We have received text from H.R. 5281: Requiring Enhanced and Accurate Lists of Health Providers Act. This bill was received on 2025-09-10, and currently has 5 cosponsors.
Here is a short summary of the bill:
This bill, titled the "Requiring Enhanced and Accurate Lists of Health Providers Act" (or "REAL Health Providers Act"), aims to improve the accuracy of provider directories for Medicare Advantage (MA) plans. It sets forth specific requirements for MA organizations to maintain updated and accurate information about healthcare providers available to their enrollees. The main components of the bill include:
Provider Directory Requirements
Starting in 2028, each MA organization offering a specified MA plan must:
- Maintain an Accurate Provider Directory: This directory must be publicly accessible and regularly updated.
- Verification of Provider Information: Provider information must be verified at least once every 90 days. For hospitals or other facilities, verification can occur less frequently but at least once a year.
- Indication of Unverified Providers: If an organization cannot verify a provider's information, it must note that the information may not be current.
- Remove Departed Providers Quickly: Any provider who is no longer part of the plan's network must be removed from the directory within five business days.
Accountability for Directory Accuracy
In regards to cost-sharing and directory accuracy, the bill stipulates that:
- Costs for Non-Participating Providers: If a plan enrollee sees a provider listed in the directory who is actually out-of-network, the enrollee will be responsible for lower out-of-pocket costs, equivalent to what they would have paid had they seen an in-network provider.
- Notifications of Protections: MA organizations must inform enrollees about these cost-sharing protections, ideally at the beginning of annual enrollment periods.
Accuracy Analysis and Reporting
Beginning in 2028, the bill requires annual analyses from MA organizations on the accuracy of their provider directories, including:
- Random sampling of provider information.
- A report of accuracy scores that is submitted to the Secretary of Health and Human Services.
- Public posting of these scores starting in 2029, ensuring transparency about the accuracy of provider directories.
Guidance Issuance
The Secretary of Health and Human Services is tasked with providing guidance for maintaining accurate provider directories, including:
- Best practices for updating provider directories.
- Information on data sources for maintaining directory accuracy.
- Guidance for providers on updating their information in relevant systems.
Funding Provisions
The bill allocates $4 million for fiscal year 2026 specifically for the implementation of the new requirements.
GAO Study and Reporting Mandate
The Government Accountability Office (GAO) is directed to study the implementation of these new provisions and report their findings by January 2032, focusing on cost-sharing protections and accuracy in provider information.
Enforcement and Compliance
MA organizations will be subject to scrutiny to ensure compliance with directory accuracy and reporting requirements.
Relevant Companies
- MRNA (Moderna, Inc.) - As a major healthcare provider, changes in how provider information is handled could impact their operational logistics and patient interactions.
- CI (Cigna Corporation) - As a health insurance provider, Cigna will need to adjust their practices to meet the new directory accuracy requirements.
- UNH (UnitedHealth Group Incorporated) - Similar to Cigna, UnitedHealth must adapt to compliance with the enhanced provider directory accuracy standards.
Representative Jimmy Panetta Bill Proposals
Here are some bills which have recently been proposed by Representative Jimmy Panetta:
- H.R.5442: To build on America's spirit of service to nurture, promote, and expand a culture of service to secure the Nation's future, address critical needs of the Nation, and strengthen the civic fabric of American society.
- H.R.5382: To improve training requirements for health profession opportunity grant programs and exclude assistance provided by those programs from income tax, and for other purposes.
- H.R.5334: To amend the Internal Revenue Code of 1986 to allow early childhood educators to take the educator expense deduction, and for other purposes.
- H.R.5281: REAL Health Providers Act
- H.R.5208: To amend title 37, United States Code, to exclude the basic allowance for housing from the calculation of gross household income for purposes of the basic needs allowance for eligible members of the Armed Forces.
- H.R.4817: Immigrant Witness and Victim Protection Act of 2025
You can track bills proposed by Representative Jimmy Panetta on Quiver Quantitative's politician page for Panetta.
Representative Jimmy Panetta Net Worth
Quiver Quantitative estimates that Representative Jimmy Panetta is worth $398.5K, as of September 19th, 2025. This is the 416th highest net worth in Congress, per our live estimates.
Panetta has approximately $0 invested in publicly traded assets which Quiver is able to track live.
You can track Representative Jimmy Panetta's net worth on Quiver Quantitative's politician page for Panetta.
This article is not financial advice. See Quiver Quantitative's disclaimers for more information.
