HR-5281 : Still Just a Bill

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The "Requiring Enhanced and Accurate Lists of Health Providers Act" or the "REAL Health Providers Act" (H.R. 5281) amends Title XVIII of the Social Security Act to improve the accuracy of provider directories under Medicare Advantage plans. Key provisions include:

• Provider Directory Requirements:
  • Medicare Advantage organizations offering specific network-based plans or private fee-for-service plans must maintain accurate, publicly available online provider directories.
  • Provider information must be verified at least every 90 days (or less frequently, but no less than every 12 months for hospitals/facilities).
  • Directories must indicate if provider information is unverified and remove providers within 5 business days if they no longer participate in the plan's network.
  • Directories must include essential information, such as provider name, specialty, contact information, address, acceptance of new patients, accommodations for disabilities, cultural/linguistic capabilities, and telehealth capabilities.
• Accountability for Inaccurate Directories:
  • Enrollees will only be responsible for the lower cost-sharing amount if they receive care from a provider listed in the plan's directory (when the appointment was made) but not participating in the plan’s network. This amount will either be what they would normally pay if the provider was in-network or what they would otherwise pay out-of-network.
  • Medicare Advantage organizations must notify enrollees of these cost-sharing protections.
• Provider Directory Analysis and Reporting:
  • Medicare Advantage organizations must annually analyze the accuracy of their provider directories.
  • They must submit accuracy reports to the Secretary of Health and Human Services, including an accuracy score.
  • The Secretary will publish these accuracy scores online.
• Increased Transparency:
  • The plan's provider directory accuracy score will be prominently displayed on the plan's provider directory.
• Guidance and Stakeholder Input:
  • The Secretary of Health and Human Services must convene a public meeting to gather input on maintaining accurate provider directories.
  • The Secretary must issue guidance to Medicare Advantage organizations and Part B providers on maintaining accurate directories and updating the National Plan and Provider Enumeration System.
• GAO Study:
  • The Comptroller General must study the implementation of these amendments and submit a report to Congress with recommendations.

The bill appropriates $4,000,000 for fiscal year 2026 to the Centers for Medicare & Medicaid Services Program Management Account to carry out these amendments.

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