REAL Health Providers Act
- Bill Number
- S. 3750
- Origin Chamber
- Senate
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-01-29: Read twice and referred to the Committee on Finance.
- Last Updated
- 2026-06-29T16:40:22Z
AI-Generated Summary
Purpose of the Legislation
The REAL Health Providers Act (S. 3750) aims to improve the accuracy and reliability of provider directories in Medicare Advantage (MA) plans. These directories list doctors, hospitals, and other healthcare providers available to enrollees. By requiring regular updates and accountability measures, the bill seeks to help Medicare beneficiaries easily find in-network providers and avoid unexpected costs when directories are wrong.
Key Provisions
- Provider Directory Maintenance (Starting 2028):
- MA organizations must keep an up-to-date, publicly available online directory for certain plans (network-based plans and specific private fee-for-service plans).
- Directories must include key details like provider names, specialties, contact information, office addresses, whether they accept new patients, disability accommodations, language support, and telehealth options.
- Verification: Check provider info at least every 90 days (or every 12 months for hospitals and similar facilities); flag unverified info; remove providers no longer in the network within 5 business days.
- Cost-Sharing Protections (Starting 2028):
- If an enrollee books an appointment based on the directory but the provider is not actually in-network, the enrollee pays only the lower of the in-network cost or the standard out-of-network cost for covered services.
- MA organizations must notify enrollees of this protection annually (before open enrollment), include it in directories, and mention it in the first benefits explanation each year.
- Accuracy Reporting and Analysis (Starting 2028):
- MA organizations conduct yearly random checks on directory accuracy, focusing on high-error specialties like mental health or substance use disorder treatment.
- Submit reports with an "accuracy score" to the Secretary of Health and Human Services using methods like phone checks or public data.
- CMS posts these scores online starting 2029 in a readable format; exceptions for low-enrollment plans.
- $4 million appropriated to CMS for fiscal year 2026 to implement reporting.
- Guidance and Oversight:
- Within 6 months of enactment: Public meeting with stakeholders (e.g., CMS, providers, insurers, patient advocates) to discuss best practices for accurate directories and reducing paperwork.
- Within 18 months: CMS guidance for MA organizations on verifying info, using data sources, and minimizing burdens.
- Within 12 months: Guidance for Medicare Part B providers (doctors and suppliers) on updating their info in the National Provider Identifier system.
- By January 2033: Government Accountability Office (GAO) study on implementation, including cost trends, accuracy improvements, and recommendations to Congress.
Significant Changes to Existing Law
- Amends sections of the Social Security Act (title XVIII, parts on MA plans) to add mandatory directory accuracy rules, which previously lacked specific verification timelines or public posting requirements.
- Introduces new cost-sharing safeguards not in current law, shifting financial risk to MA plans for directory errors.
- Adds annual accuracy audits and public transparency, building on existing MA contract rules but with targeted focus on high-inaccuracy areas like behavioral health.
- No changes to non-specified MA plans (e.g., some fee-for-service without networks).
Potential Impacts
- Government Agencies: CMS gains responsibilities for guidance, score posting, and verification method approvals, supported by new funding; increases oversight of MA plans but may streamline through standardized data use. GAO provides evaluation for future policy tweaks.
- Citizens (Medicare Beneficiaries): Easier access to reliable provider info reduces confusion and surprise costs during care-seeking; especially benefits those needing mental health or specialized services. Notifications empower informed plan choices.
- International Relations: None; this is a domestic healthcare policy focused on U.S. Medicare.
Main Stakeholders Affected
- Medicare Advantage Organizations: Must invest in verification systems and reporting; face potential cost increases from protections but gain guidance to ease burdens.
- Healthcare Providers: Required to respond to verification checks and update their own data; reduced administrative hassle through standardization.
- Medicare Enrollees: Primary beneficiaries of accurate info and cost protections, aiding access to care.
- CMS and Federal Government: Oversees compliance and implementation; taxpayers fund the $4 million startup.
- Patient Advocates and Insurers: Involved in stakeholder input; advocates gain tools to hold plans accountable.
Notable Legal, Constitutional, or Political Implications
- Legal: Enhances administrative enforcement under Medicare law without creating new rights; uses existing contract mechanisms for compliance. Potential for enforcement actions if plans fail accuracy standards, promoting fairness in managed care.
- Constitutional: No significant issues; aligns with Congress's authority over federal programs like Medicare.
- Political: Bipartisan sponsorship (Sens. Bennet, Tillis, Wyden) signals broad support for consumer protections in private Medicare plans. Could influence future reforms by highlighting directory issues in behavioral health, a priority area, and may reduce complaints to Congress about access barriers.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Sen. Bennet, Michael F. [D-CO]
Cosponsors (2)
Sen. Tillis, Thomas [R-NC], Sen. Wyden, Ron [D-OR]
Recent Actions
- 2026-01-29: Read twice and referred to the Committee on Finance.
- 2026-01-29: Introduced in Senate
Bill Versions
- Requiring Enhanced and Accurate Lists of Health Providers Act — issued 2026-01-29 — PDF (15 pages)