Federal Register, Volume 90 Issue 180 (Friday, September 19, 2025)

[Federal Register Volume 90, Number 180 (Friday, September 19, 2025)]
[Rules and Regulations]
[Pages 45140-45151]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-18236]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 422

[CMS-4208-F2]
RIN 0938-AV40

Medicare and Medicaid Programs; Contract Year 2026 Policy and
Technical Changes to the Medicare Advantage Program, Medicare
Prescription Drug Benefit Program, Medicare Cost Plan Program, and
Programs of All-Inclusive Care for the Elderly (PACE)--Finalization of
Format Provider Directories for Medicare Plan Finder

AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).

ACTION: Final rule.

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SUMMARY: This final rule implements Medicare Advantage disclosure
requirement changes.

DATES:
Effective date: These regulations are effective November 17, 2025.
Applicability date: This final rule is applicable beginning January
1, 2026.

FOR FURTHER INFORMATION CONTACT: Naseem Tarmohamed, (410) 786-0814.

SUPPLEMENTARY INFORMATION:

I. Executive Summary

A. Purpose

The primary purpose of this final rule is to amend the regulations
pertaining to disclosure requirements under 42 CFR 422.111 for the
Medicare Advantage (MA) (that is, Part C) program. In this final rule,
CMS is finalizing a new requirement that will increase beneficiaries'
access to provider data while comparing plans in the CMS Medicare Plan
Finder (MPF) tool, which will contribute to the beneficiaries' ability
to make more informed decisions about their health care.

B. Summary of the Provision--Format Provider Directories for Medicare
Plan Finder

CMS is finalizing the proposed requirement for MA provider
directory data to be submitted to CMS/HHS for publication online in
accordance with guidance from CMS/HHS. In addition, CMS is finalizing
the proposal that MA provider directory data be updated within 30 days
of the date an MA organization becomes aware of changes to that data.
CMS is also finalizing the proposal to require MA organizations to
attest at least annually that the MA provider directory information is
accurate when the attestation is provided to CMS. These regulatory
changes will further promote informed beneficiary choice and
transparency found in online resources, empowering people with Medicare
to make informed choices about their coverage. CMS is not finalizing
the portion of the proposal that would have required MA organizations
to attest that their MA provider directory data are consistent with
data submitted to comply with CMS's MA network adequacy requirements
under Sec. 422.116(a)(2)(i). MA organizations already attest that they
have an adequate network for access and availability of a specific
provider or facility type.

C. Summary of Costs and Benefits

Table 1--Summary of Costs and Benefits
----------------------------------------------------------------------------------------------------------------
Provision Description Financial impact
----------------------------------------------------------------------------------------------------------------
Format Provider Directories for Medicare To require MA provider directory data, as These changes will not
Plan Finder. required under Sec. 422.111(b)(3)(i), affect the Medicare Trust
to be submitted to CMS/HHS for fund. The paperwork
publication online in a format, manner, burden is $500,000
and timeframe determined by CMS/HHS. annually.
Additionally, to also require MA
organizations to attest at least annually
that this information is accurate when
the attestation is submitted to CMS in
accordance with guidance from CMS/HHS.
CMS is not finalizing the portion of the
proposed attestation requirement that
would have required MA organizations to
attest that the provider directory data
are consistent with data submitted to
comply with CMS's MA network adequacy
requirements at Sec. 422.116(a)(2)(i).
MA organizations already attest that they
have an adequate network for access and
availability of a specific provider or
facility type.
----------------------------------------------------------------------------------------------------------------

D. Publication of the Proposed and Final Rules

The proposed rule titled ``Medicare and Medicaid Programs; Contract
Year 2026 Policy and Technical Changes to the Medicare Advantage
Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan
Program, and Programs of All-Inclusive Care for the Elderly'' appeared
in the December 10, 2024, Federal Register (89 FR 99340) (hereinafter
referred to as the ``December 2024 proposed rule'').
In response to the December 2024 proposed rule, CMS received
approximately 31,227 timely pieces of correspondence containing
multiple comments on the proposed rule, with

[[Page 45141]]

approximately 130 received about the provision to format provider
directories for MPF being finalized here. CMS notes that some of the
public comments were outside of the scope of the proposed rule.
In the subsequent final rule of the same title that appeared in the
April 15, 2025, Federal Register (90 FR 15792) (hereinafter referred to
as the ``April 2025 final rule''), CMS finalized several of the
provisions from the proposed rule and noted the provisions of the
proposed rule that would not be addressed or finalized. CMS also
indicated that any remaining provisions may be finalized in subsequent
rulemaking, as appropriate. For more information, see the April 2025
final rule (90 FR 15891).

