Continued access to diabetes related technologies

(a) In general Section 1861(ww) of the Social Security Act (42 U.S.C. 1395x(ww)) is amended— (1) in paragraph (1)— (A) by striking and after upon the agreement with the individual,; and (B) by inserting and ensuring care continuity for individuals using diabetes technology covered under part B as described in paragraph (5), after (as defined in paragraph (4)),; and (2) by adding at the end the following new paragraph: (5) (A) Subject to subparagraphs (B) and (C) of this paragraph, during the first 12 months of an individual’s enrollment for benefits under part B, a provider (as defined in subparagraph (E)) may certify to the Secretary that an individual is using 1 or multiple diabetes technologies covered under part B (as defined in subparagraph (D)). (B) During the initial preventive physical examination or other covered service as determined appropriate by the Secretary during the period described in subparagraph (A), the provider may make a determination of the individual’s use of diabetes technology covered under part B. In the case where the provider makes such determination, the provider shall submit a certification to the Secretary as required under subparagraph (C). (C) Not later than January 1, 2027, the Secretary shall— (i) issue a finalized certification form, developed pursuant to public notice and opportunity for comment, for use under this paragraph; (ii) issue guidance and instructions to medicare administrative contractors (as defined in section 1874A(a)(3)), that require the relevant medicare administrative contractors to only assess whether the certification form is included in the individual’s medical records when making a determination of whether coverage of the diabetes technology covered under part B is reasonable and necessary as described in section 1862(a)(1)(A); (iii) develop a process through notice and comment rulemaking for considering whether an individual’s diabetes technology that is not covered under part B at the time of the certification described in subparagraph (A) should be a covered benefit under existing statutory authority; and (iv) issue appropriate guidance to relevant audit and oversight entities to ensure those entities do not inappropriately cause disruptions in access to diabetes technology covered under part B. (D) For purposes of this paragraph, the term diabetes technology covered under part B means, with respect to an individual, any device, related supplies, and software or algorithm that, at the time the certification described in subparagraph (C) is made with respect to the individual, is covered under part B for an individual that has diabetes under the applicable ICD–10 code list, as determined by the Secretary. (E) For purposes of this paragraph, the term provider means a physician (as defined in section 1861(r)), nurse practitioner, clinical nurse specialist, physician assistant, (as those terms are defined in section 1861(aa)(5)), or certified nurse-midwife (as defined in section 1861(gg)(2)), or other provider of services or supplier as determined appropriate by the Secretary.. (b) Effective date The amendments made by this section shall apply to items and services furnished on or after January 1, 2027.