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Congress·In Committee·H.R. 5281

Congress Proposes New Rules to Fix Inaccurate Medicare Advantage Doctor Directories and Protect Patients

REAL Health Providers Act

6 months ago·View on Congress.gov
Part of: Congress Targets Medicare Advantage 'Ghost Networks' with Directory Reform
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Stalled

No legislative action in over 90 days.

Legislative Progress

House
Senate
President
Law

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 If a plan cannot confirm a doctor's information, they must clearly label that doctor's listing as potentially out of date so patients are not misled.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  • The policy specifically targets mental health and substance use disorder providers, which often have the most outdated information.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.
Healthcare

Impact Analysis

Personal Impact

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Milestones

2 milestones2 actions
Sep 10, 2025House

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.

Sep 10, 2025

Introduced in House

Related Bills

4 bills
H.R. 7148Related bill

Consolidated Appropriations Act, 2026

Feb 3 — Became Public Law No: 119-75.

S. 3750Related bill

REAL Health Providers Act

Jan 29 — Read twice and referred to the Committee on Finance.

H.R. 1768Related bill

Lower Costs for Everyday Americans Act

Mar 3 — Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Budget, the Judiciary, and Education and Workforce, 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.

S. 891Related bill

Bipartisan Health Care Act

Mar 6 — Read twice and referred to the Committee on Finance.

Source Information

Document Type

Congressional Bill

Official Title

REAL Health Providers Act

Bill NumberHR 5281
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred 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.

Sponsor

Cosponsors

(8)
D: 5R: 3

Analysis generated by AI. Always verify with official sources.