II. Proposal To Format MA Organizations' Provider Directories for
Medicare Plan Finder (Sec. Sec. 422.111 and 422.2265) and Analysis of
and Responses to Public Comments

CMS continues to take steps to improve the usability of MPF to
assist beneficiaries in making informed choices about their Medicare
coverage. It is important that Medicare beneficiaries have the
information they need to make the best choice for their health when
they are exploring their plan options. Understanding which providers
are in a plan's network is a vital piece for beneficiaries to make an
informed choice. Provider directories allow beneficiaries and their
caregivers to weigh Medicare options and decide if a plan's network
meets their needs. Beneficiaries can check a provider directory to see
if their existing providers are in the plan's network and which other
contracted providers are available to deliver medical care. As the
landscape of MA has evolved, CMS has implemented rules and made
modifications to required materials, disclaimers, and website
requirements to ensure that people with Medicare and the trusted
individuals they rely on to aid in their decision making have the
information necessary to make decisions about their Medicare options.
In the December 2024 proposed rule, CMS proposed additional
regulatory changes to allow the agency to leverage technological
methods that streamline the beneficiary experience so that
beneficiaries have the provider network information they need to make
the best choice for their needs. CMS proposed to make changes that
would allow MA provider directory data to be viewable on MPF for the
2026 Annual Election Period (AEP). In addition, to ensure the accuracy
of the data being submitted, CMS proposed that MA organizations would
be required to update the provider directory data being made available
to CMS for inclusion online in MPF within 30 days of receiving
information from providers of a change, and to require MA organizations
to attest to the accuracy of the provider directory data being
submitted. In total, CMS articulated the expectation that these
proposed changes, if finalized, would result in an advancement of
informed beneficiary choice and transparency benefiting people with
Medicare, while also promoting robust competition within the Medicare
market.
Section 1851(d)(1) of the Social Security Act (the Act) states that
the Secretary shall provide for activities to broadly disseminate
information to current and prospective Medicare beneficiaries on MA
plan coverage options to promote an active, informed selection among
such options. Specifically, per section 1851(d)(2)(A)(ii) of the Act,
at least 15 days before the beginning of each annual coordinated
election period, the Secretary shall provide MA-eligible individuals
with a list identifying the MA plans that are (or will be) available to
residents of the areas in which they reside, including certain
information concerning such MA plans, presented in a comparative form.
This information is described in section 1851(d)(4) of the Act and
includes plan benefits, premiums, service area, quality and performance
indicators, and supplemental benefits. Section 1851(d)(4)(A)(vii) of
the Act also sets forth that information comparing MA plan options must
specifically include the extent to which an enrollee may select among
in-network providers and the types of providers participating in the
plan's network. In addition, section 1851(d)(7) of the Act provides
that MA organizations shall provide CMS with such information about the
MA organization and each MA plan that it offers, as may be required for
the preparation of the information for Medicare Open Enrollment
described in section 1851(d)(2)(A) of the Act.
Section 1852(d)(1) of the Act requires access to services for MA
enrollees and states that MA organizations offering an MA plan may
select the providers from whom the benefits under the plan are provided
if the MA organization complies with several conditions, including
access to appropriate providers (section 1852(d)(1)(D) of the Act).
Specifically, network-based MA plans must demonstrate an adequate
contracted provider network that is sufficient to provide access to
covered services in accordance with the access standards at section
1852(d)(1) of the Act. Section 422.116(a)(2) further clarifies this
obligation by providing network adequacy access requirements for MA
plans. Section 422.116(a)(2)(i) requires that MA organizations must
attest that they have an adequate network for access and availability
of a specific provider or facility type that CMS does not independently
evaluate in a given year.
Section 1852(c)(1)(C) of the Act further requires MA plans to
disclose the number, mix, and distribution of plan providers, among
other disclosures. Based on this statutory requirement, CMS has
implemented regulations at Sec. 422.111(b)(3)(i) that require MA plans
to disclose the number, mix, and distribution (addresses) of providers
from whom enrollees may reasonably be expected to obtain services.
These regulations establish the overarching requirements for the MA
provider directory content.
The Medicare and Medicaid Programs; Patient Protection and
Affordable Care Act; Interoperability and Patient Access for Medicare
Advantage Organization and Medicaid Managed Care Plans, State Medicaid
Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of
Qualified Health Plans on the Federally-Facilitated Exchanges, and
Health Care Providers (85 FR 25510) (hereinafter referred to as the
``May 2020 Interoperability and Patient Access final rule'') became
effective on June 30, 2020, and required MA organizations, beginning on
January 1, 2021, to make standardized information about their provider
networks accessible through a Provider Directory Application
Programming Interface (API) that conforms with the CMS/HHS technical
standards at Sec. 422.119(c). The May 2020 Interoperability and
Patient Access final rule also included in Sec. 422.120 that the
Provider Directory API must be accessible via a public-facing digital
endpoint on the MA organization's website to ensure that this
information is viewable and accessible to prospective and current
enrollees as well as third-party application developers, who can create
services to help patients find providers for care and treatment.
Requirements at Sec. 422.120 further specify that the MA plan's
directory of contracted providers must be complete and accurate and
include names, addresses, phone number, specialties and (as applicable
for MA-PDs) the number of pharmacies in the network and mix of pharmacy
types. MA organizations must ensure this information is updated within
30 calendar days of receiving updated

