S. 4070 — Diabetes Foot Health Access and Modernization Act of 2026

This section expands the definition of physicians' services under Medicaid—currently limited to services by doctors of medicine or osteopathy (i.e., cross-referencing SSA §1861(r)(1))—to also include services by doctors of podiatric medicine (i.e., by cross-referencing paragraphs (1) and (3) of SSA §1861(r)). (Thus, podiatrists' services qualify as mandatory physicians' services for Medicaid-eligible individuals such as children under age 21 (or lower at state option), pregnant women, seniors age 65 or older, and blind or disabled persons.) The change applies to services furnished on or after January 1, 2026, with a hold-harmless provision for states requiring legislation (i.e., plans not deemed noncompliant until the first calendar quarter after the first regular legislative session following enactment).

This section revises Medicare coverage criteria under section 1861(s)(12) of the Social Security Act for extra-depth shoes with inserts or custom-molded shoes with inserts for individuals with diabetes, requiring (1) a certifying physician to document risk factors such as peripheral neuropathy, pre-ulcerative calluses, foot deformity, prior amputation, or poor circulation; (2) the physician to attest to the individual's diabetes diagnosis and enrollment in a comprehensive diabetes care plan; and (3) the physician to attest to the medical necessity of the shoes, which must be fitted and furnished by a physician or other qualified provider (e.g., pedorthist or orthotist) as specified by the Secretary. It also adds such shoes as a new exception under the Stark Law (42 U.S.C. 1395nn(h)(6)(M)) to the prohibition on physician self-referrals for designated health services. The coverage criteria changes apply to items and services furnished on or after January 1, 2028.