,,ii #aahth ,,congress #ast ,session ,s4 #cjei ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #ag1 #bjbc,mr4 ,bennet 7for himself1 ,mr4 ,tillis1 and ,mr4 ,wyden7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish provider directory requirements1 and to provide accountability for provider directory accuracy1 under ,medicare ,advantage4 #a4 ,short title ,this ,act may be cited as the ,requiring ,enhanced ,accurate ,lists of ,health ,providers ,act or the ,,real ,health ,providers ,act4 #b4 ,provider directory requirements ,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 the following before the period3 1 and1 in the case of a network-based ,,ma 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 ,,ma plan shall1 for each network-based ,,ma 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 days1 verify in a manner specified by the ,secretary 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 plan has an agreement for furnishing items and services covered under such plan such as name1 specialty1 contact information1 primary office or facility address1 availability1 accommodations for people with disabilities1 cultural and linguistic capabilities1 and telehealth capabilities4 7,c7 ,network-based ,,ma plan defined ,in this paragraph1 the term network-based ,,ma plan means an ,,ma plan that has a network of providers that contract or make arrangements with the ,,ma organization offering the plan to furnish items and services covered under such plan4 4 #c4 ,accountability for provider directory accuracy 7a7 ,cost ,sharing for ,services ,furnished ,based on ,reliance on ,incorrect ,provider ,network ,information ,section #aheb7;d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;d77 is amended by adding at the end the following new paragraph3 7#g7 ,cost sharing for services furnished based on reliance on incorrect provider network 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 ,,ma 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 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 ,,ma 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 ,,ma plan offered by the ,,ma organization2 and 7iii7 notify enrollees of their cost-sharing protections under this paragraph in an explanation of benefits4 4 7b7 ,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 ,,ma plan 7as defined in section #aheb7;c77#c77;,c77 offered by the organization1 to annually-- 7i7 conduct an analysis of the accuracy of the provider directory of such plan 7including provider types with high inaccuracy rates1 such as providers specializing in mental health and substance use disorder treatment1 as determined by the ,secretary72 and 7ii7 submit a report to the ,secretary containing the results of such analysis and other information required by the ,secretary4 7,b7 ,considerations ,in establishing requirements with respect to analysis and reporting under this paragraph1 the ,secretary shall take into account-- 7i7 data sources maintained by of ,,ma organizations2 7ii7 publicly available data sets2 and 7iii7 the administrative burden of maintaining provider directories on plans and providers4 7,c7 ,exception ,the ,secretary may waive the requirements of this paragraph in the case of a network-based ,,ma plan with low enrollment 7as defined by the ,secretary74 7,d7 ,transparency ,the ,secretary shall post accuracy scores 7as reported under subparagraph 7,a771 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 ,information regarding the accuracy of the plan's provider directory 7as reported under section #aheg7;e77#f77 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 #bjbf1 to remain available until expended1 to carry out the amendments made by this subsection4 7c7 ,,gao study and report 7#a7 ,analysis ,the ,comptroller ,general of the ,united ,states 7in this subsection referred to as the ,comptroller ,general7 shall conduct study of the implementation of the amendments made by subsections 7a7 and 7b74 ,such study shall include an analysis of-- 7,a7 the use of protections required under section #aheb7;d77#g7 of the ,social ,security ,act1 as added by subsection 7a72 7,b7 the provider directory accuracy scores trends under section #aheg7;e77#f7 of the ,social ,security ,act 7as added by subsection 7b77#a771 both overall and among providers specializing in mental health and substance disorder treatment2 and 7,c7 other items determined appropriate by the ,comptroller ,general4 7#b7 ,report ,not later than ,january #a1 #bjca1 the ,comptroller ,general shall submit to ,congress1 the ,commissioner of ,social ,security1 and the ,secretary of ,health and ,human ,services a report containing the results of the study conducted under paragraph 7#a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #d4 ,guidance on best practices for maintaining accurate provider directories ,not later than #ab months after the date of enactment of this ,act1 the ,secretary of ,health and ,human ,services 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 plans4 ,such guidance may include the following1 as determined appropriate by the ,secretary3 7#a7 ,best practices for ,medicare ,advantage plans on how to work with providers to maintain the accuracy of provider directories of such plans and reduce provider and ,medicare ,advantage plan burden4 7#b7 ,information on data sets and data sources with information that could be used by such plans to maintain accurate provider directories4 7#c7 ,approaches for utilizing existing information assets of plans and publicly available data sets and data sources to maintain accurate provider directories4 7#d7 ,information that may be useful for beneficiaries to assess plan networks when selecting a plan and accessing providers participating in plan networks during the plan year4