Cost sharing for services furnished based on reliance on incorrect provider directory information

For plan year 2028 and subsequent plan years, if an enrollee in a specified MA plan (as defined in subsection (c)(3)(C)) is furnished an item or service by a provider that is not participating in the network of such plan but is listed in the provider directory of such plan (as required to be provided to an enrollee pursuant to subsection (c)(1)(C)) on the date on which the appointment is made, and if such item or service would otherwise be covered under such plan if furnished by a provider that is participating in the network of such plan, the MA organization offering such plan shall ensure that the enrollee is only responsible for the lesser of—

(i) the amount of cost sharing that would apply if such provider had been participating in the network of such plan; or

(ii) the amount of cost sharing that would otherwise apply (without regard to this subparagraph).

For plan year 2028 and subsequent plan years, each MA organization that offers a specified MA plan shall—

(i) notify enrollees of their cost-sharing protections under this paragraph and make such notifications, to the extent practicable, by not later than the first day of an annual, coordinated election period under section 1395w–21(e)(3) of this title with respect to a year;

(ii) include information regarding such cost-sharing protections in the provider directory of each specified MA plan offered by the MA organization.; and

(iii) notify enrollees of their cost-sharing protections under this paragraph in the first explanation of benefits issued in a plan year.