REAL Health Providers Act
Sponsored By: Representative Panetta
Introduced
Summary
Strengthens accuracy and accountability for Medicare Advantage provider directories. The bill would apply to specified MA plans starting in plan year 2028 and require regular verification, richer directory data, and cost-sharing protections when a listed non‑participating provider furnishes care.
Show full summary
- Medicare Advantage enrollees would see more detailed public online directories that must include provider name, specialty, contact info, primary office address, whether the provider is accepting new patients, disability accommodations, cultural and linguistic capabilities, and telehealth capabilities. Plans must notify enrollees and explain cost‑sharing protections in enrollment materials and explanations of benefits.
- MA organizations would verify directory information at least every 90 days, with hospitals or similar facilities allowed verification no less often than annually, and must remove a provider within 5 business days if they are no longer participating. Accuracy scores would be posted in machine‑readable form on CMS’s website beginning after January 1, 2029.
- The bill creates an accountability and oversight framework with annual accuracy analyses, a GAO study and final report due January 15, 2032, a public stakeholder meeting within 3 months, and HHS guidance within 12 months. It also authorizes a $4.0 million appropriation for Fiscal Year 2026 to the CMS Program Management Account to implement these changes.
*Would increase federal spending by $4.0 million in Fiscal Year 2026 for CMS program management.*
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Medicare Advantage: Lower bills for wrong listings
Starting in plan year 2028, some Medicare Advantage plans would add cost-sharing protections. If you book with a provider listed in your plan’s directory that turns out to be out-of-network, you would pay only the lower of two amounts. You would owe either your in-network cost share or the usual out-of-network amount, whichever is lower. This would apply only if the service would be covered when done by an in-network provider and only for specified Medicare Advantage plans.
Stronger Medicare Advantage provider directories
Starting in 2028, specified Medicare Advantage plans would need a public, accurate online provider directory. Plans would verify entries at least every 90 days, flag unverified info, and remove providers within 5 business days after they leave the network. Directories would include information about the new cost-sharing protections, and plans would notify enrollees during the annual election period and in explanations of benefits. Plans would run an annual random accuracy check starting in 2028 and report a score to CMS. CMS would post scores online in 2029 and later, and directories would show each plan’s accuracy score starting in 2029.
CMS funding: $4 million to implement
For fiscal year 2026, the bill would provide $4 million to CMS. The money would remain available until spent. It would fund work to carry out the new Medicare Advantage directory and protection rules.
Sponsors & CoSponsors
Sponsor
Panetta
CA • D
Cosponsors
Murphy
NC • R
Sponsored 9/10/2025
Landsman
OH • D
Sponsored 9/10/2025
Schneider
IL • D
Sponsored 9/10/2025
Fitzpatrick
PA • R
Sponsored 9/10/2025
Joyce (PA)
PA • R
Sponsored 9/15/2025
Deluzio
PA • D
Sponsored 10/24/2025
Carson
IN • D
Sponsored 11/7/2025
Auchincloss
MA • D
Sponsored 2/10/2026
Roll Call Votes
No roll call votes available for this bill.
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