REAL Health Providers Act
Congress Proposes New Rules to Fix Inaccurate Medicare Advantage Doctor Directories and Protect Patients
Stalled
No legislative action in over 90 days.
Legislative Progress
Key Points
- Medicare Advantage plans would be required to update their online lists of doctors and hospitals at least every 90 days starting in 2028. If a plan cannot confirm a doctor's information, they must clearly label that doctor's listing as potentially out of date so patients are not misled.
- If you visit a doctor who is listed as "in-network" in the directory but has actually left the plan, you will be protected from surprise bills. Under this policy, you would only have to pay the lower, in-network price for that visit, and the insurance company would have to cover the rest.
- Insurance companies would have to remove doctors from their directories within five business days of learning the doctor is no longer in their network. This prevents "ghost networks" where plans look like they have many doctors available when they actually do not.
- Starting in 2029, the government will publish "accuracy scores" for each plan's doctor list. This allows you to see which insurance companies do the best job of keeping their information current before you sign up for a plan during open enrollment.
- The policy specifically targets mental health and substance use disorder providers, which often have the most outdated information. By requiring regular check-ins, the bill aims to make it easier for people to find available mental health care when they need it most.
Impact Analysis
Personal Impact
Life & Work
Small medical practices and independent healthcare providers will face new administrative requirements to respond to verification requests from Medicare Advantage plans at least every 90 days. While more accurate directories could bring them more appropriate patient referrals, the paperwork burden of frequent verification could be a strain on small offices with limited staff.
Programs
Disabilities
Milestones
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in House
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Related News
4 articles
Medicare Advantage Plans to Face Stricter Directory Rules
Medicare Advantage plans will soon be required to take steps to improve the timeliness and accuracy of information in their medical provider directories. The rule aims to make it easier for consumers to find in-network care and avoid 'ghost networks' that mislead seniors.
Senators Aim to End 'Fraudulent' Ghost Networks with Behavioral Health Bill
The REAL Health Providers Act would protect seniors from ghost networks by ensuring Medicare Advantage online provider directories stay up-to-date. The bill addresses inaccurate listings that lead to surprise bills and delayed care, especially in mental health services.
CMS posts final rule requiring submission of Medicare Advantage provider directories
CMS finalized a rule requiring Medicare Advantage plans to submit provider directory data for the Medicare Plan Finder. Plans must update data within 30 days of changes and attest annually to accuracy, aiming to reduce 'ghost networks' and improve transparency for beneficiaries.
Source Information
Document Type
Congressional Bill
Official Title
REAL Health Providers Act
Data Sources
Sponsor
Cosponsors
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