Expanding Access to Diabetes Self-Management Training Act of 2025
- Bill Number
- S. 1925
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-02: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-04-28T11:03:22Z
AI-Generated Summary
Purpose
The Expanding Access to Diabetes Self-Management Training Act of 2025 aims to enhance Medicare coverage for diabetes outpatient self-management training (DSMT) services. DSMT refers to educational and training programs that help people with diabetes manage their condition through skills like monitoring blood sugar, diet, and medication use. The bill seeks to make these services more accessible, flexible, and affordable while testing virtual delivery options to improve health outcomes and reduce costs.
Key Provisions
- Expanded Eligibility and Ordering Authority: Medicare will cover DSMT services ordered by a physician or a qualified non-physician practitioner (such as a nurse practitioner or physician assistant who can diagnose and treat under Medicare rules).
- Flexible Service Hours:
- Initial coverage of 10 hours of individual or group DSMT sessions, available until fully used.
- Additional 2 hours per year starting after the initial 10 hours are completed.
- No limits on hours or duration if a physician or qualified non-physician practitioner deems more services medically necessary.
- Medical Nutrition Therapy (MNT) Adjustments: MNT, which involves nutrition counseling for diabetes management, will be aligned more closely with DSMT coverage requirements, ensuring consistency in how these related services are provided.
- Cost-Sharing Elimination:
- Medicare will pay 100% of the approved amount for DSMT services (the lesser of the provider's charge or the Medicare fee schedule rate).
- No annual deductible will apply to DSMT services.
- Virtual DSMT Testing Model:
- The Center for Medicare and Medicaid Innovation (CMMI), a part of the Centers for Medicare & Medicaid Services (CMS), must start testing a virtual DSMT model by January 1, 2026.
- This model will cover web-based programs (synchronous, like live video sessions, or asynchronous, like on-demand videos) that meet quality standards for diabetes education.
- The test will evaluate impacts on health (e.g., lower A1c blood sugar levels, fewer hospitalizations), medication adherence, service use (especially in rural or underserved areas), and overall Medicare spending.
- CMMI must consult with diabetes experts, primary care clinicians, digital health specialists, and patient groups within 3 months of enactment to design the model.
- Implementation Timeline:
- Cost and access improvements apply to services starting January 1, 2027.
- Virtual testing begins January 1, 2026.
Significant Changes to Existing Law
- From Limited to Flexible Coverage: Current Medicare DSMT rules limit initial coverage to 10 hours in the first year after diagnosis and 2 hours annually thereafter, with stricter time frames. The bill removes expiration on the initial 10 hours and allows unlimited additional services if medically necessary, shifting from rigid limits set by the Secretary of Health and Human Services to provider-determined needs.
- Broader Provider Input: Previously, only managing physicians could order DSMT; now qualified non-physician practitioners can too, expanding access.
- Full Coverage Introduction: DSMT was previously subject to 20% coinsurance and the Part B deductible; the bill eliminates these, making it fully covered like certain preventive services.
- MNT Revisions: Simplifies MNT billing and coverage language to better integrate it with DSMT, removing outdated clauses and emphasizing consistency with medical recommendations.
- New Innovation Mandate: Adds a required CMMI model for virtual services, which did not exist before, to explore telehealth expansions in diabetes care.
Potential Impacts
- On Medicare Beneficiaries: Increased access to DSMT could lead to better diabetes control, fewer complications (like emergency hospital visits), and lower out-of-pocket costs, particularly benefiting older adults, rural residents, and those in underserved communities who may struggle with in-person access.
- On Government Agencies: CMS and CMMI will need to update fee schedules, quality standards for virtual programs, and data tracking systems. The virtual model could inform future Medicare telehealth policies, potentially saving money by reducing expensive treatments for uncontrolled diabetes.
- On Healthcare Providers: More flexibility in service delivery may encourage certified diabetes educators and web-based programs to expand offerings, but they'll need to meet new quality criteria.
- On International Relations: Minimal direct impact, as this is a domestic Medicare-focused bill.
Main Stakeholders Affected
- Medicare Beneficiaries with Diabetes: Primary beneficiaries, gaining easier access to education and virtual options to manage their condition.
- Healthcare Providers: Physicians, non-physician practitioners, certified diabetes educators, and nutritionists who deliver DSMT and MNT services.
- Digital Health Companies: Developers of web-based diabetes programs, which could see new Medicare reimbursement opportunities through the CMMI test.
- Government Entities: CMS and CMMI, responsible for implementation, oversight, and evaluation.
- Patient Advocacy Groups: Organizations representing people with diabetes, involved in consultations to shape the virtual model.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens Medicare's preventive care framework under Title XVIII of the Social Security Act by mandating coverage expansions and innovation testing, potentially setting precedents for telehealth in chronic disease management. Ensures compliance with existing quality standards to avoid fraud or substandard care.
- Constitutional: No direct challenges; aligns with Congress's authority to regulate interstate commerce and spending for public health via Medicare.
- Political: Bipartisan sponsorship (by Senators Shaheen and Collins) highlights cross-party support for chronic disease initiatives. Could influence broader debates on Medicare sustainability, telehealth permanence post-COVID, and equity in rural healthcare, but may face scrutiny over added costs to the Medicare trust fund if utilization surges without corresponding savings.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (4)
Sen. Collins, Susan M. [R-ME], Sen. King, Angus S., Jr. [I-ME], Sen. Klobuchar, Amy [D-MN], Sen. Booker, Cory A. [D-NJ]
Recent Actions
- 2025-06-02: Read twice and referred to the Committee on Finance.
- 2025-06-02: Introduced in Senate
Bill Versions
- Expanding Access to Diabetes Self-Management Training Act of 2025 — issued 2025-06-02 — PDF (7 pages)