I 

118TH CONGRESS 

2D SESSION H. R. 7708 

To amend title XVIII of the Social Security Act to require MA organizations 

offering network-based plans to maintain an accurate provider directory, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 15, 2024 

Mr. PANETTA (for himself, Mr. MURPHY, Ms. KUSTER, Mr. SCHNEIDER, and 

Mr. FITZPATRICK) introduced the following bill; which was 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 

A BILL 

To amend title XVIII of the Social Security Act to require 

MA organizations offering network-based plans to maintain an accurate provider directory, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. REQUIRING ENHANCED & ACCURATE LISTS OF 

4 (REAL) HEALTH PROVIDERS ACT. 

5 (a) IN GENERAL.—Section 1852(c) of the Social Se6 curity Act (42 U.S.C. 1395w–22(c)) is amended— 


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1 (1) in paragraph (1)(C)— 

2 (A) by striking ‘‘plan, and any’’ and insert3 ing ‘‘plan, any’’; and 

4 (B) by inserting before the period at the 

5 end: ‘‘, and, in the case of a network-based plan 

6 (as defined in paragraph (3)(C)), for plan year 

7 2026 and subsequent plan years, the informa8 tion described in paragraph (3)(B)’’; and 

9 (2) by adding at the end the following new 

10 paragraph: 

11 ‘‘(3) PROVIDER DIRECTORY ACCURACY.— 

12 ‘‘(A) IN GENERAL.—For plan year 2026 

13 and subsequent plan years, each MA organiza14 tion offering a network-based plan (as defined 

15 in subparagraph (C)) shall, for each network16 based plan offered by the organization— 

17 ‘‘(i) maintain, on a publicly available 

18 internet website, an accurate provider di19 rectory that includes the information de20 scribed in subparagraph (B); 

21 ‘‘(ii) not less frequently than once 

22 every 90 days (or, in the case of a hospital 

23 or any other facility determined appro24 priate by the Secretary, at a lesser fre25 quency specified by the Secretary but in no 


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1 case less frequently than once every 12 

2 months), verify the provider directory in3 formation of each provider listed in such 

4 directory and, if applicable, update such 

5 provider directory information; 

6 ‘‘(iii) if the organization is unable to 

7 verify such information with respect to a 

8 provider, include in such directory an indi9 cation that the information of such pro10 vider may not be up to date; 

11 ‘‘(iv) remove a provider from such di12 rectory within 5 business days if the orga13 nization determines that the provider is no 

14 longer a provider participating in the net15 work of such plan; and 

16 ‘‘(v) meet such other requirements as 

17 the Secretary may specify. 

18 ‘‘(B) PROVIDER DIRECTORY INFORMA19 TION.—The information described in this sub20 paragraph is information enrollees may need to 

21 access covered benefits from a provider with 

22 which such organization offering such plan has 

23 an agreement for furnishing items and services 

24 covered under such plan such as name, spe25 cialty, contact information, primary office or faVerDate Sep 11 2014 19:59 Apr 02, 2024 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H7708.IH H7708

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1 cility address, whether the provider is accepting 

2 new patients, accommodations for people with 

3 disabilities, cultural and linguistic capabilities, 

4 and telehealth capabilities. 

5 ‘‘(C) NETWORK-BASED PLAN.—In this 

6 paragraph, the term ‘network-based plan’ has 

7 the meaning given that term in subsection 

8 (d)(5)(C), except such term includes a Medicare 

9 Advantage private fee-for-service plan, as deter10 mined appropriate by the Secretary.’’. 

11 (b) ACCOUNTABILITY FOR PROVIDER DIRECTORY

12 ACCURACY.— 

13 (1) COST SHARING FOR SERVICES FURNISHED

14 BASED ON RELIANCE ON INCORRECT PROVIDER DI15 RECTORY INFORMATION.—Section 1852(d) of the 

16 Social Security Act (42 U.S.C. 1395w–22(d)) is 

17 amended— 

18 (A) in paragraph (1)(C)— 

19 (i) in clause (ii), by striking ‘‘or’’ at 

20 the end; 

21 (ii) in clause (iii), by striking the 

22 semicolon at the end and inserting ‘‘, or’’; 

23 and 

24 (iii) by adding at the end the fol25 lowing new clause: 


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1 ‘‘(iv) the services are furnished by a 

2 provider that is not participating in the 

3 network of a network-based plan (as de4 fined in subsection (c)(3)(C)) but is listed 

5 in the provider directory of such plan on 

6 the date on which the appointment is 

7 made, as described in paragraph (7)(A);’’; 

8 and 

9 (B) by adding at the end the following new 

10 paragraph: 