[[Page 45142]]

provider directory information. Provider Directory API technical
standards were also modified for more specificity in the February 2024
Medicare and Medicaid Programs; Patient Protection and Affordable Care
Act; Advancing Interoperability and Improving Prior Authorization
Processes for Medicare Advantage Organizations, Medicaid Managed Care
Plans, State Medicaid Agencies, Children's Health Insurance Program
(CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified
Health Plans on the Federally-Facilitated Exchanges, Merit-Based
Incentive Payment System (MIPS) Eligible Clinicians, and Eligible
Hospitals and Critical Access Hospitals in the Medicare Promoting
Interoperability Program Final Rule (89 FR 8758), which was effective
on April 8, 2024.
To comply with the previously referenced statutory and regulatory
requirements, CMS has historically taken a two-pronged approach. CMS
implemented MPF as an online resource where current and prospective
beneficiaries and their caregivers can explore their Medicare coverage
options. On MPF, individuals can look for MA and Part D plans and make
informed choices based on the information provided, such as plan
benefits, premiums, deductibles, and Star Ratings, to name a few. While
CMS has implemented improvements to MPF over the years to incorporate
more data, MPF does not currently include information on MA plans'
contracted provider networks, such as the specific providers with which
a plan contracts and from which an enrollee may receive health care
services.
In addition to creating MPF, CMS has implemented regulations that
require each MA organization to disclose or otherwise make available
certain required information, including hardcopy and electronic
provider directory requirements under Sec. 422.2267(e)(11), as well as
a searchable online directory as required under Sec. 422.2265(b)(4).
Through these requirements, the provider directory information is made
available to prospective and existing MA plan enrollees so they may
view MA plans' in-network providers and other relevant information as
required under Sec. 422.111(b)(3)(i), such as the provider's specialty
and location in the MA organization's online PDF or a printable copy of
their provider directory (Sec. 422.2265(b)(3)). However, using MPF
while also searching multiple plan websites to determine a provider's
network status can be cumbersome. Prospective and current MA plan
enrollees must toggle between different MA plan websites and MPF to
find and review the plans' provider directories to determine if the
providers they currently see are in the various plans' networks, as
well as review the information provided by MPF.
In order to simplify and streamline the Medicare beneficiary
shopping experience, CMS proposed to expand on the existing
requirements applicable to MA organizations regarding their provider
directories at a newly established Sec. 422.111(m) to include a new
paragraph that requires MA organizations to: (1) make the information
described in Sec. 422.111(b)(3)(i) available to CMS/HHS for
publication online in accordance with guidance from CMS/HHS; (2) submit
or otherwise make available their plan provider directory data, that is
the requirements found under Sec. 422.111(b)(3)(i), available to CMS/
HHS in a format, manner, and timeframe determined by CMS/HHS; (3)
update the information subject to Sec. 422.111(m) within 30 days of
the date an MA organization becomes aware of a change; and (4) attest,
in a format and manner and at times determined by CMS/HHS, that all
information submitted or otherwise made available to CMS/HHS under
paragraph (m) is accurate and consistent with data submitted to comply
with CMS's MA network adequacy requirements at Sec. 422.116(a)(2)(i).
The combined intent of the proposed requirements was to allow CMS to
use the MA organization's provider directory data to be integrated
online by CMS/HHS for display on MPF. As noted in the preamble of the
December 2024 proposed rule (89 FR 99431) and earlier in this final
rule, CMS has previously adopted regulations to implement requirements
applicable to MA organizations for publicly accessible, accurate, and
timely provider directory information through the May 2020
Interoperability and Patient Access final rule. The provider directory
requirements of the May 2020 Interoperability and Patient Access final
rule aid in establishing the groundwork for MA plan provider directory
information to be readily accessible for MA organizations to submit to
CMS for inclusion on MPF.
In the December 2024 proposed rule (89 FR 99432), CMS also
highlighted that the requirements being proposed at 42 CFR 422.111(m)
would closely mirror the provider directory submission requirements at
45 CFR 156.230(c) for Qualified Health Plan (QHP) issuers on the
federally facilitated Exchange (FFE). Currently, 45 CFR 156.230(c)
requires issuers seeking certification to offer QHPs on the FFE to
submit provider information in a format and manner and at times
determined by HHS/CMS to HHS/CMS. This information is then used to feed
HealthCare.gov and its Direct Enrollment partner websites to allow
consumers to filter available QHPs based on the providers and drugs
covered by those QHPs. The proposed requirements for MA organizations
took a substantially similar approach. Given that many health insurance
carriers offer both MA plans and QHPs, CMS explained in the December
2024 proposed rule that this was a reasonable approach that would help
lessen the burden associated with meeting the MA requirements. CMS also
noted that the proposed requirements set forth in the December 2024
proposed rule would only apply to MA organizations (not Part D
sponsors).
In response to the December 2024 proposed rule, CMS received
comments from various stakeholders including advocates, health plans,
providers, trade organizations, drug manufacturers, and a few
individuals. The following are comments on this proposal as they
pertain to the provisions, which CMS proposed to include in its
regulations at Sec. 422.111(m)(1) through (3), that would require MA
organizations, including MA organizations that offer MA plans with Part
D coverage, to make provider directory data available to CMS/HHS for
publication online in MPF, to submit or otherwise make available their
plan provider directory data available to CMS/HHS in a format, manner,
and timeframe determined by CMS/HHS; and to update the information
within 30 days of the date an MA organization becomes aware of a
change. Note that CMS has outlined and responded to comments received
regarding the related attestation requirement, which CMS proposed at
Sec. 422.111(m)(4), in a later section of this final rule.
Comment: The majority of commenters expressed support for this
provision. Some commenters acknowledged that it is critical when
serving some of the nation's most vulnerable patients that enrollees
have dependable information about their providers. Other commenters
encouraged CMS to finalize this provision because they believed it
would streamline the current provider directory review process while
improving transparency for beneficiaries who are navigating their
healthcare options. Lastly, a commenter stated that meaningful and
accurate network comparisons on MPF will greatly improve enrollment
decisions as well as meaningful competition between plans.

