Diabetes Act

This bill ensures continued access to diabetes technology when individuals enroll in Medicare, and expands related training and education services. It amends the Social Security Act to require care continuity for diabetes technology, expand self-management training, create new billing codes for insulin pump training, and mandate reports on access barriers.

Sec. 3, Continued access to diabetes technologies: During the first 12 months of Medicare Part B enrollment, a provider can certify that an individual is using diabetes technology covered under Part B. The Secretary must issue a certification form by January 1, 2026, and develop a process to consider coverage for technologies not currently covered. This applies to items and services furnished on or after January 1, 2026.

Sec. 4, Expanding access to diabetes outpatient self-management training: Amends the definition of diabetes outpatient self-management training to allow qualified non-physician practitioners to provide and refer for services, and removes limits on the quantity or duration of training if deemed medically necessary. Applies to items and services furnished on or after January 1, 2026.

Sec. 5, Providing insulin pump training and education: By January 1, 2026, the Secretary must establish new billing codes for insulin pump hook-up, calibration, and patient training, similar to existing codes. The Secretary must also educate stakeholders on billing for these codes.

Sec. 6, National coverage determination on insulin pumps: Within 180 days of enactment, the Secretary must issue a proposed national coverage determination for insulin pumps (continuous subcutaneous insulin infusion).

Sec. 7, Report on enrollee access to diabetes-related services and technologies: Within one year, the Comptroller General must report to Congress on barriers to accessing diabetes technologies and self-management education across federal health care programs, including prior authorization, formulary restrictions, and coverage limits.