H.R. 3826 — Expanding Access to Diabetes Self-Management Training Act of 2025

This section eliminates Medicare Part B coinsurance and the Part B deductible for diabetes outpatient self-management training services (DSMTS)—education and training for beneficiaries with diabetes (or related conditions) on self-management, including blood glucose monitoring, diet, exercise, and medication—for services furnished on or after January 1, 2027 (previously, 20% coinsurance after the annual deductible). It revises DSMTS coverage requirements by (1) allowing certification of medical necessity by a physician or qualified nonphysician practitioner (previously, only the physician managing the diabetic condition); (2) specifying an initial 10 hours of individual or group sessions (available until used), plus 2 additional hours annually thereafter; and (3) prohibiting limits on quantity or duration if deemed medically necessary. It also makes conforming amendments to medical nutrition therapy services, striking a frequency limitation clause and requiring services to be consistent with standards of care (previously, after consideration of such standards).

This section requires the Center for Medicare and Medicaid Innovation (CMI) to test a new model under Medicare (title XVIII) providing coverage for virtual diabetes outpatient self-management training services—furnished via qualified web-based programs (i.e., those meeting Medicare quality standards for diabetes education and training, including therapy compliance and self-administration skills)—to applicable beneficiaries with diabetes, with implementation by January 1, 2026. (As background, the CMI tests innovative payment and service delivery models to reduce Medicare and Medicaid expenditures while preserving or enhancing care quality.) The model design, developed after consultation with diabetes stakeholders, clinicians, digital health experts, and beneficiaries within three months of enactment, evaluates participant demographics and impacts on (1) health outcomes such as reduced A1c levels, (2) diabetic-related hospitalizations, (3) service utilization including participation rates, covered hours, and access in rural/underserved areas, (4) medication adherence, and (5) Medicare expenditures.