I 
119TH CONGRESS 
1ST SESSION H. R. 5281 
To amend title XVIII of the Social Security Act to establish provider directory 
requirements, and to provide accountability for provider directory accu-
racy, under Medicare Advantage. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 10, 2025 
Mr. PANETTA (for himself, Mr. MURPHY, Mr. LANDSMAN, 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 with-
in the jurisdiction of the committee concerned 
A BILL 
To amend title XVIII of the Social Security Act to establish 
provider directory requirements, and to provide account-
ability for provider directory accuracy, under Medicare 
Advantage. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Requiring Enhanced 
and Accurate Lists of Health Providers Act’’ or the 
‘‘REAL Health Providers Act’’. 
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SEC. 2. PROVIDER DIRECTORY REQUIREMENTS UNDER 
MEDICARE ADVANTAGE. 
(a) IN GENERAL.—Section 1852(c) of the Social Se-
curity Act (42 U.S.C. 1395w–22(c)) is amended— 
(1) in paragraph (1)(C)— 
(A) by striking ‘‘plan, and any’’ and insert-
ing ‘‘plan, any’’; and 
(B) by inserting the following before the 
period: ‘‘, and, in the case of a specified MA 
plan (as defined in paragraph (3)(C)), for plan 
year 2028 and subsequent plan years, the infor-
mation described in paragraph (3)(B)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(3) PROVIDER DIRECTORY ACCURACY.— 
‘‘(A) IN GENERAL.—For plan year 2028 
and subsequent plan years, each MA organiza-
tion offering a specified MA plan (as defined in 
subparagraph (C)) shall, for each such plan of-
fered by the organization— 
‘‘(i) maintain, on a publicly available 
internet website, an accurate provider di-
rectory that includes the information de-
scribed in subparagraph (B); 
‘‘(ii) not less frequently than once 
every 90 days (or, in the case of a hospital 
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or any other facility determined appro-
priate by the Secretary, at a lesser fre-
quency specified by the Secretary but in no 
case less frequently than once every 12 
months), verify the provider directory in-
formation of each provider listed in such 
directory and, if applicable, update such 
provider directory information; 
‘‘(iii) if the organization is unable to 
verify such information with respect to a 
provider, include in such directory an indi-
cation that the information of such pro-
vider may not be up to date; and 
‘‘(iv) remove a provider from such di-
rectory within 5 business days if the orga-
nization determines that the provider is no 
longer a provider participating in the net-
work of such plan. 
‘‘(B) PROVIDER
DIRECTORY
INFORMA-
TION.—The information described in this sub-
paragraph is information enrollees may need to 
access covered benefits from a provider with 
which such organization offering such plan has 
an agreement for furnishing items and services 
covered under such plan such as name, spe-
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cialty, contact information, primary office or fa-
cility address, whether the provider is accepting 
new patients, accommodations for people with 
disabilities, cultural and linguistic capabilities, 
and telehealth capabilities. 
‘‘(C) SPECIFIED MA PLAN.—In this para-
graph, the term ‘specified MA plan’ means— 
‘‘(i) a network-based plan (as defined 
in subsection (d)(5)(C)); or 
‘‘(ii) a Medicare Advantage private 
fee-for-service plan (as defined in section 
1859(b)(2)) that meets the access stand-
ards under subsection (d)(4), in whole or 
in part, through entering into contracts or 
agreements as provided for under subpara-
graph (B) of such subsection.’’. 
(b) ACCOUNTABILITY
FOR PROVIDER DIRECTORY 
ACCURACY.— 
(1) COST SHARING FOR SERVICES FURNISHED 
BASED ON RELIANCE ON INCORRECT PROVIDER DI-
RECTORY
INFORMATION.—Section 1852(d) of the 
Social Security Act (42 U.S.C. 1395w–22(d)) is 
amended— 
(A) in paragraph (1)(C)— 
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(i) in clause (ii), by striking ‘‘or’’ at 
the end; 
(ii) in clause (iii), by striking the 
semicolon at the end and inserting ‘‘, or’’; 
and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iv) the services are furnished by a 
provider that is not participating in the 
network of a specified MA plan (as defined 
in subsection (c)(3)(C)) but is listed in the 
provider directory of such plan on the date 
on which the appointment is made, as de-
scribed in paragraph (7)(A);’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(7) COST SHARING FOR SERVICES FURNISHED 
BASED ON RELIANCE ON INCORRECT PROVIDER DI-
RECTORY INFORMATION.— 
‘‘(A) IN GENERAL.—For plan year 2028 
and subsequent plan years, if an enrollee is fur-
nished an item or service by a provider that is 
not participating in the network of a specified 
MA plan (as defined in subsection (c)(3)(C)) 
but is listed in the provider directory of such 
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plan (as required to be provided to an enrollee 
pursuant to subsection (c)(1)(C)) on the date 
on which the appointment is made, and if such 
item or service would otherwise be covered 
under such plan if furnished by a provider that 
is participating in the network of such plan, the 
MA organization offering such plan shall ensure 
that the enrollee is only responsible for the less-
er of— 
‘‘(i) the amount of cost sharing that 
would apply if such provider had been par-
ticipating in the network of such plan; or 
‘‘(ii) the amount of cost sharing that 
would otherwise apply (without regard to 
this subparagraph). 
