§2. Provider directory requirements under Medicare Advantage
This section establishes provider directory accuracy requirements for specified Medicare Advantage (MA) plans (i.e., network-based plans or private fee-for-service plans meeting access standards through provider contracts) effective for plan year 2028 and subsequent years. Such plans must maintain an accurate, publicly available online provider directory—including provider name, specialty, contact information, office addresses, new patient status, disability accommodations, cultural/linguistic capabilities, and telehealth capabilities—verify listed information at least every 90 days (or every 12 months for hospitals or other facilities specified by the Secretary), indicate unverified information, and remove non-participating providers within five business days.
This section further provides cost-sharing protections for enrollees in specified MA plans who, starting in plan year 2028, receive covered services from a provider listed in the plan's directory on the appointment date but not actually in-network: enrollees pay the lesser of in-network cost-sharing or the otherwise applicable amount. MA organizations must notify enrollees of these protections annually before the coordinated election period, include the information in directories, and reference it in the first explanation of benefits each plan year.
This section requires MA organizations offering specified plans, beginning with plan years on or after January 1, 2028, to annually analyze directory accuracy using random samples of providers (including high-inaccuracy specialties) and submit related reports.