11 ‘‘(7) COST SHARING FOR SERVICES FURNISHED

12 BASED ON RELIANCE ON INCORRECT PROVIDER DI13 RECTORY INFORMATION.— 

14 ‘‘(A) IN GENERAL.—For plan year 2026 

15 and subsequent plan years, if an enrollee is fur16 nished an item or service by a provider that is 

17 not participating in the network of a network18 based plan (as defined in subsection (c)(3)(C)) 

19 but is listed in the provider directory of such 

20 plan (as required to be provided to an enrollee 

21 pursuant to subsection (c)(1)(C)) on the date 

22 on which the appointment is made, and if such 

23 item or service would otherwise be covered 

24 under such plan if furnished by a provider that 

25 is participating in the network of such plan, the 


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1 MA organization offering such plan shall ensure 

2 that the enrollee is only responsible for the 

3 amount of cost sharing that would apply if such 

4 provider had been participating in the network 

5 of such plan. 

6 ‘‘(B) NOTIFICATION REQUIREMENT.—For 

7 plan year 2026 and subsequent plan years, each 

8 MA organization that offers a network-based 

9 plan shall— 

10 ‘‘(i) notify enrollees of their cost-shar11 ing protections under this paragraph and 

12 make such notifications, to the extent 

13 practicable, by not later than the first day 

14 of an annual, coordinated election period 

15 under section 1851(e)(3) with respect to a 

16 year; 

17 ‘‘(ii) include information regarding 

18 such cost-sharing protections in the pro19 vider directory of each network-based plan 

20 offered by the MA organization.; and 

21 ‘‘(iii) notify enrollees of their cost22 sharing protections under this paragraph 

23 in an explanation of benefits.’’. 

24 (2) REQUIRED PROVIDER DIRECTORY ACCU25 RACY ANALYSIS AND REPORTS.— 


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1 (A) IN GENERAL.—Section 1857(e) of the 

2 Social Security Act (42 U.S.C. 1395w–27(e)) is 

3 amended by adding at the end the following 

4 new paragraph: 

5 ‘‘(6) PROVIDER DIRECTORY ACCURACY ANAL6 YSIS AND REPORTS.— 

7 ‘‘(A) IN GENERAL.—Beginning with plan 

8 years beginning on or after January 1, 2026, 

9 subject to subparagraph (C), a contract under 

10 this section with an MA organization shall re11 quire the organization, for each network-based 

12 plan (as defined in section 1852(c)(3)(C)) of13 fered by the organization, to annually— 

14 ‘‘(i) conduct an analysis estimating 

15 the accuracy of the provider directory of 

16 such plan using a sample of providers in17 cluded in such provider directory (includ18 ing provider specialties with high inaccu19 racy rates of provider directory informa20 tion, such as providers specializing in men21 tal health or substance use disorder treat22 ment, as determined by the Secretary); and 

23 ‘‘(ii) submit a report to the Secretary 

24 containing the results of such analysis, in25 cluding an accuracy score for such provider 


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1 directory (as determined using a method2 ology specified by the Secretary under sub3 paragraph (B)(i)), and other information 

4 required by the Secretary. 

5 ‘‘(B) DETERMINATION OF ACCURACY

6 SCORE.— 

7 ‘‘(i) IN GENERAL.—The Secretary 

8 shall specify methodologies for MA plans 

9 to use in estimating the accuracy of the 

10 provider directory information of such 

11 plans and determining the accuracy score 

12 for the plan’s provider directory. 

13 ‘‘(ii) CONSIDERATIONS.—In carrying 

14 out clause (i), the Secretary shall take into 

15 consideration— 

16 ‘‘(I) data sources maintained by 

17 MA organizations; 

18 ‘‘(II) publicly available data sets; 

19 ‘‘(III) the administrative burden 

20 on plans and providers; and 

21 ‘‘(IV) the relative importance of 

22 certain provider directory information 

23 on enrollee ability to access care. 

24 ‘‘(C) EXCEPTION.—The Secretary may 

25 waive the requirements of this paragraph in the 


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1 case of a network-based plan with low enroll2 ment (as defined by the Secretary). 

3 ‘‘(D) TRANSPARENCY.—Beginning with 

4 plan years beginning on or after January 1, 

5 2027, the Secretary shall post accuracy scores 

6 (as reported under subparagraph (A)(ii)), in a 

7 machine readable file, on the internet website of 

8 the Centers for Medicare & Medicaid Services. 

9 ‘‘(E) IMPLEMENTATION.—The Secretary 

10 shall implement this paragraph through notice 

11 and comment rulemaking.’’. 

12 (B) PROVISION OF INFORMATION TO

13 BENEFICIARIES.—Section 1851(d)(4) of the So14 cial Security Act (42 U.S.C. 1395w–21(d)(4)) 

15 is amended by adding at the end the following 

16 new subparagraph: 

17 ‘‘(F) PROVIDER DIRECTORY.—Beginning 

18 with plan years beginning on or after January 

19 1, 2027, the accuracy score of the plan’s pro20 vider directory (as reported under section 

21 1857(e)(6)(A)(ii)) on the plan’s provider direc22 tory.’’. 