‘‘(B) NOTIFICATION REQUIREMENT.—For 
plan year 2028 and subsequent plan years, each 
MA organization that offers a specified MA 
plan shall— 
‘‘(i) notify enrollees of their cost-shar-
ing protections under this paragraph and 
make such notifications, to the extent 
practicable, by not later than the first day 
of an annual, coordinated election period 
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under section 1851(e)(3) with respect to a 
year; 
‘‘(ii) include information regarding 
such cost-sharing protections in the pro-
vider directory of each specified MA plan 
offered by the MA organization; and 
‘‘(iii) notify enrollees of their cost- 
sharing protections under this paragraph 
in an explanation of benefits.’’. 
(2) REQUIRED
PROVIDER
DIRECTORY
ACCU-
RACY ANALYSIS AND REPORTS.— 
(A) IN GENERAL.—Section 1857(e) of the 
Social Security Act (42 U.S.C. 1395w–27(e)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(6) PROVIDER
DIRECTORY
ACCURACY
ANAL-
YSIS AND REPORTS.— 
‘‘(A) IN GENERAL.—Beginning with plan 
years beginning on or after January 1, 2028, 
subject to subparagraph (C), a contract under 
this section with an MA organization shall re-
quire the organization, for each specified MA 
plan (as defined in section 1852(c)(3)(C)) of-
fered by the organization to annually do the fol-
lowing: 
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‘‘(i) Conduct an analysis estimating 
the accuracy of the provider directory in-
formation of such plan using a random 
sample of providers included in such pro-
vider directory as follows: 
‘‘(I) Such a random sample shall 
include a random sample of each spe-
cialty of providers with a high inaccu-
racy rate of provider directory infor-
mation relative to other specialties of 
providers, as determined by the Sec-
retary. 
‘‘(II) For purposes of subclause 
(I), one type of specialty may be pro-
viders specializing in mental health or 
substance use disorder treatment. 
‘‘(ii) Submit to the Secretary a report 
containing the results of the analysis con-
ducted under clause (i), including an accu-
racy score for such provider directory in-
formation (as determined using a plan 
verification method specified by the Sec-
retary under subparagraph (B)(i)). 
‘‘(B) 
DETERMINATION
OF
ACCURACY 
SCORE.— 
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‘‘(i) IN
GENERAL.—The Secretary 
shall specify plan verification methods, 
such as using telephonic verification or 
other approaches using data sources main-
tained by an MA organization or using 
publicly available data sets, that MA orga-
nizations may use for estimating accuracy 
scores of the provider directory information 
of specified MA plans offered by such or-
ganizations. 
‘‘(ii) 
ACCURACY
SCORE
METHOD-
OLOGY.—With respect to each such meth-
od specified by the Secretary as described 
in clause (i), the Secretary shall specify a 
methodology for MA organizations to use 
in estimating such accuracy scores. Each 
such methodology shall take into account 
the administrative burden on plans and 
providers and the relative importance of 
certain provider directory information on 
enrollee ability to access care. 
‘‘(C) EXCEPTION.—The Secretary may 
waive the requirements of this paragraph in the 
case of a specified MA plan with low enrollment 
(as defined by the Secretary). 
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‘‘(D) 
TRANSPARENCY.—Beginning 
with 
plan years beginning on or after January 1, 
2029, the Secretary shall post accuracy scores 
(as reported under subparagraph (A)(ii)), in a 
machine readable file, on the internet website of 
the Centers for Medicare & Medicaid Services.’’. 
(B) PROVISION
OF
INFORMATION
TO 
BENEFICIARIES.—Section 1851(d)(4) of the So-
cial Security Act (42 U.S.C. 1395w–21(d)(4)) 
is amended by adding at the end the following 
new subparagraph: 
‘‘(F) PROVIDER
DIRECTORY.—Beginning 
with plan years beginning on or after January 
1, 2029, the accuracy score of the plan’s pro-
vider directory (as reported under section 
1857(e)(6)(A)(ii)) listed prominently on the 
plan’s provider directory.’’. 
