II 

118TH CONGRESS 

1ST SESSION S. 3059 

To amend title XVIII of the Social Security Act to establish provider directory 

requirements, and to provide accountability for provider directory accuracy, under Medicare Advantage. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 17, 2023 

Mr. BENNET (for himself, Mr. TILLIS, and Mr. WYDEN) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to establish 

provider directory requirements, and to provide accountability for provider directory accuracy, under Medicare 

Advantage. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Requiring Enhanced 

5 & Accurate Lists of Health Providers Act’’ or the ‘‘REAL 

6 Health Providers Act’’. 

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1 SEC. 2. PROVIDER DIRECTORY REQUIREMENTS. 

2 Section 1852(c) of the Social Security Act (42 U.S.C. 

3 1395w–22(c)) is amended— 

4 (1) in paragraph (1)(C)— 

5 (A) by striking ‘‘plan, and any’’ and insert6 ing ‘‘plan, any’’; and 

7 (B) by inserting the following before the 

8 period: ‘‘, and, in the case of a network-based 

9 MA plan (as defined in paragraph (3)(C)), for 

10 plan year 2026 and subsequent plan years, the 

11 information described in paragraph (3)(B)’’; 

12 and 

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

14 paragraph: 

15 ‘‘(3) PROVIDER DIRECTORY ACCURACY.— 

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

17 and subsequent plan years, each MA organiza18 tion offering a network-based MA plan shall, 

19 for each network-based MA plan offered by the 

20 organization— 

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

22 internet website, an accurate provider di23 rectory that includes the information de24 scribed in subparagraph (B); 

25 ‘‘(ii) not less frequently than once 

26 every 90 days, verify in a manner specified 

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1 by the Secretary the provider directory in2 formation of each provider listed in such 

3 directory and, if applicable, update such 

4 provider directory information; 

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

6 verify such information with respect to a 

7 provider, include in such directory an indi8 cation that the information of such pro9 vider may not be up to date; 

10 ‘‘(iv) remove a provider from such di11 rectory within 5 business days if the orga12 nization determines that the provider is no 

13 longer a provider participating in the net14 work of such plan; and 

15 ‘‘(v) meet such other requirements as 

16 the Secretary may specify. 

17 ‘‘(B) PROVIDER DIRECTORY INFORMA18 TION.—The information described in this sub19 paragraph is information enrollees may need to 

20 access covered benefits from a provider with 

21 which such plan has an agreement for fur22 nishing items and services covered under such 

23 plan such as name, specialty, contact informa24 tion, primary office or facility address, avail25 ability, accommodations for people with disabilVerDate Sep 11 2014 04:17 Oct 18, 2023 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S3059.IS S3059
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1 ities, cultural and linguistic capabilities, and 

2 telehealth capabilities. 

3 ‘‘(C) NETWORK-BASED MA PLAN DE4 FINED.—In this paragraph, the term ‘network5 based MA plan’ means an MA plan that has a 

6 network of providers that contract or make ar7 rangements with the MA organization offering 

8 the plan to furnish items and services covered 

9 under such plan.’’. 

10 SEC. 3. ACCOUNTABILITY FOR PROVIDER DIRECTORY AC11 CURACY. 

12 (a) COST SHARING FOR SERVICES FURNISHED

13 BASED ON RELIANCE ON INCORRECT PROVIDER NET14 WORK INFORMATION.—Section 1852(d) of the Social Se15 curity Act (42 U.S.C. 1395w–22(d)) is amended by adding 

16 at the end the following new paragraph: 

17 ‘‘(7) COST SHARING FOR SERVICES FURNISHED

18 BASED ON RELIANCE ON INCORRECT PROVIDER NET19 WORK INFORMATION.— 

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

21 and subsequent plan years, if an enrollee is fur22 nished an item or service by a provider that is 

23 not participating in the network of a network24 based MA plan (as defined in subsection 

25 (c)(3)(C)) but is listed in the provider directory 

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1 of such plan (as required to be provided to an 

2 enrollee pursuant to subsection (c)(1)(C)) on 

3 the date on which the appointment is made, the 

4 MA organization offering such plan shall ensure 

5 that the enrollee is only responsible for the 

6 amount of cost sharing that would apply if such 

7 provider had been participating in the network 

8 of such plan. 

9 ‘‘(B) NOTIFICATION REQUIREMENT.—For 

10 plan year 2026 and subsequent plan years, each 

11 MA organization that offers a network-based 

12 MA plan shall— 

13 ‘‘(i) notify enrollees of their cost-shar14 ing protections under this paragraph and 

15 make such notifications, to the extent 

16 practicable, by not later than the first day 

17 of an annual, coordinated election period 

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

19 year; 

20 ‘‘(ii) include information regarding 

21 such cost-sharing protections in the pro22 vider directory of each network-based MA 

23 plan offered by the MA organization; and 

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1 ‘‘(iii) notify enrollees of their cost2 sharing protections under this paragraph 

3 in an explanation of benefits.’’. 

