CMS proposes rule on provider directories under CAA 2026
CMS published a proposed rule on October 20, 2026, at 91 FR 66408, to implement three sections of the Consolidated Appropriations Act, 2026. It would set provider directory accuracy duties for Medicare Advantage plans from contract year 2028, add Part D pharmacy benefit manager rules and cut a Part D copay. Comments are due December 15, 2026.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · 
In short: this is a proposal, not a final rule. Its provider directory part affects hospitals and practices that sit in Medicare Advantage networks, because plans would verify listings every 90 days and remove delisted providers within 5 business days.
What did CMS propose on October 20, 2026?
The document is titled Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026, file code CMS-4214-P, RIN 0938-AV88. It amends 42 CFR parts 422 (Medicare Advantage) and 423 (Part D) and appears at 91 FR 66408. The Act became law on February 3, 2026 as Public Law 119-75.
CMS says comments must be received by 5 p.m. Eastern Standard Time on December 15, 2026. The docket is CMS-2026-2533 on regulations.gov.
What are the three parts of the proposal?
| Section of the Act | What CMS proposes | Start |
|---|---|---|
| 6219, Part D cost sharing reductions | Lower the generic drug copayment from $1 to $0 for full-benefit dual eligible individuals at or below 100 percent of the federal poverty level | Plan years starting January 1, 2028 |
| 6220, REAL Health Providers Act | New Medicare Advantage provider directory accuracy rules at proposed 42 CFR 422.123, annual accuracy reporting, public accuracy scores and enrollee cost sharing protections at proposed 422.124 | Contract year 2028; public display of scores in contract year 2029 |
| 6224, PBM accountability | Rules on pharmacy benefit manager remuneration, data reporting, transparency of pricing commitments to plan sponsors, disclosure of manufacturer agreements and disgorgement of funds to CMS for violations | Part D, dates set in the proposal |
Any new marketing and communications policies in the rule are proposed to apply to all contract year 2028 marketing and communications, which begin October 1, 2027.
What would the provider directory rules require?
Under the statute CMS is implementing, each Medicare Advantage organization must keep an accurate directory on a public website and verify each listed provider's information at least every 90 days. For a hospital or other facility CMS may set a lesser frequency, but no less often than once every 12 months.
- Unconfirmed listings: if the plan cannot verify a provider's information, the directory must indicate that the information may not be up to date.
- Removal: the plan must remove a provider within 5 business days after it determines that the provider no longer participates in the network.
- Updates: other changes to the online and printable directory would be made within 30 days of receiving information that requires an update. A quarterly addendum would go to enrollees who requested a hard copy.
- Cost sharing protection: if a provider was listed as in-network on the date an enrollee made the appointment but is out of network when care is furnished, the plan must limit cost sharing to the lesser of the in-network or otherwise applicable amount.
Who does the proposal affect?
Medicare Advantage plans carry the duties. Hospitals and practices in those networks are affected because plans will contact you to verify listings, and under the proposal an inaccurate listing would change what the enrollee owes.
The Part D PBM and copayment parts reach pharmacies and Part D plan sponsors and have less direct effect on facility billing, so a hospital team can note them and move on. For how payer rules vary see our Medicare payer page.
What should billing teams do now?
- Ask your contracting lead which Medicare Advantage plans list your facility and providers, and which contact each plan uses for directory updates.
- Answer plan verification requests quickly once they begin, since the statute requires plans to verify listings.
- Notify a plan the day a provider leaves its network, since removal must follow within 5 business days of its determination.
- Decide whether to comment by December 15, 2026.
What is still open?
CMS must read comments and publish a final rule, and the final text may differ. For background on price and payment rules see the No Surprises Act FAQ and good faith estimates, and for out-of-network billing help see out-of-network billing and IDR or book a call.
- Medicare Program; Implementation of Sections 6219, 6220, and 6224 of the Consolidated Appropriations Act, 2026, proposed rule, 91 FR 66408 (October 20, 2026) · Federal Register (govinfo)
- Regulations.gov docket CMS-2026-2533 · CMS
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Common questions
Straight answers from the team that does the work.
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01What is the CMS-4214-P proposed rule?
It is a CMS proposed rule published October 20, 2026 at 91 FR 66408 that would implement sections 6219, 6220 and 6224 of the Consolidated Appropriations Act, 2026. It covers a Part D copayment change, Medicare Advantage provider directory accuracy and Part D pharmacy benefit manager accountability.
02When are comments due on the CMS-4214-P proposed rule?
The notice says comments must be received by 5 p.m. Eastern Standard Time on December 15, 2026. You can submit them electronically at regulations.gov, docket CMS-2026-2533, or by mail to the CMS addresses printed in the notice, referring to file code CMS-4214-P.
03How often would Medicare Advantage plans verify provider directories?
The statute CMS is implementing requires verification at least every 90 days. For a hospital or other facility, CMS may set a lesser frequency, but no less often than once every 12 months. A plan must remove a delisted provider within 5 business days, starting in contract year 2028.
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