Expanding Access to Diabetes Self-Management Training Act of 2025
The Expanding Access to Diabetes Self-Management Training Act of 2025 aims to broaden Medicare coverage and access for diabetes self-management training (DSMT). It creates a more generous DSMT benefit under Medicare Part B by guaranteeing an initial bag of hours (10 hours) plus an ongoing annual allotment (2 hours per year after the initial 10), with no statutory cap if a physician or qualified nonphysician practitioner deems it medically necessary. It also tweaks related diabetes care provisions (notably Medical Nutrition Therapy) and establishes a pathway for testing virtual DSMT through the Center for Medicare and Medicaid Innovation (CMMI), including a dedicated model to study the impact of virtual DSMT on health outcomes, hospitalizations, service use, medication adherence, and costs. The bill sets a clear implementation timeline, with virtual DSMT testing to begin by 2026 and overall DSMT-related changes to take effect for services furnished on or after January 1, 2027. In short, the bill expands DSMT access, removes patient cost barriers for DSMT, and accelerates experimentation with virtual DSMT programs to improve outcomes and potentially reduce Medicare spending.
Key Points
- 1Expanded DSMT benefit and provider flexibility
- 2- Introduces a new DSMT benefit structure: initial 10 hours of教育/training (individual or group) available until used, plus 2 additional hours per year thereafter; the total can be extended if medically necessary, and supervision may be provided by a physician or a qualified nonphysician practitioner.
- 3Medical Nutrition Therapy (MNT) and cost controls
- 4- Updates MNT-related provisions to align terminology and requirements with the revised DSMT framework, aiming for consistency with the new standard (the exact changes adjust how MNT is described and required).
- 5No patient cost-sharing for DSMT
- 6- Amends cost-sharing to ensure the Medicare payment for DSMT is fully covered to the extent it matches the applicable fee schedule or the actual charge, with the deductible not applying to DSMT services.
- 7Implementation timeline
- 8- Applies to items and services furnished on or after January 1, 2027; DSMT benefits and related changes become effective for that date.
- 9Testing virtual DSMT with CMMI
- 10- Directs the Center for Medicare and Medicaid Innovation to design and implement a model by 2026 to test virtual DSMT coverage under Part XVIII (Medicare). The model will assess health outcomes (including A1c), hospitalizations, DSMT utilization (especially in rural/underserved areas), medication adherence, and overall expenditures. It requires stakeholder consultation within 3 months after enactment and defines key terms like “applicable beneficiary,” “qualified web-based program,” and “virtual DSMT.”