REAL Health Providers Act
Sponsored By: Senator Bennet, Michael F. [D-CO]
Introduced
Summary
Accurate provider directories would be required for Medicare Advantage plans to make it easier to find participating clinicians. The bill would also add protections for enrollees' out-of-pocket costs when directories list non-network providers.
Show full summary
- Medicare Advantage enrollees would get directories verified at least every 90 days, see notices when information may be out of date, and have a listed provider removed within five business days after leaving the network. They would pay the lesser of the in-network cost-sharing amount or the amount that would apply if the provider were in-network when a non-network provider is listed.
- Providers would need to keep detailed contact and capability information current. Directories must show specialty, primary office addresses, whether accepting new patients, disability accommodations, language services, and telehealth capabilities.
- Medicare Advantage organizations would run annual accuracy analyses using random samples and follow CMS-specified verification and scoring methods. Accuracy scores must be posted by CMS in a machine-readable file beginning plan year 2029.
- CMS would issue guidance and hold stakeholder meetings, and the bill authorizes implementation funding, including a $4.0 million appropriation for FY2026. The Government Accountability Office would study implementation and deliver a final report by January 15, 2033.
*This bill would increase federal spending and explicitly includes a $4.0 million appropriation for FY2026 to support implementation.*
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
2 provisions identified: 2 benefits, 0 costs, 0 mixed.
More accurate Medicare provider lists
This bill would require Medicare Advantage plans that use a provider network to keep a public provider directory with specific contact, location, specialty, language, disability, and telehealth details. Plans would verify provider information at least every 90 days (hospitals and some facilities may be verified at least once per year), mark entries that could not be verified, and remove a provider within five business days if they stop participating. Plans would run annual random-sample accuracy analyses and report accuracy scores to CMS. Beginning with plan years starting on or after January 1, 2029, CMS would post those scores in a machine-readable file and plans would show the score in their directory. If you get a covered service from a provider listed in the plan directory but not participating in-network on the appointment date, you would pay the lesser of the in-network cost sharing or the otherwise applicable cost sharing. Plans would need to notify enrollees about this cost-sharing protection by, to the extent practicable, the first day of the annual coordinated election period and in the first explanation of benefits each plan year.
Funds for CMS provider work
This bill would appropriate $4,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026. The funds would remain available until expended and come from the Treasury. CMS would use the money to implement the provider directory verification, accuracy analysis, reporting, and related guidance. Medicare beneficiaries and providers would be indirect, downstream beneficiaries through the program's implementation.
Sponsors & CoSponsors
Sponsor
Bennet, Michael F. [D-CO]
CO • D
Cosponsors
Sen. Tillis, Thomas [R-NC]
NC • R
Sponsored 1/29/2026
Sen. Wyden, Ron [D-OR]
OR • D
Sponsored 1/29/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov