The REAL Health Providers Act (S. 3750)

Summary

The REAL Health Providers Act is a bill introduced in the Senate on January 29, 2026. The main purpose of the bill is to amend Medicare Advantage regulations to:

1. Establish provider directory requirements: The bill would require Medicare Advantage (MA) organizations offering "specified MA plans" (network-based plans and certain fee-for-service plans) to:

   • Maintain accurate, publicly available online provider directories
   • Verify and update provider directory information at least every 90 days (or less frequently for certain providers)
   • Indicate in the directory if they are unable to verify a provider's information
   • Remove providers from the directory within 5 business days if they are no longer in the plan's network

2. Provide accountability for provider directory accuracy: The bill would:

   • Require MA organizations to ensure enrollees only pay the lower of the in-network or out-of-network cost-sharing amount if they receive care from an out-of-network provider listed in the plan's directory
   • Mandate MA organizations to notify enrollees of this cost-sharing protection
   • Require MA organizations to conduct annual analyses of provider directory accuracy and report the results to the Centers for Medicare & Medicaid Services (CMS)

The key effect of this bill would be to improve the accuracy and transparency of Medicare Advantage provider directories, thereby helping enrollees make more informed decisions about their healthcare providers and reducing unexpected out-of-pocket costs when relying on inaccurate directory information.

Key Provisions

• Establishes new requirements for MA organizations to maintain accurate, frequently updated online provider directories for their "specified MA plans"
• Requires MA organizations to ensure enrollees only pay in-network cost-sharing if they receive care from an out-of-network provider listed in the plan's directory
• Mandates MA organizations to notify enrollees of this cost-sharing protection
• Directs MA organizations to conduct annual analyses of provider directory accuracy and report the results to CMS

Affected Stakeholders

• Medicare Advantage enrollees, who would benefit from more accurate provider directories and protection from unexpected out-of-network costs
• Medicare Advantage organizations, which would be subject to the new provider directory requirements and accountability measures
• Healthcare providers participating in Medicare Advantage networks, whose directory information would need to be frequently verified
• The Centers for Medicare & Medicaid Services, which would receive the annual provider directory accuracy reports from MA organizations

Timeline

• Introduced in the Senate on January 29, 2026
• If enacted, the provider directory requirements and cost-sharing protections would take effect for plan year 2028 and subsequent years