Sec. 5123. Requiring accurate, updated, and searchable provider directories
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Section 1932(a)(5) of the Social Security Act ( 42 U.S.C. 1396u–2(a)(5) ) is amended— in subparagraph (B)(i), by inserting , including as required by subparagraph
(E)before the period at the end; and by adding at the end the following new subparagraph: Each managed care organization, prepaid inpatient health plan (as defined by the Secretary), prepaid ambulatory health plan (as defined by the Secretary), and, when appropriate, primary care case management entity (as defined by the Secretary) with a contract with a State to enroll individuals who are eligible for medical assistance under the State plan under this title or under a waiver of such plan, shall publish (and update on at least a quarterly basis or more frequently as required by the Secretary) on a public website, a searchable directory of network providers, which shall include physicians, hospitals, pharmacies, providers of mental health services, providers of substance use disorder services, providers of long term services and supports as appropriate, and such other providers as required by the Secretary, and that includes with respect to each such provider— the name of the provider; the specialty of the provider; the address at which the provider provides services; the telephone number of the provider; and information regarding— the provider’s cultural and linguistic capabilities, including languages (including American Sign Language) offered by the provider or by a skilled medical interpreter who provides interpretation services at the provider’s office; whether the provider is accepting as new patients, individuals who receive medical assistance under this title; whether the provider's office or facility has accommodations for individuals with physical disabilities, including offices, exam rooms, and equipment; the Internet website of such provider, if applicable; and whether the provider offers covered services via telehealth; and other relevant information, as required by the Secretary. In this subparagraph, the term network provider includes any provider, group of providers, or entity that has a network provider agreement with a managed care organization, a prepaid inpatient health plan (as defined by the Secretary), a prepaid ambulatory health plan (as defined by the Secretary), or a primary care case management entity (as defined by the Secretary) or a subcontractor of any such entity or plan, and receives payment under this title directly or indirectly to order, refer, or render covered services as a result of the State's contract with the entity or plan. For purposes of this subparagraph, a network provider shall not be considered to be a subcontractor by virtue of the network provider agreement. . Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a ) is amended— by striking paragraph
(83)and inserting the following: provide that in the case of a State plan (or waiver of the plan) that provides medical assistance on a fee-for-service basis or through a primary care case-management system described in section 1915(b)(1), the State shall publish (and update on at least a quarterly basis or more frequently as required by the Secretary) on the public website of the State agency administering the State plan, a searchable directory of the providers described in subsection
(mm)that, in addition to such other requirements as the Secretary may specify, such as making paper directories available to enrollees, includes with respect to each such provider— the name of the provider; the specialty of the provider; the address at which the provider provides services; the telephone number of the provider; information regarding— the provider’s cultural and linguistic capabilities, including languages (including American Sign Language) offered by the provider or by a skilled medical interpreter who provides interpretation services at the provider’s office; whether the provider is accepting as new patients individuals who receive medical assistance under this title; whether the provider's office or facility has accommodations for individuals with physical disabilities, including offices, exam rooms, and equipment; the Internet website of such provider, if applicable; and whether the provider offers covered services via telehealth; and other relevant information as required by the Secretary; ; and by striking subsection
(mm)and inserting the following: A provider described in this subsection, at a minimum, includes physicians, hospitals, pharmacies, providers of mental health services, providers of substance use disorder services, providers of long term services and supports as appropriate, and such other providers as required by the Secretary, and— in the case of a provider or a provider type for which the State agency, as a condition of receiving payment for items and services furnished by the provider to individuals eligible to receive medical assistance under the State plan (or a waiver of the plan), requires the enrollment of the provider with the State agency, includes a provider that— is enrolled with the agency as of the date on which the directory is published or updated (as applicable) under subsection (a)(83); and received payment under the State plan in the 12-month period preceding such date; and in the case of a provider or a provider type for which the State agency does not require such enrollment, includes a provider that received payment under the State plan (or a waiver of the plan) in the 12-month period preceding the date on which the directory is published or updated (as applicable) under subsection (a)(83). At State option, a provider described in this subsection may include any provider who furnishes services and is participating under the State plan under this title or under a waiver of such plan. . Section 2107(e)(1)(G) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1)(G) ) is amended by inserting and subsection (a)(83) of section 1902 (relating to searchable directories of the providers described in subsection
(mm)of such section) before the period. The amendments made by this section shall take effect on July 1, 2025.
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- 42 USC 1396u–2(a)(5)
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Sec. 5123
Requiring accurate, updated, and searchable provider directories
Cite42 USC 1396u–2(a)(5)
Cites 3Cited by 0 across 0 sources