REAL Health Providers Act

HR 5281, the REAL Health Providers Act, requires Medicare Advantage (MA) plans to maintain accurate, publicly accessible provider directories starting in 2028. It mandates that plans verify directory information every 90 days (or annually for hospitals), flag outdated entries, and remove providers no longer in-network within 5 business days. The bill also ensures Medicare beneficiaries are not charged extra for services from providers listed in directories but not actually in-network, covering the difference between in-network and out-of-network cost-sharing. MA plans must report annual accuracy scores to Medicare, which will be published online starting in 2029, with $4 million allocated for implementation. This directly affects MA organizations and beneficiaries by improving access to reliable provider information and reducing unexpected costs.