Bill > S3059

This bill, the REAL Health Providers Act, aims to establish provider directory requirements and accountability measures for provider directory accuracy under Medicare Advantage plans. The key provisions include: 1. Requiring Medicare Advantage organizations to maintain accurate provider directories, verify provider information at least every 90 days, and remove providers who are no longer in the network. These directories must include information like provider name, specialty, contact details, and availability. 2. Ensuring that if an enrollee receives services from a provider listed in the directory but not in the plan's network, the enrollee only pays the in-network cost-sharing amount. The organizations must notify enrollees of this protection. 3. Requiring Medicare Advantage organizations to annually analyze the accuracy of their provider directories, submit reports to the Secretary of Health and Human Services, and making the accuracy scores publicly available. This provision includes an exception for plans with low enrollment. 4. Directing the Secretary to issue guidance on best practices for maintaining accurate provider directories, including recommendations on collaborating with providers, leveraging data sources, and providing useful information to beneficiaries. The overall goal of the bill is to improve the accuracy and transparency of provider directories for Medicare Advantage enrollees, ensuring they can access the in-network providers they expect.

Budget and Finance

https://www.congress.gov/bill/118th-congress/senate-bill/3059/all-info