The Expanding Access to Diabetes Self-Management Training Act of 2025 would amend Medicare’s DSMT provisions to broaden access by increasing education hours, expanding who can deliver the training, and reforming cost-sharing. It also directs the Centers for Medicare and Medicaid Innovation (CMI) to test virtual diabetes outpatient self-management training services under a demonstration.
The amendments would take effect for items and services furnished on or after January 1, 2027, and would be supported by a federal demonstration that evaluates health outcomes and expenditures.
In short, the bill tightens the linkage between education, access, and coverage, while laying groundwork for evaluating virtual delivery of DSMT. The core policy aims are to reduce diabetes-related complications through expanded education and to explore remote, potentially more accessible delivery models in Medicare.
The text also refines related nutrition therapy and cost-sharing provisions to support broader access.
At a Glance
What It Does
Amends the DSMT framework by adding an initial 10 hours of education, plus 2 hours annually thereafter, and by allowing physicians or qualified non-physician practitioners to provide these services. It also sets up 100% cost-sharing paid by Medicare for DSMT services, capped by the lesser of actual charges or the applicable fee schedule, and it removes certain prior limits if medically necessary. A separate provision tests virtual DSMT under a CMS demonstration.
Who It Affects
Medicare beneficiaries with diabetes, DSMT providers (including clinics and educators), and physicians or qualified non-physician practitioners who deliver DSMT; rural and underserved communities are specifically implicated via the virtual-delivery test.
Why It Matters
Expands access to essential diabetes education, with potential health-outcome improvements (e.g., A1c reductions) and reduced hospitalizations. The virtual-delivery test could unlock new, scalable care models if effective and cost-saving.
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What This Bill Actually Does
Section 2(a) expands DSMT hours and who can deliver them. It adds an initial 10 hours of education and an additional 2 hours per year, available beyond previous limits when medically necessary, and allows a physician or a qualified non-physician practitioner to supervise or provide the training.
These changes are designed to reduce barriers to education and ensure clinicians can refer patients to DSMT without worrying about rigid caps.
Section 2(b) updates Medical Nutrition Therapy (MNT) service provisions, reorganizing and aligning the MNT rules with the revised DSMT framework so that nutrition therapy remains covered in a way that complements DSMT. The redesign is focused on consistency and clarity in provider obligations and patient access.Section 2(c) alters cost-sharing for DSMT: the deductible will not apply to DSMT, and Medicare will pay 100% of the lesser of the actual charge or the applicable fee schedule for these services.
This reduces patient out-of-pocket costs and lowers barriers to using DSMT.Section 3 adds a testing regime under the CMΙ Innovation Center. By January 1, 2026, the Secretary must implement a model to test virtual DSMT coverage and evaluate its impact on health outcomes, hospitalizations, medication adherence, and overall expenditures.
The model includes definitions for applicable beneficiaries and qualified web-based programs and requires stakeholder input in its design. The amendments apply to items and services furnished on or after January 1, 2027, ensuring a clear transition window for implementation.
The Five Things You Need to Know
The bill adds an initial 10 hours of DSMT, plus 2 hours per year thereafter.
DSMT may be delivered by physicians or qualified non-physician practitioners.
DSMT services will be paid 100% by Medicare, up to the lesser of actual charge or fee schedule.
CMS must test virtual DSMT delivery under a dedicated demonstration.
Amendments apply to items and services furnished on or after January 1, 2027.
Section-by-Section Breakdown
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Expansion of DSMT hours and provider eligibility
Section 2(a) amends 1861(qq) to add an initial 10 hours of DSMT and 2 additional hours each year. It also expands who can furnish DSMT to include physicians or qualified non-physician practitioners, provided the services are medically necessary. The intent is to remove arbitrary caps and broaden the pool of eligible providers so more patients can receive DSMT when needed.
Medical Nutrition Therapy service adjustments
Section 2(b) reorganizes how Medical Nutrition Therapy (MNT) is defined and delivered within the Social Security Act. The changes remove a prior clause, realign subsections, and ensure MNT remains available in a way that is consistent with the revised DSMT framework. The practical effect is to harmonize nutrition therapy provisions with the expanded DSMT provisions and improve clarity for both providers and beneficiaries.
DSMT cost-sharing changes
Section 2(c) modifies cost-sharing by removing the traditional deductible in DSMT coverage and mandating 100% payment by Medicare, limited to the lesser of the actual charge or the applicable fee schedule for diabetes DSMT services. The alteration lowers patient financial barriers and aligns reimbursement with the goal of widespread DSMT utilization.
Effective date of amendments
Section 2(d) states that the amendments apply to items and services furnished on or after January 1, 2027. This provides a clear transition timeline for providers, payers, and CMS as they adapt to the expanded hours, broader provider eligibility, and new cost-sharing rules.
Testing of virtual DSMT services
Section 3 creates a new testing model under 1115A to evaluate virtual diabetes outpatient self-management training services. Not later than January 1, 2026, the Secretary must implement the model, designed to assess health outcomes, hospitalizations, medication adherence, and expenditures. The model requires consultation with diabetes care stakeholders and defines terms such as applicable beneficiaries and qualified web-based programs to ensure rigorous evaluation.
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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 gain access to more DSMT hours and reduced cost barriers.
- Certified DSMT providers and diabetes educators who can offer more hours and be reimbursed for expanded services.
- Primary care practices and clinics that rely on DSMT referrals to support diabetes management.
- Rural and underserved communities that gain access to virtual DSMT options.
- CMS and the Medicare program, which obtains a framework to evaluate virtual DSMT and its cost-effectiveness.
Who Bears the Cost
- Medicare program and taxpayers may incur higher short‑term costs from expanded DSMT coverage and the virtual DSMT demonstration.
- DSMT providers may face upfront costs to staff additional hours and adopt or expand delivery platforms (including virtual programs).
- Web-based DSMT vendors and digital health platforms may incur development and compliance costs to meet program standards and data reporting requirements.
- Administrative costs associated with implementing new documentation, supervision requirements, and quality standards for DSMT and MNT.
Key Issues
The Core Tension
Expanding access to DSMT while maintaining budgetary discipline and ensuring that virtual delivery maintains quality and yields real health improvements.
The bill’s approach to expanding DSMT hours and moving toward virtual delivery raises several tensions. On one hand, broader access to education can improve diabetes control and reduce downstream health care costs; on the other hand, expanded hours and virtual programs increase payer exposure and require robust quality controls to prevent misuse or low-value care.
The clarified MNT provisions help align nutrition therapy with DSMT, but also create potential ambiguity during the transition period as those standards are harmonized. The virtual DSMT demonstration depends on reliable data, stakeholder buy-in, and clear definitions of what constitutes an eligible beneficiary and a qualified web-based program, all of which require careful implementation and ongoing oversight.
Unresolved questions include how “medically necessary” will be evidenced to authorize additional DSMT hours, how qualified non-physician practitioners are defined in practice, and what safeguards ensure the quality and effectiveness of virtual DSMT across diverse populations. There is also the matter of budget impact and how the 100% cost-sharing reform interacts with existing Medicare cost structures, especially in a multi-payer environment.
Finally, the success of the virtual DSMT test hinges on the chosen metrics and the ability of digital platforms to meet established quality standards under section 1861(qq)(2)(B).
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