REAL Health Providers Act
- Sponsor
- Sen. Bennet, Michael F. [D-CO]
- Committees
- Finance Committee (primary)
- Last action
- Jan 29, 2026
Bottom line
The bill aims to significantly improve the accuracy of Medicare Advantage provider directories, enhance transparency, and protect enrollees from unexpected costs due to outdated or incorrect provider information.
What it actually does
This bill mandates Medicare Advantage (MA) organizations to maintain accurate, publicly available online provider directories for 'specified MA plans' starting in 2028. It requires frequent verification of provider information, timely removal of non-participating providers, and establishes cost-sharing protections for enrollees who rely on incorrect directory information. Additionally, it requires MA organizations to conduct annual accuracy analyses, submit reports to the Secretary of Health and Human Services, and makes these accuracy scores publicly available.
Proponents argue
Supporters argue that this bill is crucial for empowering Medicare Advantage enrollees by providing reliable information to find in-network care, thereby reducing frustration and unexpected medical bills. They contend it will improve access to necessary services, particularly for mental health and substance use disorder treatment, by holding MA organizations accountable for the accuracy of their provider lists.
Opponents contend
Critics may argue that the bill imposes significant new administrative burdens and compliance costs on Medicare Advantage organizations and healthcare providers, particularly with the frequent verification requirements. They might contend that these costs could ultimately be passed on to beneficiaries through higher premiums or lead to reduced provider participation in MA networks.
The bill is relatively short and its core provisions are straightforward, making it accessible for an informed reader to evaluate within a reasonable timeframe.
Section 2(a), amending Section 1852(c) of the Social Security Act
Establishment of Provider Directory Accuracy Requirements for MA Plans
This provision mandates that Medicare Advantage organizations offering certain types of plans (network-based or specific private fee-for-service plans) must maintain accurate provider directories on a publicly available website, starting in plan year 2028. It requires them to verify provider information at least every 90 days (or annually for hospitals/facilities) and to remove providers no longer in the network within 5 business days. Directories must include information like name, specialty, contact details, whether new patients are accepted, and accessibility features.
Supporters argue
Supporters contend that these requirements are essential to ensure beneficiaries can reliably find in-network providers, reducing wasted time and frustration. They argue that frequent verification is necessary to keep pace with changes in provider networks and contact information.
Critics contend
Opponents may argue that the 90-day verification cycle is overly aggressive and creates an unmanageable administrative burden for plans, especially those with large networks. They might suggest it could lead to increased operational costs that are ultimately passed on to beneficiaries.
Tradeoffs
The provision balances the critical need for accurate provider information for beneficiaries against the substantial administrative and financial burden placed on MA organizations and providers to maintain such accuracy.
Section 2(b)(1), amending Section 1852(d) of the Social Security Act
Enrollee Cost-Sharing Protections for Incorrect Directory Information
Beginning in plan year 2028, if an enrollee in a specified MA plan receives a covered service from a provider who was listed in the plan's directory at the time of appointment but is not actually participating in the network, the enrollee's cost-sharing is limited. They will only be responsible for the lesser of the in-network cost-sharing amount or the standard out-of-network cost-sharing. MA organizations are also required to notify enrollees of these protections.
Section 2(b)(2)(A), amending Section 1857(e) of the Social Security Act
Annual Accuracy Analysis and Public Reporting
Starting with plan years beginning in 2028, MA organizations must annually conduct an analysis to estimate the accuracy of their provider directories. This analysis must use a random sample of providers, including those in specialties with historically high inaccuracy rates, such as mental health or substance use disorder treatment. Organizations must submit a report with an accuracy score to the Secretary, who will specify the verification methods and scoring methodology. Beginning in 2029, the Secretary will publicly post these accuracy scores in a machine-readable format.
Section 2(c)
Stakeholder Engagement and Guidance Issuance
The bill requires the Secretary of Health and Human Services to hold a public meeting within six months of enactment to gather input from stakeholders (including CMS, health tech, insurers, providers, and patient advocates) on best practices for maintaining accurate MA provider directories and reducing administrative burden. Within 18 months, the Secretary must issue guidance to MA organizations based on this input. Additionally, within 12 months, the Secretary must issue guidance to Part B providers on when to update their information in the National Plan and Provider Enumeration System (NPPES).
The definition of 'specified MA plan,' which determines which Medicare Advantage plans are subject to the new provider directory requirements. It includes 'network-based plans' (as defined in subsection (d)(5)(C)) and certain 'Medicare Advantage private fee-for-service plans' that meet access standards through contracts.
Section 2(a)(2), amending Section 1852(c)(3)(C)
Why it matters:This is standard legislative drafting practice to avoid redundancy and maintain consistency with existing law, rather than an attempt to obscure.
Case for: Supporters would argue that referencing existing definitions ensures legal consistency and avoids creating new, potentially conflicting, definitions for established plan types.
Case against: Critics might argue that such extensive cross-referencing makes the bill less accessible to the public and requires specialized legal knowledge to fully comprehend its applicability.
Estimated impact: This definition determines the universe of MA plans (the vast majority) that will be subject to the new directory accuracy and accountability requirements.
An appropriation of $4,000,000 for fiscal year 2026 to the Centers for Medicare & Medicaid Services Program Management Account, to remain available until expended, for carrying out the amendments related to provider directory accuracy analysis and reports.
Section 2(b)(2)(C)
Why it matters:This is a common legislative practice to group funding provisions, but it can make it less prominent than the policy changes it supports.
Case for: Proponents would argue that this appropriation is necessary to provide CMS with the resources to effectively implement the new requirements, develop methodologies, and manage the reporting and public posting of accuracy scores.
Case against: Critics might argue that this is an additional cost to taxpayers, and that the full financial implications for CMS or the broader healthcare system are not fully transparent.
Estimated impact: Provides $4 million in federal funding to CMS for specific program management activities related to the bill's implementation.