Sec. 204. Requiring MA organizations to maintain accurate and updated provider directories

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Section 1852(c) of the Social Security Act ( 42 U.S.C. 1395w–22(c) ) is amended— in paragraph (1)(C)— by striking plan, and any and inserting plan, any ; and by inserting the following before the period: , and, in the case of a network-based MA plan (as defined in paragraph (3)(C)), the information described in paragraph (3)(A)(i)(II) ; and by adding at the end the following new paragraph: For plan year 2025 and subsequent plan years, each MA organization offering a network-based MA plan shall do the following:

The MA organization shall, for each network-based MA plan offered by the organization, maintain an accurate provider directory— that includes the information described in subclause (II); which, not less frequently than 90 days, the organization verifies and, if applicable, updates the provider directory information of each provider; that provides, if the organization is unable to verify such information with respect to a provider, for the inclusion along with the information in the directory with respect to such provider of a notification indicating that the information may not be up to date; that provides for the removal of a provider from such directory within 2 business days if the organization determines that the provider is no longer a participating provider; and that meets such other requirements as the Secretary may specify.

The information described in this subclause is the National Provider Identifier, name, address, specialty, telephone number, Internet website if available, availability (including whether the provider is accepting new patients), cultural and linguistic capabilities (including the languages offered by the provider or by a skilled medical interpreter who provides interpretation services for the provider), and other information as determined appropriate by the Secretary for each provider with which such MA organization has an agreement for furnishing items and services covered under such plan.

The MA organization shall submit to the Secretary the provider directory for each network-based MA plan offered by the organization in a manner specified by the Secretary. For plan year 2026 and subsequent plan years, the Secretary shall post the provider directory information submitted under subparagraph (A)(ii), in a machine readable file, on the internet website of the Centers for Medicare & Medicaid Services. In this paragraph, the term network-based MA plan means an MA plan that has a network of providers that have agreements with the MA organization offering the plan to furnish items and services covered under such plan. .

Section 1857(d) of the Social Security Act ( 42 U.S.C. 1395w–27(d) ) is amended by adding at the end the following new paragraph: Each contract under this section shall provide that the Secretary, or any person or organization designated by the Secretary, shall have the right to audit any provider directory under section 1852(c)(3)(A)(i) to determine whether such directory meets the requirements of such section. . In addition to amounts otherwise available, there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2023, out of any amounts in the Treasury not otherwise appropriated, $10,000,000, to remain available until expended, for purposes of carrying out the amendments made by this section.

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42 USC 1395w–22(c)
42 USC 1395w–27(d)

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Sec. 204

Requiring MA organizations to maintain accurate and updated provider directories

Cite42 USC 1395w–22(c)

Cite42 USC 1395w–27(d)

Cites 2Cited by 0 across 0 sources