HR3826-119

What This Bill Does

The Expanding Access to Diabetes Self-Management Training Act changes Medicare diabetes education access. Section 2 amends the diabetes outpatient self-management training benefit so referral can come from a physician or qualified nonphysician practitioner, the initial 10 hours of individual or group training remain available until used, and beneficiaries receive two additional hours each year after completing the initial hours. HHS may not limit the quantity or duration of training furnished by a certified provider when a physician or qualified nonphysician practitioner deems it medically necessary. Those benefit changes apply to items and services furnished on or after January 1, 2027. Section 3 requires the Center for Medicare and Medicaid Innovation to implement, by January 1, 2026, a model testing Medicare coverage of virtual diabetes outpatient self-management training for applicable beneficiaries. The model must evaluate health outcomes such as A1c reduction, reduced diabetes-related hospitalizations, increased training use including in rural and underserved communities, improved medication adherence, and reduced Medicare spending. HHS must consult within three months with diabetes care and education stakeholders, primary care clinicians, digital health experts, and beneficiary groups. Qualified web-based programs can deliver synchronous or asynchronous training if they meet diabetes self-management quality standards.

Who Benefits and How

Medicare beneficiaries with diabetes benefit from preserved initial training hours and medically necessary additional training. Rural beneficiaries with diabetes benefit if the CMMI virtual model expands access to web-based training. Diabetes educators benefit from broader referrals and certified-provider training coverage. Qualified web-based diabetes programs benefit from a CMMI model testing virtual training coverage.

Who Bears the Burden and How

CMS benefit policy staff must update diabetes self-management training rules for 2027. CMMI staff must design and operate the virtual diabetes training model by January 1, 2026. Medicare administrative contractors must process claims under revised hour, referral, and medical-necessity rules. Medicare trust funds may bear higher training costs if utilization rises, offset only if complications and hospitalizations fall.

Key Provisions

• Expands Medicare diabetes training referrals to qualified nonphysician practitioners.
• Preserves the initial 10 hours of diabetes self-management training until used.
• Provides two annual training hours after completion of the initial hours.
• Prohibits limits on medically necessary certified-provider training.
• Requires CMMI to test virtual diabetes self-management training coverage by January 1, 2026.
• Requires evaluation of A1c, hospitalizations, utilization, medication adherence, underserved access, and Medicare spending.