,i #aahth ,,congress #b;d ,session ,h4 ,r4 #ggjh ,,in ,,the ,,house ,,of ,,representatives ,march #ae1 #bjbd,mr4 ,panetta 7for himself1 ,mr4 ,murphy1 ,ms4 ,kuster1 ,mr4 ,schneider1 and ,mr4 ,fitzpatrick7 introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to require ,,ma organizations offering network-based plans to maintain an accurate provider directory1 and for other purposes4 #a4 ,requiring enhanced accurate lists of 7real7 health providers act 7a7 ,in general ,section #aheb7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;c77 is amended-- 7#a7 in paragraph 7#a77;,c7-- 7,a7 by striking plan1 and any and inserting plan1 any2 and 7,b7 by inserting before the period at the end3 1 and1 in the case of a network-based plan 7as defined in paragraph 7#c77;,c771 for plan year #bjbf and subsequent plan years1 the information described in paragraph 7#c77;,b72 and 7#b7 by adding at the end the following new paragraph3 7#c7 ,provider directory accuracy 7,a7 ,in general ,for plan year #bjbf and subsequent plan years1 each ,,ma organization offering a network-based plan 7as defined in subparagraph 7,c77 shall1 for each network-based plan offered by the organization-- 7i7 maintain1 on a publicly available internet website1 an accurate provider directory that includes the information described in subparagraph 7,b72 7ii7 not less frequently than once every #ij days 7or1 in the case of a hospital or any other facility determined appropriate by the ,secretary1 at a lesser frequency specified by the ,secretary but in no case less frequently than once every #ab months71 verify the provider directory information of each provider listed in such directory and1 if applicable1 update such provider directory information2 7iii7 if the organization is unable to verify such information with respect to a provider1 include in such directory an indication that the information of such provider may not be up to date2 7iv7 remove a provider from such directory within #e business days if the organization determines that the provider is no longer a provider participating in the network of such plan2 and 7v7 meet such other requirements as the ,secretary may specify4 7,b7 ,provider directory information ,the information described in this subparagraph is information enrollees may need to access covered benefits from a provider with which such organization offering such plan has an agreement for furnishing items and services covered under such plan such as name1 specialty1 contact information1 primary office or facility address1 whether the provider is accepting new patients1 accommodations for people with disabilities1 cultural and linguistic capabilities1 and telehealth capabilities4 7,c7 ,network-based plan ,in this paragraph1 the term network-based plan has the meaning given that term in subsection 7d77#e77;,c71 except such term includes a ,medicare ,advantage private fee-for-service plan1 as determined appropriate by the ,secretary4 4 7b7 ,accountability for provider directory accuracy 7#a7 ,cost sharing for services furnished based on reliance on incorrect provider directory information ,section #aheb7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77 is amended-- 7,a7 in paragraph 7#a77;,c7-- 7i7 in clause 7ii71 by striking or at the end2 7ii7 in clause 7iii71 by striking the semicolon at the end and inserting 1 or2 and 7iii7 by adding at the end the following new clause3 7iv7 the services are furnished by a provider that is not participating in the network of a network-based plan 7as defined in subsection 7c77#c77;,c77 but is listed in the provider directory of such plan on the date on which the appointment is made1 as described in paragraph 7#g77;,a72 2 and 7,b7 by adding at the end the following new paragraph3 7#g7 ,cost sharing for services furnished based on reliance on incorrect provider directory information 7,a7 ,in general ,for plan year #bjbf and subsequent plan years1 if an enrollee is furnished an item or service by a provider that is not participating in the network of a network-based plan 7as defined in subsection 7c77#c77;,c77 but is listed in the provider directory of such plan 7as required to be provided to an enrollee pursuant to subsection 7c77#a77;,c77 on the date on which the appointment is made1 and if such item or service would otherwise be covered under such plan if furnished by a provider that is participating in the network of such plan1 the ,,ma organization offering such plan shall ensure that the enrollee is only responsible for the amount of cost sharing that would apply if such provider had been participating in the network of such plan4 7,b7 ,notification requirement ,for plan year #bjbf and subsequent plan years1 each ,,ma organization that offers a network-based plan shall-- 7i7 notify enrollees of their cost-sharing protections under this paragraph and make such notifications1 to the extent practicable1 by not later than the first day of an annual1 coordinated election period under section #ahea7;e77#c7 with respect to a year2 7ii7 include information regarding such cost-sharing protections in the provider directory of each network-based plan offered by the ,,ma organization42 and 7iii7 notify enrollees of their cost-sharing protections under this paragraph in an explanation of benefits4 4 7#b7 ,required provider directory accuracy analysis and reports 7,a7 ,in general ,section #aheg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7;e77 is amended by adding at the end the following new paragraph3 7#f7 ,provider directory accuracy analysis and reports 7,a7 ,in general ,beginning with plan years beginning on or after ,january #a1 #bjbf1 subject to subparagraph 7,c71 a contract under this section with an ,,ma organization shall require the organization1 for each network-based plan 7as defined in section #aheb7;c77#c77;,c77 offered by the organization1 to annually-- 7i7 conduct an analysis estimating the accuracy of the provider directory of such plan using a sample of providers included in such provider directory 7including provider specialties with high inaccuracy rates of provider directory information1 such as providers