CMS proposes 90-day directory checks for Medicare Advantage

CMS released a proposed rule on October 16, 2026 (CMS-4214-P, published in the Federal Register on October 20) that would set accuracy requirements for Medicare Advantage provider directories. It implements section 6220 of the Consolidated Appropriations Act, 2026, and the directory requirements would apply from contract year 2028. Comments are due December 15, 2026.

Under the proposal, Medicare Advantage organizations would verify each provider’s directory information at least every 90 days, or every 12 months for acute inpatient hospitals, critical care services and surgical services. A listing that can’t be verified would carry a notice, for example “The provider’s information may not be up to date.” Plans would update the directory within 30 days of receiving new information and remove a provider who has left the network within 5 business days.

Each plan would also run an annual analysis of directory accuracy, with 35% of the sample drawn from specialties with high inaccuracy rates (for now, mental health and substance use disorder treatment). CMS would publicly display each plan’s accuracy score from contract year 2029. The proposal also includes cost-sharing protections for enrollees who rely on inaccurate directory information.

What it means for provider data: each requirement depends on knowing, for every listing, when it was last verified, how, and which system holds the correct value. Plans that keep provider data in separate contracting, credentialing and directory systems will need one mastered record per provider and location to keep a 90-day cycle and to support the accuracy analysis. A chatbot or search tool that answers network questions would need to read from that same verified record.