Clean Up on Aisle MA: CMS Wants Accurate Provider Directories

CMS announced a proposed rule on Oct. 16 that includes a measure to clean up provider directories for Medicare Advantage (MA) plans as well as establish transparency and compensation requirements for PBMs, and a third item to deliver cost-saving protections for low-income Medicare beneficiaries.

The proposed changes for Contract Year (CY) 2028 for Medicare Advantage and Part D to implement these key sections of the Consolidated Appropriations Act of 2026 will be open for public comment for 60 days following publication in the Federal Register here: https://www.federalregister.gov/public-inspection/current.

CMS said it expects to release another proposed rule consisting of policy and technical changes for Parts C and D later this fall. 

“CMS has been working to improve data connectivity and accuracy in provider directories across the healthcare system,” said CMS Administrator Mehmet Oz. “The actions we are proposing today will give Medicare Advantage and Part D enrollees more reliable information, stronger financial protections, and greater confidence in both programs.”

MA Accuracy

The MA directory proposal establishes a framework to significantly improve the accuracy of provider directories for MA plans, the agency claims. CMS said under the proposed rule, plans would be required to verify and update their provider directory information at least every 90 days and report an accuracy score to CMS.

“These scores would also be prominently displayed on the plans’ public-facing directories, empowering beneficiaries to choose plans with confidence,” the agency said.

“This proposal protects beneficiaries from unexpected costs and care disruptions that can occur when they rely on inaccurate directory information to find an in-network provider. By codifying these standards, CMS is strengthening enrollee protections and increasing transparency across the Medicare Advantage program,” CMS said.

Enrollees who rely on inaccurate directory listings that led them to receive care by an out-of-network provider would pay no more than their in-network cost-sharing amount, the CMS draft rule noted.

In assessing the proposal, Steven Littlehale, chief innovation officer, Zimmet Healthcare Services Group, said while CMS is right to hold MA plans accountable for the accuracy of their provider directories, "an accurate directory is not necessarily translated to an accessible network."

"Under the proposal, whether a provider is accepting new patients accounts for just 3 percent of the accuracy score. That seems remarkably low for information that can determine whether a beneficiary actually receives care. This is especially important for patients transitioning from hospitals to skilled nursing facilities, where timely access matters. We should be measuring meaningful access to care, not simply the accuracy of a provider listing,” he said.

PBMs

CMS also wants to install transparency and reporting requirements for PBMs aimed at curbing practices that drive up drug costs. Under the proposed rule, PBMs would have to report their compensation and cost performance to plan sponsors and CMS on an annual basis. The rule would also require PBM payments to reflect fair market value for services provided, rather than drug costs.

For more information, please view the fact sheet at: https://www.cms.gov/newsroom/fact-sheets/medicare-program-implementation-sections-6219-6220-6224-consolidated-appropriations-act-2026-cms. 

Contact Patrick Connole at pconnole@parkplacelive.com with questions or comments.