Expanding Access to Diabetes Self-Management Training Act of 2025

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3826 Introduced in House (IH)]

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119th CONGRESS
  1st Session
                                H. R. 3826

 To amend title XVIII of the Social Security Act to improve access to
 diabetes outpatient self-management training services, to require the
 Center for Medicare and Medicaid Innovation to test the provision of
virtual diabetes outpatient self-management training services, and for
                            other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              June 6, 2025

  Ms. Schrier (for herself, Mr. Bilirakis, Ms. DelBene, Ms. Wasserman
   Schultz, and Ms. Norton) introduced the following bill; which was
 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

_______________________________________________________________________

                                 A BILL

 To amend title XVIII of the Social Security Act to improve access to
 diabetes outpatient self-management training services, to require the
 Center for Medicare and Medicaid Innovation to test the provision of
virtual diabetes outpatient self-management training services, and for
                            other purposes.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Expanding Access to Diabetes Self-
Management Training Act of 2025''.

SEC. 2. IMPROVING ACCESS TO DIABETES OUTPATIENT SELF-MANAGEMENT
              TRAINING SERVICES.

    (a) In General.--Section 1861(qq) of the Social Security Act (42
U.S.C. 1395x(qq)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``the Secretary determines
                appropriate'' and inserting ``specified in paragraph
                (3)''; and
                    (B) by striking ``the physician who is managing the
                individual's diabetic condition'' and inserting ``a
                physician or qualified nonphysician practitioner'';
            (2) in paragraph (2)(B), by striking ``paragraph'' and
        inserting ``subparagraph''; and
            (3) by adding at the end the following new paragraph:
    ``(3)(A) For purposes of paragraph (1) and subject to subparagraph
(B), the times specified in this paragraph are the following:
            ``(i) An initial 10 hours of individual or group
        educational and training services to remain available until
        used.
            ``(ii) An additional 2 hours of individual or group
        educational and training services each year, beginning with the
        year in which the initial 10 hours described in subparagraph
        (A) are completed.
    ``(B) The Secretary shall not limit the quantity or duration of
educational and training services furnished by a certified provider to
an individual with diabetes if such services are deemed medically
necessary by a physician or qualified non-physician practitioner.''.
    (b) Medical Nutrition Therapy Services.--Section 1861(s)(2)(V) of
the Social Security Act (42 U.S.C. 1395x(s)(2)(V)) is amended--
            (1) by striking clause (i);
            (2) by redesignating clauses (ii) and (iii) as clauses (i)
        and (ii), respectively; and
            (3) in clause (ii), as so redesignated, by striking ``after
        consideration of'' and inserting ``consistent with''.
    (c) Cost-Sharing.--Section 1833 of the Social Security Act (42
U.S.C. 1395l) is amended--
            (1) in subsection (a)(1)--
                    (A) by striking ``and (HH)'' and inserting
                ``(HH)''; and
                    (B) by inserting the following before the semicolon
                at the end: ``and (II) with respect to diabetes
                outpatient self-management training services (as
                defined in section 1861(qq)), the amount paid shall be
                100 percent of the lesser of the actual charge for the
                services or the amount determined under the fee
                schedule that applies to such services under this
                part;''; and
            (2) in subsection (b), in the first sentence--
                    (A) by striking ``, and (13)'' and inserting
                ``(13)''; and
                    (B) by striking ``1861(n)..''and inserting
                ``1861(n), and (14) such deductible shall not apply
                with respect to diabetes outpatient self-management
                training services (as defined in section 1861(qq))''.
    (d) Application.--The amendments made by this section shall apply
with respect to items and services furnished on or after January 1,
2027.

SEC. 3. CMI TESTING OF PROVIDING VIRTUAL DIABETES OUTPATIENT SELF-
              MANAGEMENT TRAINING SERVICES.

    Section 1115A of the Social Security Act (42 U.S.C. 1315a) is
amended--
            (1) in subsection (b)(2)(A), by adding at the end the
        following new sentence: ``The models selected under this
        subparagraph shall include the testing of the model described
        in subsection (h).''; and
            (2) by adding at the end the following new subsection:
    ``(h) Testing of Providing Virtual Diabetes Outpatient Self-
Management Training Services.--
            ``(1) Establishment.--Not later than January 1, 2026, the
        Secretary shall implement a model to test the impact of
        providing coverage under title XVIII for virtual diabetes
        outpatient self-management training services furnished to
        applicable beneficiaries with respect to improved health
        outcomes for such applicable beneficiaries and reduced
        expenditures under such title XVIII.
            ``(2) Model design.--
                    ``(A) In general.--The Secretary shall design the
                model under this subsection in such a manner to allow
                for the evaluation of demographic characteristics of
                applicable beneficiaries participating in such model
                and the extent to which such model accomplishes the
                following purposes:
                            ``(i) Improvement in health outcomes with
                        respect to the diabetic conditions, including
                        by reducing A1c levels.
                            ``(ii) Reduced hospitalizations due to
                        diabetic-related complications.
                            ``(iii) Increased utilization of diabetes
                        outpatient self-management training services as
                        evidenced by, for example, Medicare beneficiary
                        participation and utilization of covered hours
                        during the first year and subsequent years or
                        use of diabetes outpatient self-management
                        training services in rural and underserved
                        communities.
                            ``(iv) Improved medication adherence.
                            ``(v) Reduced expenditures under this title
                        attributable to the model.
                    ``(B) Consultation.--In designing the model under
                this subsection, the Secretary shall, not later than 3
                months after the date of the enactment of this
                subsection, consult with stakeholders in the field of
                diabetes care and education, clinicians in the primary
                care community, experts in digital health, and
                beneficiary groups.
            ``(3) Definitions.--In this subsection:
                    ``(A) Applicable beneficiary.--The term `applicable
                beneficiary' means an individual with diabetes as
                described in section 1861(qq).
                    ``(B) Qualified web-based program.--The term
                `qualified web-based program' means a web-based
                program--
                            ``(i) designed to furnish educational and
                        training services to an individual with
                        diabetes to ensure therapy compliance with
                        respect to the individual's diabetic condition
                        or to provide the individual with necessary
                        skills and knowledge (including skills related
                        to the self-administration of injectable drugs)
                        to participate in the individual's management
                        of such condition; and
                            ``(ii) that meets the quality standards
                        described in section 1861(qq)(2)(B).
                    ``(C) Virtual diabetes outpatient self-management
                training services.--The term `virtual diabetes
                outpatient self-management training services' means any
                diabetes outpatient self-management training services
                (as defined in section 1861(qq)) furnished by a
                qualified web-based program for synchronous or
                asynchronous diabetes outpatient self-management
                training services.''.
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