119-hr3826

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3826 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3826

 To amend title XVIII of the Social Security Act to improve access to 
 diabetes outpatient self-management training services, to require the 
 Center for Medicare and Medicaid Innovation to test the provision of 
virtual diabetes outpatient self-management training services, and for 
 other purposes.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 June 6, 2025

 Ms. Schrier (for herself, Mr. Bilirakis, Ms. DelBene, Ms. Wasserman 
 Schultz, and Ms. Norton) introduced the following bill; which was 
 referred to the Committee on Energy and Commerce, and in addition to 
 the Committee on Ways and Means, for a period to be subsequently 
 determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

 A BILL

 To amend title XVIII of the Social Security Act to improve access to 
 diabetes outpatient self-management training services, to require the 
 Center for Medicare and Medicaid Innovation to test the provision of 
virtual diabetes outpatient self-management training services, and for 
 other purposes.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Expanding Access to Diabetes Self-
Management Training Act of 2025''.

SEC. 2. IMPROVING ACCESS TO DIABETES OUTPATIENT SELF-MANAGEMENT 
 TRAINING SERVICES.

    (a) In General.--

Section 1861

    (qq) of the Social Security Act (42 
U.S.C. 1395x

    (qq) ) is amended--

    (1) in paragraph

    (1) --
        (A) by striking ``the Secretary determines 
 appropriate'' and inserting ``specified in paragraph

    (3) ''; and
        (B) by striking ``the physician who is managing the 
 individual's diabetic condition'' and inserting ``a 
 physician or qualified nonphysician practitioner'';

    (2) in paragraph

    (2)
        (B) , by striking ``paragraph'' and 
 inserting ``subparagraph''; and

    (3) by adding at the end the following new paragraph:
 ``

    (3)
        (A) For purposes of paragraph

    (1) and subject to subparagraph
        (B) , the times specified in this paragraph are the following:
 ``
            (i) An initial 10 hours of individual or group 
 educational and training services to remain available until 
 used.
 ``
            (ii) An additional 2 hours of individual or group 
 educational and training services each year, beginning with the 
 year in which the initial 10 hours described in subparagraph
        (A) are completed.
 ``
        (B) The Secretary shall not limit the quantity or duration of 
educational and training services furnished by a certified provider to 
an individual with diabetes if such services are deemed medically 
necessary by a physician or qualified non-physician practitioner.''.

    (b) Medical Nutrition Therapy Services.--

Section 1861

    (s)

    (2)
            (V) of 
the Social Security Act (42 U.S.C. 1395x

    (s)

    (2)
            (V) ) is amended--

    (1) by striking clause
            (i) ;

    (2) by redesignating clauses
            (ii) and
            (iii) as clauses
            (i) and
            (ii) , respectively; and

    (3) in clause
            (ii) , as so redesignated, by striking ``after 
 consideration of'' and inserting ``consistent with''.
            (c) Cost-Sharing.--

Section 1833 of the Social Security Act (42 
U.S.C. 1395l) is amended--

    (1) in subsection

    (a)

    (1) --
        (A) by striking ``and

    (HH) '' and inserting 
 ``

    (HH) ''; and
        (B) by inserting the following before the semicolon 
 at the end: ``and
            (II) with respect to diabetes 
 outpatient self-management training services (as 
 defined in 

section 1861

    (qq) ), the amount paid shall be 
 100 percent of the lesser of the actual charge for the 
 services or the amount determined under the fee 
 schedule that applies to such services under this 
 part;''; and

    (2) in subsection

    (b) , in the first sentence--
        (A) by striking ``, and

    (13) '' and inserting 
 ``

    (13) ''; and
        (B) by striking ``1861

    (n) ..''and inserting 
 ``1861

    (n) , and

    (14) such deductible shall not apply 
 with respect to diabetes outpatient self-management 
 training services (as defined in 

section 1861

    (qq) )''.
            (d) Application.--The amendments made by this section shall apply 
with respect to items and services furnished on or after January 1, 
2027.

SEC. 3. CMI TESTING OF PROVIDING VIRTUAL DIABETES OUTPATIENT SELF-
 MANAGEMENT TRAINING SERVICES.

 

Section 1115A of the Social Security Act (42 U.S.C. 1315a) is 
amended--

    (1) in subsection

    (b)

    (2)
        (A) , by adding at the end the 
 following new sentence: ``The models selected under this 
 subparagraph shall include the testing of the model described 
 in subsection

    (h) .''; and

    (2) by adding at the end the following new subsection:
 ``

    (h) Testing of Providing Virtual Diabetes Outpatient Self-
Management Training Services.--
 ``

    (1) Establishment.--Not later than January 1, 2026, the 
 Secretary shall implement a model to test the impact of 
 providing coverage under title XVIII for virtual diabetes 
 outpatient self-management training services furnished to 
 applicable beneficiaries with respect to improved health 
 outcomes for such applicable beneficiaries and reduced 
 expenditures under such title XVIII.
 ``

    (2) Model design.--
 ``
        (A) In general.--The Secretary shall design the 
 model under this subsection in such a manner to allow 
 for the evaluation of demographic characteristics of 
 applicable beneficiaries participating in such model 
 and the extent to which such model accomplishes the 
 following purposes:
 ``
            (i) Improvement in health outcomes with 
 respect to the diabetic conditions, including 
 by reducing A1c levels.
 ``
            (ii) Reduced hospitalizations due to 
 diabetic-related complications.
 ``
            (iii) Increased utilization of diabetes 
 outpatient self-management training services as 
 evidenced by, for example, Medicare beneficiary 
 participation and utilization of covered hours 
 during the first year and subsequent years or 
 use of diabetes outpatient self-management 
 training services in rural and underserved 
 communities.
 ``
            (iv) Improved medication adherence.
 ``
            (v) Reduced expenditures under this title 
 attributable to the model.
 ``
        (B) Consultation.--In designing the model under 
 this subsection, the Secretary shall, not later than 3 
 months after the date of the enactment of this 
 subsection, consult with stakeholders in the field of 
 diabetes care and education, clinicians in the primary 
 care community, experts in digital health, and 
 beneficiary groups.
 ``

    (3) === Definitions. ===
-In this subsection:
 ``
        (A) Applicable beneficiary.--The term `applicable 
 beneficiary' means an individual with diabetes as 
 described in 

section 1861

    (qq) .
 ``
        (B) Qualified web-based program.--The term 
 `qualified web-based program' means a web-based 
 program--
 ``
            (i) designed to furnish educational and 
 training services to an individual with 
 diabetes to ensure therapy compliance with 
 respect to the individual's diabetic condition 
 or to provide the individual with necessary 
 skills and knowledge (including skills related 
 to the self-administration of injectable drugs) 
 to participate in the individual's management 
 of such condition; and
 ``
            (ii) that meets the quality standards 
 described in 

section 1861

    (qq)

    (2)
        (B) .
 ``
            (C) Virtual diabetes outpatient self-management 
 training services.--The term `virtual diabetes 
 outpatient self-management training services' means any 
 diabetes outpatient self-management training services 
 (as defined in 

section 1861

    (qq) ) furnished by a 
 qualified web-based program for synchronous or 
 asynchronous diabetes outpatient self-management 
 training services.''.
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