-management training services furnished to
applicable beneficiaries with respect to improved health
outcomes for such applicable beneficiaries and reduced
expenditures under such title XVIII.
``(2) Model design.--
``(A) In general.--The Secretary shall design the
model under this subsection in such a manner to allow
for the evaluation of demographic characteristics of
applicable beneficiaries participating in such model
and the extent to which such model accomplishes the
following purposes:
``(i) Improvement in health outcomes with
respect to the diabetic conditions, including
by reducing A1c levels.
``(ii) Reduced hospitalizations due to
diabetic-related complications.
``(iii) Increased utilization of diabetes
outpatient self-management training services as
evidenced by, for example, Medicare beneficiary
participation and utilization of covered hours
during the first year and subsequent years or
use of diabetes outpatient self-management
training services in rural and underserved
communities.
``(iv) Improved medication adherence.
``(v) Reduced expenditures under this title
attributable to the model.
``(B) Consultation.--In designing the model under
this subsection, the Secretary shall, not later than 3
months after the date of the enactment of this
subsection, consult with stakeholders in the field of
diabetes care and education, clinicians in the primary
care community, experts in digital health, and
beneficiary groups.
``(3) Definitions.--In this subsection:
``(A) Applicable beneficiary.--The term `applicable
beneficiary' means an individual with diabetes as
described in section 1861(qq).
``(B) Qualified web-based program.--The term
`qualified web-based program' means a web-based
program--
``(i) designed to furnish educational and
training services to an individual with
diabetes to ensure therapy compliance with
respect to the individual's diabetic condition
or to provide the individual with necessary
skills and knowledge (including skills related
to the self-administration of injectable drugs)
to participate in the individual's management
of such condition; and
``(ii) that meets the quality standards
described in section 1861(qq)(2)(B).
``(C) Virtual diabetes outpatient self-management
training services.--The term `virtual diabetes
outpatient self-management training services' means any
diabetes outpatient self-management training services
(as defined in section 1861(qq)) furnished by a
qualified web-based program for synchronous or
asynchronous diabetes outpatient self-management
training services.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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