Expanding Access to Diabetes Self-Management Training Act of 2025
- Bill Number
- H.R. 3826
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-06: 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.
- Last Updated
- 2026-06-30T08:06:38Z
AI-Generated Summary
Purpose of the Legislation
The "Expanding Access to Diabetes Self-Management Training Act of 2025" (H.R. 3826) aims to enhance Medicare coverage for diabetes education and training services. It seeks to make these services more accessible by increasing available hours, removing financial barriers for patients, broadening who can refer patients, and testing virtual delivery options to improve health outcomes and reduce costs.
Key Provisions
- Expanded Coverage for Diabetes Self-Management Training Services (amending Section 1861(qq) of the Social Security Act):
- Services can now be referred by a physician or a qualified nonphysician practitioner (e.g., nurse practitioner or physician assistant managing the patient's diabetes).
- Specifies covered hours: An initial 10 hours of individual or group education and training, available until used; plus 2 additional hours per year starting after the initial hours are completed.
- No limits on quantity or duration if deemed medically necessary by the referring provider.
- Updates to Medical Nutrition Therapy Services (amending Section 1861(s)(2)(V)):
- Removes outdated restrictions on initial referrals and follow-up services.
- Requires services to be "consistent with" (rather than just considering) a patient's medical condition and goals.
- Elimination of Cost-Sharing (amending Section 1833):
- Medicare pays 100% of the cost for these services (up to the fee schedule amount), with no deductible or copayment required for beneficiaries.
- Implementation Timeline:
- Changes apply to services provided on or after January 1, 2027.
- Testing of Virtual Services Model (amending Section 1115A via the Center for Medicare and Medicaid Innovation, or CMI):
- Requires CMI to start a pilot program by January 1, 2026, to test virtual diabetes self-management training under Medicare.
- The model will evaluate impacts on health (e.g., lowering A1c blood sugar levels), reduced hospital stays for diabetes complications, higher use of services (especially in rural or underserved areas), better medication adherence, and overall cost savings.
- CMI must consult stakeholders like diabetes experts, primary care clinicians, digital health specialists, and patient groups within 3 months of enactment.
- Defines key terms:
- Applicable beneficiary: Medicare enrollees with diabetes eligible for these services.
- Qualified web-based program: Online platforms providing diabetes education that meet quality standards (e.g., teaching therapy compliance, self-injection skills).
- Virtual services: Synchronous (live) or asynchronous (on-demand) online training.
Significant Changes to Existing Law
- Broader Access and Flexibility: Previously, services were limited by what the Secretary of Health and Human Services deemed appropriate, with referrals only from managing physicians. Now, hours are explicitly defined and expandable if medically necessary, and referrals include nonphysicians.
- Financial Relief for Patients: Introduces full Medicare coverage without deductibles or copays, shifting from partial coverage that could deter use.
- Integration of Virtual Options: Mandates a new CMI innovation model specifically for virtual delivery, which was not previously required or defined in law. This builds on existing telehealth expansions but targets diabetes education explicitly.
- Streamlined Nutrition Therapy: Simplifies rules by removing time-based referral limits and aligning services more directly with patient needs.
Potential Impacts
- On Citizens: Medicare beneficiaries with diabetes (about 1 in 4 enrollees) gain easier, cost-free access to education, potentially leading to better disease management, fewer complications, and improved quality of life. Virtual options could increase participation, especially for those in remote or mobility-limited situations.
- On Government Agencies: The Centers for Medicare & Medicaid Services (CMS) must update fee schedules, certify providers, and run the virtual pilot, which could involve administrative costs but aim for long-term savings through reduced hospitalizations (diabetes complications cost Medicare billions annually). No direct impact on international relations.
- Broader Healthcare System: Encourages higher utilization of preventive services, possibly lowering overall Medicare spending if the model proves effective.
Main Stakeholders Affected
- Medicare Beneficiaries with Diabetes: Primary beneficiaries of expanded, free services and virtual access.
- Healthcare Providers: Physicians, nonphysician practitioners (e.g., nurses), and certified diabetes educators who can refer patients and deliver services.
- Digital Health and Education Providers: Companies offering web-based programs that must meet quality standards to participate in the virtual model.
- Government Entities: CMS and CMI for implementation and evaluation; congressional committees (Energy and Commerce, Ways and Means) for oversight.
- Patient and Professional Groups: Diabetes care organizations, clinicians, and advocates consulted in model design.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's role in chronic disease prevention under Title XVIII of the Social Security Act, potentially influencing future expansions of telehealth (virtual services) amid post-pandemic policy shifts. Ensures compliance with existing quality standards for providers without creating new regulatory burdens.
- Constitutional: No direct challenges; aligns with Congress's authority to regulate interstate commerce and social welfare programs like Medicare.
- Political: Bipartisan sponsorship (e.g., by Reps. Schrier and Bilirakis) highlights focus on affordable healthcare access. Could set precedent for innovation models in other chronic conditions, influencing budget debates on Medicare spending versus preventive investments.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (12)
Rep. Bilirakis, Gus M. [R-FL-12], Rep. DelBene, Suzan K. [D-WA-1], Rep. Wasserman Schultz, Debbie [D-FL-25], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Pocan, Mark [D-WI-2], Rep. Kelly, Mike [R-PA-16], Rep. Pingree, Chellie [D-ME-1], Rep. Grijalva, Adelita S. [D-AZ-7], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Pou, Nellie [D-NJ-9], Rep. Wilson, Joe [R-SC-2]
Recent Actions
- 2025-06-06: 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.
- 2025-06-06: 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.
- 2025-06-06: Introduced in House
- 2025-06-06: Introduced in House
Bill Versions
- Expanding Access to Diabetes Self-Management Training Act of 2025 — issued 2025-06-06 — PDF (8 pages)