H.R. 7905 — Diabetes Foot Health Access and Modernization Act of 2026

This section expands the Medicaid definition of physicians' services to include those provided by doctors of podiatric medicine, as specified in paragraphs (1) and (3) of section 1861(r) of the Social Security Act (previously limited to paragraph (1)), for services furnished on or after January 1, 2026. (Thus, states must cover qualifying podiatric services comparably to other physician services.) It provides a state legislation grace period, under which a state plan is not deemed noncompliant until the first day of the first calendar quarter after the first regular legislative session following enactment (treating each year of a two-year session as separate).

This section revises Medicare Part B coverage criteria for extra-depth shoes with inserts or custom-molded shoes with inserts for individuals with diabetes under SSA §1861(s)(12) to require that a physician (1) document the presence of peripheral neuropathy (which may include altered foot sensation, weakness, or diminished motor control of the lower extremity), a history of pre-ulcerative calluses or other foot ulceration, foot deformity, previous lower extremity amputation, or poor lower extremity circulation; (2) attest that the individual has a diabetes diagnosis and is being treated under a comprehensive plan of care for the diabetic condition; and (3) attest that the individual needs the shoes, with the shoes fitted and furnished by a physician or other qualified individual (e.g., pedorthist or orthotist) as specified by the Secretary. (As background, these shoes are covered to prevent foot ulcers and amputations among at-risk Medicare beneficiaries with diabetes.) It further excludes these shoes from the definition of designated health services under the physician self-referral law (i.e., adds them to the list of excepted items and services in SSA §1877(h)(6)). (Thus, physicians with financial relationships in entities providing these shoes are not subject to Stark Law referral prohibitions for such shoes.) The coverage criteria changes apply to items and services furnished on or after January 1, 2028.