Bill > HR5281

This bill, known as the REAL Health Providers Act, aims to improve the accuracy and transparency of provider directories for Medicare Advantage (MA) plans. Starting in 2028, MA organizations offering specified plans must maintain an up-to-date, publicly available online provider directory that includes detailed information such as provider names, specialties, contact information, patient acceptance status, disability accommodations, and telehealth capabilities. Organizations will be required to verify and update directory information at least every 90 days and remove providers who are no longer in the network within 5 business days. The bill introduces protections for enrollees who receive services from a provider listed in the directory but who is not actually in the plan's network, ensuring they will only be responsible for the lower of two potential cost-sharing amounts. Additionally, MA organizations will be required to conduct annual accuracy analyses of their provider directories, with the results to be publicly posted online starting in 2029. The bill also mandates a stakeholder meeting and subsequent guidance to help organizations maintain accurate directories while reducing administrative burden. A GAO study will be conducted to evaluate the implementation and effectiveness of these new requirements, with a report to Congress due by January 15, 2032.

Budget and Finance

https://www.congress.gov/bill/119th-congress/house-bill/5281/all-info