Expanding Access to Diabetes Self-Management Training Act of 2025
- Sponsor
- Rep. Schrier, Kim [D-WA-8]
- Committees
- Ways and Means Committee (primary)
- Last action
- Jun 6, 2025
Bottom line
This bill aims to improve health outcomes for Medicare beneficiaries with diabetes by making self-management training more accessible and affordable, including through virtual options, while potentially increasing federal expenditures.
What it actually does
This bill amends the Social Security Act to expand Medicare coverage for diabetes outpatient self-management training (DSMT) services by increasing the number of covered hours, eliminating beneficiary cost-sharing (deductibles and coinsurance), and requiring the Center for Medicare and Medicaid Innovation (CMMI) to test a model for providing virtual DSMT services. It also streamlines administrative requirements for medical nutrition therapy (MNT) services.
Proponents argue
Proponents argue that expanding access to comprehensive DSMT services is crucial for effective diabetes management, preventing severe complications, and ultimately reducing long-term healthcare costs. They contend that removing financial barriers like deductibles and coinsurance, along with increasing covered hours, will encourage greater utilization, especially among underserved populations, leading to better health outcomes and fewer hospitalizations. The inclusion of virtual options is seen as a vital step to enhance accessibility and modernize care delivery.
Opponents contend
Potential opponents might raise concerns about the increased federal expenditure associated with expanding covered services and eliminating cost-sharing, questioning the long-term fiscal sustainability of Medicare. Some may argue that existing programs are sufficient if properly utilized, or express skepticism about the efficacy or security of virtual health services for all beneficiaries, particularly those with limited digital access or literacy.
The bill is short and its provisions are clearly articulated, allowing for a quick and comprehensive understanding of its intended effects.
Section 2(a), amending Section 1861(qq) of the Social Security Act
Expanded Hours for Diabetes Outpatient Self-Management Training (DSMT) Services
This provision significantly increases the amount of diabetes outpatient self-management training (DSMT) services Medicare will cover. It specifies an initial 10 hours of individual or group training that remain available until used, followed by an additional 2 hours of individual or group training each year after the initial 10 hours are completed. It also removes the Secretary's discretion to determine appropriate hours, instead setting these specific limits, and allows a physician or qualified nonphysician practitioner to refer patients. Crucially, it states that the Secretary shall not limit services deemed medically necessary by a practitioner.
Supporters argue
Supporters argue that the current limits on DSMT hours are insufficient for comprehensive, ongoing diabetes management, leading to poorer health outcomes. Expanding these hours, especially with the 'medically necessary' clause, ensures beneficiaries receive the vital education needed to prevent complications, thereby improving quality of life and potentially reducing long-term healthcare costs.
Critics contend
Critics might argue that expanding hours without strict limits could lead to overutilization or services that are not truly cost-effective, potentially increasing Medicare expenditures without proportional health benefits. They might also question the oversight mechanisms for 'medically necessary' determinations.
Tradeoffs
This provision balances the need for comprehensive, ongoing diabetes education to improve health outcomes against concerns about potential overutilization and increased program costs.
Section 2(b), amending Section 1861(s)(2)(V) of the Social Security Act
Streamlined Medical Nutrition Therapy (MNT) Services
This provision amends the Social Security Act by striking a clause related to medical nutrition therapy (MNT) services and redesignating subsequent clauses. Specifically, it removes the requirement for the Secretary to consider certain factors when determining the amount, duration, and frequency of MNT services, instead stating that these services should be 'consistent with' the referral. This change aims to streamline the process for beneficiaries to receive MNT services.
Section 2(c), amending Section 1833 of the Social Security Act
Elimination of Cost-Sharing for DSMT Services
This provision amends Medicare's cost-sharing rules to eliminate financial barriers for beneficiaries seeking DSMT. It mandates that Medicare will pay 100 percent of the lesser of the actual charge or the fee schedule amount for diabetes outpatient self-management training services, effectively eliminating coinsurance. Additionally, it specifies that the annual Medicare deductible shall not apply to these services.
Section 3, amending Section 1115A of the Social Security Act
CMMI Testing of Virtual Diabetes Outpatient Self-Management Training Services
This provision mandates that the Center for Medicare and Medicaid Innovation (CMMI) establish a model by January 1, 2026, to test the impact of providing Medicare coverage for virtual diabetes outpatient self-management training services. The model must evaluate health outcomes (e.g., A1c levels, hospitalizations), service utilization (especially in rural/underserved areas), medication adherence, and expenditure reductions. The bill also defines 'qualified web-based program' and 'virtual diabetes outpatient self-management training services' for the purposes of this model.
The amendments made by Section 2 (expanded hours, MNT streamlining, cost-sharing elimination) shall apply with respect to items and services furnished on or after January 1, 2027.
Section 2(d)
Why it matters:This is standard legislative practice to place effective dates at the end of a section, providing lead time for implementation.
Case for: Provides lead time for CMS, healthcare providers, and beneficiaries to prepare for the changes, including updating billing systems, educating staff, and understanding new coverage parameters.
Case against: Delays the implementation of beneficial changes, meaning Medicare beneficiaries will continue to face current limitations and cost-sharing for DSMT services for nearly two years after the bill's potential enactment.
Estimated impact: Delays the fiscal impact and health benefits for Medicare beneficiaries by approximately two years.
Requires the Secretary, in designing the virtual DSMT model, to consult with stakeholders in the field of diabetes care and education, clinicians in the primary care community, experts in digital health, and beneficiary groups, not later than 3 months after the date of the enactment of this subsection.
Section 3, subsection (h)(2)(B)
Why it matters:Standard practice for detailing procedural requirements within a larger program design, ensuring comprehensive input.
Case for: Ensures the CMMI model is informed by diverse expertise and practical experience, leading to a more effective and equitable program design that addresses real-world needs and challenges. This broad consultation can enhance the model's relevance and acceptance.
Case against: No specific opposition, as stakeholder consultation is generally viewed as good practice. Some might argue it could slightly slow down the initial design phase, but the 3-month timeline is relatively short.
Estimated impact: Enhances the quality, relevance, and potential success of the virtual DSMT model by incorporating diverse perspectives.