4 (b) REQUIRED PROVIDER DIRECTORY ACCURACY

5 ANALYSIS AND REPORTS.— 

6 (1) IN GENERAL.—Section 1857(e) of the So7 cial Security Act (42 U.S.C. 1395w–27(e)) is 

8 amended by adding at the end the following new 

9 paragraph: 

10 ‘‘(6) PROVIDER DIRECTORY ACCURACY ANAL11 YSIS AND REPORTS.— 

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

13 years beginning on or after January 1, 2026, 

14 subject to subparagraph (C), a contract under 

15 this section with an MA organization shall re16 quire the organization, for each network-based 

17 MA plan (as defined in section 1852(c)(3)(C)) 

18 offered by the organization, to annually— 

19 ‘‘(i) conduct an analysis of the accu20 racy of the provider directory of such plan 

21 (including provider types with high inaccu22 racy rates, such as providers specializing in 

23 mental health and substance use disorder 

24 treatment, as determined by the Sec25 retary); and 

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

2 containing the results of such analysis and 

3 other information required by the Sec4 retary. 

5 ‘‘(B) CONSIDERATIONS.—In establishing 

6 requirements with respect to analysis and re7 porting under this paragraph, the Secretary 

8 shall take into account— 

9 ‘‘(i) data sources maintained by of 

10 MA organizations; 

11 ‘‘(ii) publicly available data sets; and 

12 ‘‘(iii) the administrative burden of 

13 maintaining provider directories on plans 

14 and providers. 

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

16 waive the requirements of this paragraph in the 

17 case of a network-based MA plan with low en18 rollment (as defined by the Secretary). 

19 ‘‘(D) TRANSPARENCY.—The Secretary 

20 shall post accuracy scores (as reported under 

21 subparagraph (A)), in a machine readable file, 

22 on the internet website of the Centers for Medi23 care & Medicaid Services. 

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1 ‘‘(E) IMPLEMENTATION.—The Secretary 

2 shall implement this paragraph through notice 

3 and comment rulemaking.’’. 

4 (2) PROVISION OF INFORMATION TO BENE5 FICIARIES.—Section 1851(d)(4) of the Social Secu6 rity Act (42 U.S.C. 1395w–21(d)(4)) is amended by 

7 adding at the end the following new subparagraph: 

8 ‘‘(F) PROVIDER DIRECTORY.—Information 

9 regarding the accuracy of the plan’s provider 

10 directory (as reported under section 1857(e)(6)) 

11 on the plan’s provider directory.’’. 

12 (3) FUNDING.—In addition to amounts other13 wise available, there is appropriated to the Centers 

14 for Medicare & Medicaid Services Program Manage15 ment Account, out of any money in the Treasury not 

16 otherwise appropriated, $1,000,000 for fiscal year 

17 2026, to remain available until expended, to carry 

18 out the amendments made by this subsection. 

19 (c) GAO STUDY AND REPORT.— 

20 (1) ANALYSIS.—The Comptroller General of the 

21 United States (in this subsection referred to as the 

22 ‘‘Comptroller General’’) shall conduct study of the 

23 implementation of the amendments made by sub24 sections (a) and (b). Such study shall include an 

25 analysis of— 

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1 (A) the use of protections required under 

2 section 1852(d)(7) of the Social Security Act, 

3 as added by subsection (a); 

4 (B) the provider directory accuracy scores 

5 trends under section 1857(e)(6) of the Social 

6 Security Act (as added by subsection (b)(1)), 

7 both overall and among providers specializing in 

8 mental health and substance disorder treat9 ment; and 

10 (C) other items determined appropriate by 

11 the Comptroller General. 

12 (2) REPORT.—Not later than January 1, 2031, 

13 the Comptroller General shall submit to Congress, 

14 the Commissioner of Social Security, and the Sec15 retary of Health and Human Services a report con16 taining the results of the study conducted under 

17 paragraph (1), together with recommendations for 

18 such legislation and administrative action as the 

19 Comptroller General determines appropriate. 

20 SEC. 4. GUIDANCE ON BEST PRACTICES FOR MAINTAINING 

21 ACCURATE PROVIDER DIRECTORIES. 

22 Not later than 12 months after the date of enactment 

23 of this Act, the Secretary of Health and Human Services 

24 shall issue guidance to Medicare Advantage organizations 

25 offering Medicare Advantage plans under part C of title 

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1 XVIII of the Social Security Act (42 U.S.C. 1395w–21 

2 et seq.) on maintaining accurate provider directories for 

3 such plans. Such guidance may include the following, as 

4 determined appropriate by the Secretary: 

5 (1) Best practices for Medicare Advantage 

6 plans on how to work with providers to maintain the 

7 accuracy of provider directories of such plans and 

8 reduce provider and Medicare Advantage plan bur9 den. 

10 (2) Information on data sets and data sources 

11 with information that could be used by such plans 

12 to maintain accurate provider directories. 

13 (3) Approaches for utilizing existing informa14 tion assets of plans and publicly available data sets 

15 and data sources to maintain accurate provider di16 rectories. 

17 (4) Information that may be useful for bene18 ficiaries to assess plan networks when selecting a 

19 plan and accessing providers participating in plan 

20 networks during the plan year. 

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