Provider directory accuracy
(A) In general
(A)In general#
For plan year 2028 and subsequent plan years, each MA organization offering a specified MA plan (as defined in subparagraph (C)) shall, for each such plan offered by the organization—
(i) maintain, on a publicly available internet website, an accurate provider directory that includes the information described in subparagraph (B);
(ii) not less frequently than once every 90 days (or, in the case of a hospital or any other facility determined appropriate by the Secretary, at a lesser frequency specified by the Secretary but in no case less frequently than once every 12 months), verify the provider directory information of each provider listed in such directory and, if applicable, update such information;
(iii) if the organization is unable to verify such information with respect to a provider, include in such directory an indication that the information of such provider may not be up to date; and
(iv) remove a provider from such directory within 5 business days if the organization determines that the provider is no longer a provider participating in the network of such plan.
(A)(i)#
maintain, on a publicly available internet website, an accurate provider directory that includes the information described in subparagraph (B);
(A)(ii)#
not less frequently than once every 90 days (or, in the case of a hospital or any other facility determined appropriate by the Secretary, at a lesser frequency specified by the Secretary but in no case less frequently than once every 12 months), verify the provider directory information of each provider listed in such directory and, if applicable, update such information;
(B)Provider directory information#
The information described in this subparagraph is information enrollees may need to access covered benefits from a provider with which such organization offering such plan has an agreement for furnishing items and services covered under such plan, such as name, specialty, contact information, primary office or facility addresses where items or services are furnished, whether the provider is accepting new patients, accommodations for people with disabilities, cultural and linguistic capabilities, and telehealth capabilities.
(C)Specified MA plan#
In this paragraph, the term “specified MA plan” means—
(i) a network-based plan (as defined in subsection (d)(5)(C)); or
(ii) a Medicare Advantage private fee-for-service plan (as defined in section 1395w–28(b)(2) of this title ) that meets the access standards under subsection (d)(4), in whole or in part, through entering into contracts or agreements as provided for under subparagraph (B) of such subsection.
(C)(i)#
a network-based plan (as defined in subsection (d)(5)(C)); or
(C)(ii)#
a Medicare Advantage private fee-for-service plan (as defined in section 1395w–28(b)(2) of this title ) that meets the access standards under subsection (d)(4), in whole or in part, through entering into contracts or agreements as provided for under subparagraph (B) of such subsection.