A bill to ensure continued access to diabetes technology upon Medicare enrollment, and for other purposes.
SB4037, the DIABETES Act, is a Medicare-focused bill intended to preserve and expand access to diabetes technologies and diabetes education services for beneficiaries, especially as they enroll in Medicare. It would direct the Secretary of Health and Human Services to recognize the software and algorithms that power automated insulin delivery systems as separately payable items under Medicare, and it would create a certification process during a beneficiary’s first year in Part B to help ensure continuity of coverage for diabetes technologies already in use. The bill also seeks to improve access to diabetes outpatient self-management training by expanding who may certify services, setting minimum covered training hours, and eliminating cost-sharing and deductibles for those services.
The bill further requires CMS to test virtual diabetes self-management training through a model under the Center for Medicare and Medicaid Innovation, establish new billing codes for insulin pump hook-up, calibration, and patient training, and issue a proposed national coverage determination for insulin pumps. It also directs the Government Accountability Office, in coordination with HHS, to report on barriers to access across federal health programs, including prior authorization, preferred formularies, and other utilization management practices. Finally, it would amend Medicare competitive bidding and coverage rules to protect access to continuous glucose monitors and insulin pumps, including a later change to how certain diabetes-related items are treated under the competitive bidding program.
If enacted, the bill would amend multiple provisions of the Social Security Act governing Medicare Part B, durable medical equipment, diabetes self-management education, cost-sharing, competitive bidding, and coverage determinations. It would create new administrative duties for HHS and CMS, including issuing certification forms, guidance to Medicare contractors, new HCPCS billing codes, a proposed national coverage determination, and a CMMI demonstration model. The bill would also affect Medicare beneficiaries with diabetes, providers who furnish diabetes education and pump services, suppliers of CGMs and insulin pumps, and potentially other federal health programs through the required access report.
The bill’s stated purpose and structure suggest generally supportive sentiment toward expanding access to diabetes technology and education, with a strong emphasis on continuity of care, innovation, and reducing barriers for Medicare beneficiaries. The introduction by Senators Shaheen and Collins indicates bipartisan sponsorship, and the bill’s findings frame the issue as a patient-access and public-health concern. No committee transcript or vote record is provided, so there is no recorded opposition or amendment debate in the available materials.
The main points of potential contention are the bill’s impact on Medicare spending, administrative complexity, and the scope of coverage obligations. The bill explicitly criticizes current Medicare reimbursement and competitive bidding policies, especially CMS’s treatment of continuous glucose monitors, insulin pumps, and the software/algorithms used in automated insulin delivery systems. Stakeholders who favor tighter utilization management or lower program costs may object to mandatory coverage expansions, elimination of cost-sharing for self-management training, and limits on audit or contractor actions that could disrupt access. By contrast, diabetes advocates, clinicians, and technology manufacturers are likely to support the bill’s access protections and reimbursement changes.