The Expanding Access to Diabetes Self-Management Training Act of 2025 broadens Medicare coverage for diabetes outpatient self-management training (DSMT). It increases the available DSMT hours, allows physicians or qualified nonphysician practitioners to provide DSMT, and removes unconstrained limits so long as services are medically necessary.
The bill also revises cost-sharing to ensure DSMT services are fully covered (to the lesser of actual charge or the applicable fee schedule) and eliminates the deductible for these services, with an effective date for items and services furnished on or after January 1, 2027. In addition, the bill directs the Center for Medicare and Medicaid Innovation (CMI) to test a model that covers virtual DSMT, designed to evaluate health outcomes, utilization, and total expenditures, and to consult stakeholders in diabetes care and digital health during model design.
The overarching aim is to increase access, improve diabetes control, and inform future delivery of DSMT through virtual channels where appropriate.
At a Glance
What It Does
Amends DSMT provisions to provide an initial 10 hours plus 2 hours per year thereafter, removes limits if medically necessary, and expands provider eligibility to physicians or qualified nonphysician practitioners. It also reworks cost-sharing for DSMT services and adds a CMS Innovation Center test of virtual DSMT.
Who It Affects
Medicare beneficiaries with diabetes, DSMT providers (including non-traditional providers that become eligible), and web-based DSMT programs serving Medicare populations, especially in rural or underserved areas through virtual care.
Why It Matters
This signals a shift toward greater access to education and self-management support, which can improve clinical outcomes and potentially reduce diabetes-related complications and hospitalizations. The virtual DSMT test under CMS Innovation Center will generate evidence on digital delivery models and their impact on costs and health outcomes.
More articles like this one.
A weekly email with all the latest developments on this topic.
What This Bill Actually Does
The bill starts by clarifying and expanding the core DSMT provisions under Medicare. It adds a guaranteed initial block of 10 DSMT hours, followed by 2 additional hours each year, and it removes any hard cap as long as the services are medically necessary.
It also broadens who can deliver these DSMT services beyond physicians to include qualified nonphysician practitioners, ensuring a wider pool of providers can refer and deliver training. In tandem, the bill revises the medical nutrition therapy framework and makes DSMT costs more predictable for beneficiaries by requiring coverage of 100 percent of the lesser of the actual charge or the applicable fee schedule, and it eliminates the deductible for DSMT services.
The new provisions apply to items and services furnished on or after January 1, 2027, giving the system time to adapt and implement changes.
Separately, the act directs the CMS Innovation Center to design and test a model for virtual DSMT coverage. The design will assess whether virtual, web-based DSMT can improve health outcomes—such as lowering A1c—reduce hospitalizations related to diabetes, increase DSMT utilization (including in rural areas), improve medication adherence, and lower overall expenditures under title XVIII.
The Secretary must consult with diabetes care clinicians, primary care experts, digital health specialists, and beneficiary groups within three months of enactment to inform the model. Together, these provisions aim to remove access barriers, modernize DSMT delivery, and build evidence on virtual care mechanisms for diabetes management.
The Five Things You Need to Know
The bill sets an initial 10 hours of DSMT and 2 hours per year thereafter, with no undue cap if medically necessary.
It expands DSMT provider eligibility to include physicians and qualified nonphysician practitioners.
DSMT cost-sharing is set at 100% of the lesser of the actual charge or the applicable fee schedule; deductibles for DSMT are removed.
CMS must test virtual DSMT through a dedicated model that evaluates health outcomes, utilization, and expenditures.
The changes apply to items and services furnished on or after January 1, 2027.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short Title
This section designates the act as the Expanding Access to Diabetes Self-Management Training Act of 2025.
Improvements to Diabetes Outpatient Self-Management Training Access
Section 2(a) modifies 1861(qq) to establish an initial 10 hours of DSMT and 2 additional hours each year, with no fixed cap if the services are medically necessary. It also expands the pool of eligible providers to include physicians or qualified non-physician practitioners. Section 2(b) reworks the medical nutrition therapy provisions to align with the expanded DSMT framework, including its relationship to DSMT services. Section 2(c) updates cost-sharing under 1833, making DSMT services eligible for the 100 percent of the lesser of the actual charge or the applicable fee schedule, and removes the DSMT-related deductible. Section 2(d) specifies that these amendments apply to items and services furnished on or after January 1, 2027.
Testing of Virtual Diabetes Outpatient Self-Management Training Services
Section 3 adds a new CMS Innovation Center testing framework (1115A) to evaluate virtual DSMT coverage. The model must be designed to evaluate health outcomes (including A1c), hospitalizations, DSMT utilization, medication adherence, and overall expenditures under title XVIII. It requires stakeholder consultation within three months of enactment and defines key terms such as “applicable beneficiary,” “qualified web-based program,” and “virtual DSMT services.” The model should demonstrate whether virtual DSMT can improve outcomes and reduce costs while expanding access.
Provider Scope and Access
This subsection expands who can deliver DSMT to include physicians and qualified non-physician practitioners and clarifies that providers cannot be limited in quantity or duration if medical necessity is established by a physician or qualified practitioner, thus broadening access and capacity for DSMT delivery.
Effective Date
The amendments in Section 2 apply to items and services furnished on or after January 1, 2027, allowing time for implementation, provider training, and system adjustments for the expanded DSMT benefits and cost-sharing changes.
This bill is one of many.
Codify tracks hundreds of bills on Healthcare across all five countries.
Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries with diabetes who will gain more DSMT hours and improved access to education and self-management support
- Rural and underserved populations who can access DSMT via virtual formats and remote providers
- Certified DSMT providers and diabetes education programs that expand capacity and eligibility to offer DSMT
- Physicians and qualified non-physician practitioners who can refer or deliver DSMT more broadly
- Qualified web-based DSMT program developers that meet quality standards and participate in the virtual DSMT testing framework
Who Bears the Cost
- Medicare program costs associated with broader DSMT coverage and higher utilization
- CMS and the Innovation Center to design, implement, and evaluate the virtual DSMT model
- Providers and clinics expanding DSMT services may incur start-up and training costs to meet quality standards
- Payers (including Medicare Advantage plans) may face higher reimbursements for DSMT services until utilization stabilizes
- Administration and enforcement costs tied to monitoring medical necessity and program integrity for virtual DSMT
Key Issues
The Core Tension
The central dilemma is balancing expanded access and potential cost savings from better diabetes management against the risk of higher near-term Medicare expenditures and the challenges of deploying high-quality virtual DSMT at scale.
Analytically, the bill raises several tensions. Expanding DSMT hours and allowing non-physician practitioners to provide services could raise total Medicare expenditures in the near term, even if improved diabetes control reduces long-term costs.
The cost-sharing overhaul — moving to 100 percent of the lesser of actual charge or fee schedule and removing the DSMT deductible — improves patient access but creates higher immediate outlays for the Medicare program and could pressure DSMT providers to adjust pricing and billing practices. The virtual DSMT testing introduces uncertainty about effectiveness, patient eligibility, privacy safeguards, and technology equity, especially in populations with limited internet access.
The model’s success will hinge on selecting appropriate qualified web-based programs, ensuring consistent quality standards, and achieving measurable health outcomes. The bill also leaves several implementation questions open, including how “medically necessary” will be determined in diverse clinical settings and how the results of the CMS Innovation Center study will be integrated into future policy decisions.
Try it yourself.
Ask a question in plain English, or pick a topic below. Results in seconds.