23 (C) FUNDING.—In addition to amounts 

24 otherwise available, there is appropriated to the 

25 Centers for Medicare & Medicaid Services ProVerDate Sep 11 2014 19:59 Apr 02, 2024 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H7708.IH H7708

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1 gram Management Account, out of any money 

2 in the Treasury not otherwise appropriated, 

3 $1,000,000 for fiscal year 2025, to remain 

4 available until expended, to carry out the 

5 amendments made by this paragraph. 

6 (3) GAO STUDY AND REPORT.— 

7 (A) ANALYSIS.—The Comptroller General 

8 of the United States (in this paragraph referred 

9 to as the ‘‘Comptroller General’’) shall conduct 

10 study of the implementation of the amendments 

11 made by paragraphs (1) and (2). To the extent 

12 data are available and reliable, such study shall 

13 include an analysis of— 

14 (i) the use of protections required 

15 under section 1852(d)(7) of the Social Se16 curity Act, as added by paragraph (1); 

17 (ii) the provider directory accuracy 

18 scores trends under section 

19 1857(e)(6)(A)(ii) of the Social Security 

20 Act (as added by paragraph (2)(A)), both 

21 overall and among providers specializing in 

22 mental health or substance disorder treat23 ment; 

24 (iii) provider response rates by plan 

25 verification methods; and 


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1 (iv) other items determined appro2 priate by the Comptroller General. 

3 (B) REPORT.—Not later than January 15, 

4 2031, the Comptroller General shall submit to 

5 Congress a report containing the results of the 

6 study conducted under subparagraph (A), to7 gether with recommendations for such legisla8 tion and administrative action as the Comp9 troller General determines appropriate. 

10 (c) GUIDANCE ON MAINTAINING ACCURATE PRO11 VIDER DIRECTORIES.— 

12 (1) STAKEHOLDER MEETING.— 

13 (A) IN GENERAL.—Not later than 3 

14 months after the date of enactment of this Act, 

15 the Secretary of Health and Human Services 

16 (referred to in this subsection as the ‘‘Sec17 retary’’) shall hold a public stakeholder meeting 

18 to receive input on approaches for maintaining 

19 accurate provider directories for Medicare Ad20 vantage plans under part C of title XVIII of the 

21 Social Security Act (42 U.S.C. 1395w–21 et 

22 seq.), including input on approaches for reduc23 ing administrative burden such as data stand24 ardization and best practices to maintain pro25 vider directory information. 


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1 (B) PARTICIPANTS.—Participants of the 

2 meeting under subparagraph (A) shall include 

3 representatives from the Centers for Medicare & 

4 Medicaid Services and the Office of the Na5 tional Coordinator for Health Information 

6 Technology, health care providers, companies 

7 that specialize in relevant technologies, health 

8 insurers, and patient advocates. 

9 (2) GUIDANCE TO MEDICARE ADVANTAGE OR10 GANIZATIONS.—Not later than 12 months after the 

11 date of enactment of this Act, the Secretary shall 

12 issue guidance to Medicare Advantage organizations 

13 offering Medicare Advantage plans under part C of 

14 title XVIII of the Social Security Act (42 U.S.C. 

15 1395w–21 et seq.) on maintaining accurate provider 

16 directories for such plans, taking into consideration 

17 input received during the stakeholder meeting under 

18 paragraph (1). Such guidance may include the fol19 lowing, as determined appropriate by the Secretary: 

20 (A) Best practices for Medicare Advantage 

21 organizations on how to work with providers to 

22 maintain the accuracy of provider directories 

23 and reduce provider and Medicare Advantage 

24 organization burden with respect to maintaining 

25 the accuracy of provider directories. 


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1 (B) Information on data sets and data 

2 sources with information that could be used by 

3 Medicare Advantage organizations to maintain 

4 accurate provider directories. 

5 (C) Approaches for utilizing data sources 

6 maintained by Medicare Advantage organiza7 tions and publicly available data sets to main8 tain accurate provider directories. 

9 (D) Information to be included in the pro10 vider directory that may be useful for Medicare 

11 beneficiaries to assess plan networks when se12 lecting a plan and accessing providers partici13 pating in plan networks during the plan year. 

14 (3) GUIDANCE TO PART B PROVIDERS.—Not 

15 later than 12 months after the date of enactment of 

16 this Act, the Secretary shall issue guidance to pro17 viders of services and suppliers who furnish items or 

18 services for which benefits are available under part 

19 B of title XVIII of the Social Security Act (42 

20 U.S.C. 1395j et seq.) on when to update the Na21 tional Plan and Provider Enumeration System re22 garding any information changes. 

Æ 


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