(C) FUNDING.—In addition to amounts 
otherwise available, there is appropriated to the 
Centers for Medicare & Medicaid Services Pro-
gram Management Account, out of any money 
in the Treasury not otherwise appropriated, 
$4,000,000 for fiscal year 2026, to remain 
available until expended, to carry out the 
amendments made by this paragraph. 
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(3) GAO STUDY AND REPORT.— 
(A) ANALYSIS.—The Comptroller General 
of the United States (in this paragraph referred 
to as the ‘‘Comptroller General’’) shall conduct 
a study of the implementation of the amend-
ments made by paragraphs (1) and (2). To the 
extent data are available and reliable, such 
study shall include an analysis of— 
(i) the use of cost-sharing protections 
required under section 1852(d)(7)(A) of 
the Social Security Act, as added by para-
graph (1); 
(ii) the trends in provider directory in-
formation accuracy scores under section 
1857(e)(6)(A)(ii) of the Social Security 
Act (as added by paragraph (2)(A)), both 
overall and among providers specializing in 
mental health or substance use disorder 
treatment; 
(iii) provider response rates by plan 
verification methods; 
(iv) administrative costs to providers 
and Medicare Advantage organizations; 
and 
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(v) other items determined appro-
priate by the Comptroller General. 
(B) REPORT.—Not later than January 15, 
2032, the Comptroller General shall submit to 
Congress a report containing the results of the 
study conducted under subparagraph (A), to-
gether with recommendations for such legisla-
tion and administrative action as the Comp-
troller General determines appropriate. 
(c) GUIDANCE
ON MAINTAINING ACCURATE PRO-
VIDER DIRECTORIES.— 
(1) STAKEHOLDER MEETING.— 
(A) IN
GENERAL.—Not later than 3 
months after the date of enactment of this Act, 
the Secretary of Health and Human Services 
(referred to in this subsection as the ‘‘Sec-
retary’’) shall hold a public meeting to receive 
input on approaches for maintaining accurate 
provider directories for Medicare Advantage 
plans under part C of title XVIII of the Social 
Security Act (42 U.S.C. 1395w–21 et seq.), in-
cluding input on approaches for reducing ad-
ministrative burden, such as data standardiza-
tion, and best practices to maintain accurate 
provider directory information. 
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(B) PARTICIPANTS.—Participants of the 
meeting under subparagraph (A) shall include 
representatives from the Centers for Medicare & 
Medicaid Services and the Assistant Secretary 
for Technology Policy and Office of the Na-
tional Coordinator for Health Information 
Technology. Such meeting shall be open to the 
public. To the extent practicable, the Secretary 
shall include health care providers, companies 
that specialize in relevant technologies, health 
insurers, and patient advocates. 
(2) GUIDANCE TO MEDICARE ADVANTAGE OR-
GANIZATIONS.—Not later than 12 months after the 
date of enactment of this Act, the Secretary shall 
issue guidance to Medicare Advantage organizations 
offering Medicare Advantage plans under part C of 
title XVIII of the Social Security Act (42 U.S.C. 
1395w–21 et seq.) on maintaining accurate provider 
directories for such plans, taking into consideration 
input received during the stakeholder meeting under 
paragraph (1). Such guidance may include the fol-
lowing, as determined appropriate by the Secretary: 
(A) Best practices for Medicare Advantage 
organizations on how to work with providers to 
maintain the accuracy of provider directories 
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and reduce provider and Medicare Advantage 
organization burden with respect to maintaining 
the accuracy of provider directories. 
(B) Information on data sets and data 
sources with information that could be used by 
Medicare Advantage organizations to maintain 
accurate provider directories. 
(C) Approaches for utilizing data sources 
maintained by Medicare Advantage organiza-
tions and publicly available data sets to main-
tain accurate provider directories. 
(D) Information to be included in provider 
directories that may be useful for Medicare 
beneficiaries to assess plan networks when se-
lecting a plan and accessing providers partici-
pating in plan networks during the plan year. 
(3) GUIDANCE
TO
PART
B
PROVIDERS.—Not 
later than 12 months after the date of enactment of 
this Act, the Secretary shall issue guidance to pro-
viders of services and suppliers who furnish items or 
services for which benefits are available under part 
B of title XVIII of the Social Security Act (42 
U.S.C. 1395j et seq.) on when to update the Na-
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tional Plan and Provider Enumeration System for 
information changes. 
Æ 
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