The proposed changes would implement key healthcare provisions in a government funding package from February.

The Consolidation Appropriations Act of 2026, signed into law by President Donald Trump in February, ended a short government shutdown by approving funding through September. It also included notable reform for the healthcare industry, like the heightened standards for MA provider directories and stricter PBM oversight that the CMS moved to implement in Friday’s proposed rule.

The MA directory changes are aimed at giving the 36 million seniors in the privatized Medicare program more reliable information about what doctors and hospitals are covered by an MA plan when seeking out services or choosing between carriers.

Bad provider directories are a major problem, with one study from 2023 finding upwards of 80% of provider listings contained inconsistencies. In MA alone, a CMS review of directories from 2018 found inaccuracies ranging from 5% to 93% of all listings, depending on the plan examined.

The CMS finalized a rule last fall requiring MA plans to update their provider directories within 30 days of learning about changes, and attest at least once a year that directories are accurate. The new rule would heighten those standards, requiring rolling reviews and more frequent attestation.

The rule would also require plans to report an accuracy score to the CMS — and publicly post it on their directories.

The heightened provider directory verification and maintenance standards, annual accuracy analysis and cost-sharing protections for seniors would go into effect in 2028.

MA carriers would have until 2029 to publicly display accuracy scores in their provider lists.

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