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Congress·In Committee·6 months ago

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

Legislative Progress

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Impact Analysis

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

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 If a plan cannot confirm a doctor's information, they must clearly label that doctor's listing as potentially out of date so patients are not misled.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  • The policy specifically targets mental health and substance use disorder providers, which often have the most outdated information.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

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 News

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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.

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Behavioral Health Business·almost 2 years ago

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.

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Becker's Payer Issues·5 months ago

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.

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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. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.