REAL Health Providers Act
Sponsored By: Senator Michael Bennet
Introduced
Summary
Accurate and transparent provider directories for Medicare Advantage enrollees would be required, and plans would face verification and reporting rules plus limits on patient cost sharing when a listed provider is not actually in-network. This aims to make it easier to find doctors and avoid surprise costs.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 5 benefits, 0 costs, 0 mixed.
Accurate online provider directories for Medicare
This bill would require Medicare Advantage plans that use provider networks to publish a public online provider directory starting with plan years beginning in 2028. The directory would have provider name, specialty, contact details, primary office addresses, whether the provider is accepting new patients, disability accommodations, cultural and language capabilities, and telehealth ability. Plans would have to verify most providers at least every 90 days and mark entries they could not verify as possibly out of date. If a plan learns a provider is no longer in-network, it would remove the provider within 5 business days.
Medicare plan directory accuracy scores
This bill would require Medicare Advantage plans to run an annual analysis of how accurate their provider directory is starting with plan years beginning January 1, 2028. Plans would use random samples that include specialties with high inaccuracy rates (for example, mental health or substance use disorder providers) and submit a report and an accuracy score to the Secretary. The Secretary would set acceptable verification methods and scoring rules and must post plans' reported accuracy scores in a machine-readable file on CMS's website beginning with plan years starting January 1, 2029. Plans would have to show their accuracy score prominently on their directory.
Protections for wrong-directory medical bills
For plan years beginning in 2028, this bill would cap what you pay if you get a covered item or service from a provider who was listed in your Medicare Advantage plan's directory on the date you made the appointment but is not actually in-network. You would only owe the smaller of (1) the in-network cost sharing that would have applied, or (2) the normal out-of-network cost sharing. Plans would have to notify enrollees of this protection by the start of the annual coordinated election period, include it in the directory, and tell enrollees in the first explanation of benefits each plan year.
CMS funding and guidance for directories
The bill would appropriate $4,000,000 to CMS for fiscal year 2026 to support implementing the provider directory requirements. The funds would remain available until expended. The Secretary would hold a public stakeholder meeting within 6 months after enactment and must issue guidance to Medicare Advantage organizations within 18 months and guidance to Part B providers within 12 months on keeping directory data current and updating the National Plan and Provider Enumeration System.
GAO study on provider directories
The bill would direct the Government Accountability Office to study how the directory and cost-sharing changes are working and to report to Congress by January 15, 2033. The study would look at usage of the cost-sharing protections, accuracy trends overall and for mental health and substance use disorder providers, provider response rates by verification method, and administrative costs to providers and plans. The GAO would give recommendations for legislative or administrative changes.
Sponsors & CoSponsors
Sponsor
Michael Bennet
CO • D
Cosponsors
Thomas Tillis
NC • R
Sponsored 1/29/2026
Ron Wyden
OR • D
Sponsored 1/29/2026
Roll Call Votes
No roll call votes available for this bill.
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