specializing in mental health or substance use disorder treatment1 as determined by the ,secretary72 and 7ii7 submit a report to the ,secretary containing the results of such analysis1 including an accuracy score for such provider directory 7as determined using a methodology specified by the ,secretary under subparagraph 7,b77i771 and other information required by the ,secretary4 7,b7 ,determination of accuracy score 7i7 ,in general ,the ,secretary shall specify methodologies for ,,ma plans to use in estimating the accuracy of the provider directory information of such plans and determining the accuracy score for the plan's provider directory4 7ii7 ,considerations ,in carrying out clause 7i71 the ,secretary shall take into consideration-- 7,i7 data sources maintained by ,,ma organizations2 7,,ii7 publicly available data sets2 7,,iii7 the administrative burden on plans and providers2 and 7,,iv7 the relative importance of certain provider directory information on enrollee ability to access care4 7,c7 ,exception ,the ,secretary may waive the requirements of this paragraph in the case of a network-based plan with low enrollment 7as defined by the ,secretary74 7,d7 ,transparency ,beginning with plan years beginning on or after ,january #a1 #bjbg1 the ,secretary shall post accuracy scores 7as reported under subparagraph 7,a77ii771 in a machine readable file1 on the internet website of the ,centers for ,medicare ,medicaid ,services4 7,e7 ,implementation ,the ,secretary shall implement this paragraph through notice and comment rulemaking4 4 7,b7 ,provision of information to beneficiaries ,section #ahea7;d77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;d77#d77 is amended by adding at the end the following new subparagraph3 7,f7 ,provider directory ,beginning with plan years beginning on or after ,january #a1 #bjbg1 the accuracy score of the plan's provider directory 7as reported under section #aheg7;e77#f77;,a77ii77 on the plan's provider directory4 4 7,c7 ,funding ,in addition to amounts otherwise available1 there is appropriated to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 out of any money in the ,treasury not otherwise appropriated1 #a1jjj1jjj for fiscal year #bjbe1 to remain available until expended1 to carry out the amendments made by this paragraph4 7#c7 ,,gao study and report 7,a7 ,analysis ,the ,comptroller ,general of the ,united ,states 7in this paragraph referred to as the ,comptroller ,general7 shall conduct study of the implementation of the amendments made by paragraphs 7#a7 and 7#b74 ,to the extent data are available and reliable1 such study shall include an analysis of-- 7i7 the use of protections required under section #aheb7;d77#g7 of the ,social ,security ,act1 as added by paragraph 7#a72 7ii7 the provider directory accuracy scores trends under section #aheg7;e77#f77;,a77ii7 of the ,social ,security ,act 7as added by paragraph 7#b77;,a771 both overall and among providers specializing in mental health or substance disorder treatment2 7iii7 provider response rates by plan verification methods2 and 7iv7 other items determined appropriate by the ,comptroller ,general4 7,b7 ,report ,not later than ,january #ae1 #bjca1 the ,comptroller ,general shall submit to ,congress a report containing the results of the study conducted under subparagraph 7,a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 7c7 ,guidance on maintaining accurate provider directories 7#a7 ,stakeholder meeting 7,a7 ,in general ,not later than #c months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 7referred to in this subsection as the ,secretary7 shall hold a public stakeholder meeting to receive input on approaches for maintaining accurate provider directories for ,medicare ,advantage plans under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq471 including input on approaches for reducing administrative burden such as data standardization and best practices to maintain provider directory information4 7,b7 ,participants ,participants of the meeting under subparagraph 7,a7 shall include representatives from the ,centers for ,medicare ,medicaid ,services and the ,office of the ,national ,coordinator for ,health ,information ,technology1 health care providers1 companies that specialize in relevant technologies1 health insurers1 and patient advocates4 7#b7 ,guidance to medicare advantage organizations ,not later than #ab months after the date of enactment of this ,act1 the ,secretary shall issue guidance to ,medicare ,advantage organizations offering ,medicare ,advantage plans under part ,c of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba et seq47 on maintaining accurate provider directories for such plans1 taking into consideration input received during the stakeholder meeting under paragraph 7#a74 ,such guidance may include the following1 as determined appropriate by the ,secretary3 7,a7 ,best practices for ,medicare ,advantage organizations on how to work with providers to maintain the accuracy of provider directories and reduce provider and ,medicare ,advantage organization burden with respect to maintaining the accuracy of provider directories4 7,b7 ,information on data sets and data sources with information that could be used by ,medicare ,advantage organizations to maintain accurate provider directories4 7,c7 ,approaches for utilizing data sources maintained by ,medicare ,advantage organizations and publicly available data sets to maintain accurate provider directories4 7,d7 ,information to be included in the provider directory that may be useful for ,medicare beneficiaries to assess plan networks when selecting a plan and accessing providers participating in plan networks during the plan year4 7#c7 ,guidance to part b providers ,not later than #ab months after the date of enactment of this ,act1 the ,secretary shall issue guidance to providers of services and suppliers who furnish items or services for which benefits are available under part ,b of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;j et seq47 on when to update the ,national ,plan and ,provider ,enumeration ,system regarding any information changes4