Expanding Access to Diabetes Self-Management Training Act of 2025
The Expanding Access to Diabetes Self-Management Training Act of 2025 would broaden and strengthen Medicare coverage for diabetes outpatient self-management training (DSMT). Key changes include expanding the amount of DSMT that can be provided (an initial 10 hours, plus 2 hours per year thereafter, with no hard cap if medically necessary), widening who may supervise the training to include physicians or qualified nonphysician practitioners, and ensuring DSMT costs are fully covered (Medicare would pay 100% of the lesser of the actual charge or the applicable fee schedule; deductibles for DSMT would not apply). The bill also requires the Center for Medicare and Medicaid Innovation (CMI) to pilot and evaluate virtual DSMT services through a dedicated model, with a plan to test coverage for virtual DSMT for Medicare beneficiaries. These provisions are effective for items and services furnished on or after January 1, 2027. The virtual DSMT testing would be designed to assess health outcomes (like A1c), hospitalizations, service utilization, medication adherence, and overall expenditures, and would involve stakeholder consultation. In short, the bill aims to improve access to DSMT, reduce out-of-pocket costs for beneficiaries, broaden provider eligibility, and explore the viability of virtual, web-based DSMT programs through a formal pilot with defined quality standards.
Key Points
- 1Expanded DSMT hours and no rigid cap when medically necessary
- 2- Initial 10 hours of DSMT (individual or group) available until used.
- 3- Additional 2 hours per year thereafter.
- 4- No limit on quantity or duration if deemed medically necessary by a physician or qualified nonphysician practitioner.
- 5Broadening who can provide DSMT and professional scope
- 6- Replaces “physician who is managing the condition” with “a physician or qualified nonphysician practitioner” for supervising DSMT.
- 7Improved cost-sharing and patient protections
- 8- Medicare would pay 100% of the lesser of the actual charge or the applicable fee schedule for DSMT services.
- 9- DSMT-related deductibles would not apply, effectively reducing or eliminating patient out-of-pocket costs for these services.
- 10- Applies to items and services furnished on or after January 1, 2027.
- 11Medical Nutrition Therapy (MNT) linkage clarified
- 12- Adjusts MNT-related provisions to reflect “consistent with” current standards, aligning with the DSMT changes.
- 13Virtual DSMT testing and pilot by CMI
- 14- CMI must test virtual DSMT coverage under Medicare, with a model implemented not later than January 1, 2026.
- 15- Model design aims to evaluate outcomes such as reduced A1c, fewer hospitalizations, increased DSMT use (including in rural/underserved areas), improved medication adherence, and reduced expenditures.
- 16- Requires a flexible stakeholder consultation process within 3 months after enactment to inform model design.
- 17- Defines key terms: applicable beneficiary (adult with diabetes), qualified web-based program (meets quality standards and provides DSMT via web-based means), and virtual DSMT (synchronous or asynchronous DSMT delivered through a qualified web-based program).