Diabetes Foot Health Access and Modernization Act of 2026
Summary
What This Bill Does
The Diabetes Foot Health Act expands the Medicaid definition of physician services. It adds the Medicare definition of a doctor of podiatric medicine, allowing qualifying podiatrists to furnish Medicaid physician services within the scope of practice permitted by state law. The change applies to services furnished on or after January 1, 2026, with extra implementation time for states that must enact legislation.
For Medicare's diabetic therapeutic-shoe benefit, the bill allows a physician as defined in the relevant Medicare subsection, including a qualifying podiatrist for covered functions, to document the patient's risk condition, attest to comprehensive diabetes care, and certify the need for therapeutic shoes. The same physician or another qualified individual may fit and furnish the shoes. This removes the current text's separate-prescriber structure and its general separation between the certifying physician and the supplier.
The bill also broadens listed foot-risk wording. Peripheral neuropathy may include altered sensation, weakness, or motor-control impairment; previous amputation reaches the lower extremity; and the ulceration language reaches other ulceration. At the same time, it expressly adds therapeutic shoes for people with diabetes to Medicare's designated health services, bringing them within the physician self-referral framework. These Medicare changes apply to items and services furnished on or after January 1, 2028.
Who Benefits and How
Medicaid enrollees gain access to podiatric physician services without a separate medical-doctor gatekeeper where state scope rules allow it. Medicare beneficiaries with diabetes gain a more direct certification and furnishing path. Podiatrists and therapeutic-footwear suppliers gain additional service opportunities, while anti-fraud officials gain an express self-referral hook for therapeutic shoes.
Who Bears the Burden and How
Federal and state Medicaid programs may pay for more podiatry services and must update claims and provider rules. Some physicians may lose certification visits or referrals. CMS, states, plans, and suppliers must implement new definitions and effective dates. Podiatrists or suppliers with prohibited financial relationships face tighter Stark-law compliance even as the certification pathway becomes less restrictive.
Key Provisions
- Expands Medicaid physician services to qualifying podiatrists.
- Limits podiatric services to state-authorized scope of practice.
- Applies the Medicaid change to services from January 1, 2026.
- Provides state-legislation implementation relief.
- Expands who may certify diabetic therapeutic-shoe need.
- Allows the certifying physician to fit or furnish covered shoes.
- Broadens listed diabetic foot-risk conditions.
- Adds therapeutic shoes to designated health services.
- Applies the Medicare changes from January 1, 2028.
- Preserves ordinary Medicare coverage and medical-necessity requirements.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
Expands Medicaid physician services to include podiatrists within state scope-of-practice limits, broadens and streamlines Medicare diabetic therapeutic-shoe certification and furnishing, and expressly subjects therapeutic shoes to Medicare physician self-referral restrictions.
Key Policy Areas
Diabetes Foot Care, Medicaid Physician Services, Medicare Therapeutic Shoes, Podiatry, Physician Self-Referral
Primary Purpose
Expands Medicaid physician services to include podiatrists within state scope-of-practice limits, broadens and streamlines Medicare diabetic therapeutic-shoe certification and furnishing, and expressly subjects therapeutic shoes to Medicare physician self-referral restrictions.
Policy Domains
Sections 2 and 3 Medicaid podiatry and Medicare therapeutic-shoe reforms
Identified Gains
- Medicaid enrollees needing podiatric care
- Medicare beneficiaries needing therapeutic shoes
- Podiatrists serving Medicaid patients
- Podiatrists certifying therapeutic shoes
- Therapeutic-footwear suppliers
- Rural patients lacking medical-doctor access
- Medicare anti-fraud enforcement officials
Identified Costs
- State Medicaid agencies updating physician rules
- Federal Medicaid accounts financing added services
- CMS claims-policy staff
- Physicians losing separate certification visits
- Suppliers subject to self-referral restrictions
- Podiatry practices reviewing financial relationships
- States requiring implementing legislation
Sponsors
Legislative Progress
In CommitteeReferred to the Committee on Energy and Commerce, and in …
Introduced in House
Mr. Joyce of Pennsylvania (for himself, Ms. DeGette, Mr. Rulli, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Foot-care referral programs, Medicaid enrollees needing podiatric care, Medicaid enrollees with diabetes
Medical doctors furnishing equivalent foot care, Physicians providing separate certification visits, Podiatrists certifying therapeutic shoes
CMS therapeutic-shoe policy staff, Federal Medicaid accounts, Medicare anti-fraud enforcement officials
Positive-direction: CMS therapeutic-shoe policy staff, Medicare anti-fraud enforcement officials, Medicare claims-processing contractors, Medicare trust funds
Negative-direction: Federal Medicaid accounts
State Medicaid agencies, State Medicaid claims staff, States requiring implementing legislation
Suppliers with physician financial relationships, Therapeutic-footwear suppliers
Rural diabetic-foot programs, Rural patients lacking physician access
Health plans updating shoe-benefit rules, Medicaid managed-care plans
Positive-direction: Health plans updating shoe-benefit rules
Negative-direction: Medicaid managed-care plans
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "patient"
- → Medicaid or Medicare beneficiary needing foot care
- "referrer"
- → Physician subject to Medicare self-referral restrictions
- "supplier"
- → Qualified individual fitting or furnishing therapeutic shoes
- "podiatrist"
- → Doctor of podiatric medicine acting within state scope
- "administrator"
- → CMS or state Medicaid official implementing coverage
Note: {'scope_ids': ['podiatry_and_therapeutic_shoe_access'], 'description': 'The bill loosens professional gatekeeping and supplier separation for therapeutic shoes while tightening financial-relationship rules by adding the shoes to designated health services; all podiatric authority remains bounded by state scope-of-practice law.'}
Key Definitions
Terms defined in this bill
A physician under the referenced Medicare definition who documents the qualifying condition, diabetes care, and need for therapeutic shoes.
Therapeutic shoes for a person with diabetes expressly added to the Medicare physician self-referral law's designated health services.
A doctor of podiatric medicine whose Medicaid physician services remain limited to functions authorized by state law.
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
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