The Centers for Medicare & Medicaid Services (CMS) aims to crack down on ghost networks in provider directories in the final rule released late Thursday. The new requirements will help people determine if their providers are in-network for their available Medicare Advantage plans and enhance the 2027 shopping and plan comparison experience.
The final rule is scheduled to be published in the Federal Register today.
In the memo sent to Medicare Advantage organizations at the end of the day Thursday, CMS said that the rule will make it easier for beneficiaries to access provider directory information offered by Medicare Advantage plans through the Medicare Plan Finder and improve transparency in comparing plan coverage for 2027.
The rule also finalizes a requirement that Medicare Advantage organizations attest to the accuracy of the provider directory data that they provide to CMS to populate online.
Not finalized: A portion of the requirement in the 2026 Medicare Advantage proposed rule that would have Medicare Advantage organizations attest that their provider directory data is consistent with information submitted to comply with network adequacy requirements.
CMS said it will soon release guidance that includes technical specifications on how plans can prepare provider directory data and comply with the new requirements. The guidance will provide timing of milestones, such as when plans must make the provider directory data available to CMS.
In the memo, CMS said it will not immediately populate the 2026 Medicare Plan Finder with the provider data that plans prepare in response to the final rule. To ensure that the directory data submitted is accurate, CMS will conduct a testing period prior to the release of the information in the 2027 Medicare Plan Finder.
The memo also clarifies that the final rule is independent of CMS’ plans announced August 25 to populate the 2026 Medicare Plan Finder with provider directory information supplied by third-party vendors.
The new rule will require Medicare Advantage organizations for plan years beginning on or after January 1, 2026 to
- Make the provider information available to CMS for publication online
- Submit the information in a format determined by CMS
- Update the provider data within 30 days of learning of a change
- Ensure the accuracy of the provider directory information it an annual attestation