REAL Health Providers Act

Improved Information Access: MA organizations must maintain a publicly available website with specific information such as provider name, specialty, contact info, address, whether they accept new patients, and disability accommodations (Section 2(a)(2)(B)).

Increased Directory Accuracy: Organizations are required to verify provider information at least every 90 days or, for hospitals, at a frequency determined by the Secretary but no less than every 12 months (Section 2(a)(2)(A)(ii)).

Prompt Removal of Inactive Providers: Organizations must remove a provider from the directory within 5 business days if they are no longer participating in the plan's network (Section 2(a)(2)(A)(iv)).

Financial Protections for Enrollees: If an enrollee relies on an incorrect directory and sees a provider not in the network, the MA organization must ensure the enrollee only pays the lesser of the in-network cost-sharing amount or the regular cost-sharing amount (Section 2(b)(1)(A)(ii)).

Transparency Through Scoring: The Secretary will post provider directory accuracy scores online, and these scores must be listed prominently on the plan's provider directory (Section 2(b)(1)(A)(D) and Section 2(b)(1)(B)).

Clear Communication of Rights: MA organizations are required to notify enrollees of their cost-sharing protections via annual notifications, the provider directory, and the first explanation of benefits (Section 2(b)(1)(B)).

Administrative Burden: The bill notes that the methodology for determining accuracy scores should take into account the administrative burden placed on both plans and providers (Section 2(b)(1)(A)(B)(ii)).

Potential for Variable Verification Schedules: While most must verify every 90 days, hospitals or other facilities may follow a different schedule determined by the Secretary, which could be up to every 12 months (Section 2(a)(2)(A)(ii)).