[[Page 45143]]

Response: CMS agrees and thanks commenters for their feedback. The
goal of this provision is to improve the plan comparison experience and
help beneficiaries make an informed choice by making provider
information accessible on MPF.
Comment: Several commenters expressed concerns with this proposal,
stating that it failed to address key underlying causes of inaccuracy,
which drive provider directory problems, and that this proposal may
cause MA plans to be penalized due to circumstances beyond their
control. Specifically, when providers fail to promptly update their
address, telephone number, or other provider directory information, MA
plans are held accountable for inaccurate provider directories.
Response: Thank you for your comments. CMS understands the
complexities that may contribute to provider directory accuracy issues.
However, CMS notes that there are existing regulatory requirements to
ensure provider directory accuracy, including those under Sec. Sec.
422.111(a)(2), 422.2262(a)(1)(i), 422.2267(c)(1), and
422.2267(e)(11)(iv). In addition, CMS's annual CY 2026 Medicare
Advantage and Section 1876 Cost Plan Provider Directory Model and
Instructions, issued June 16, 2025, strongly encourages MA
organizations to institute procedures that support the ongoing accuracy
of their provider directory. Therefore, the MA organization retains
responsibility for data accuracy through the implementation of best
practices. Moreover, while the focus of this provision is not provider
directory accuracy, CMS notes that including provider directory data on
MPF is another tool to help provide more accurate provider directory
data for Medicare beneficiaries. CMS will bear in mind the information
that was provided by these commenters as CMS considers future
policymaking regarding underlying provider directory accuracy issues.
Comment: Several commenters stated that the inclusion of the
information on MPF would be redundant since provider directories were
already available on plan websites and there were already requirements
to inform beneficiaries when changes to networks occurred.
Response: With regard to the concerns expressed associated with
redundancy of effort, CMS acknowledges that there are other provider
directory requirements such as those that MA organizations provide
their members with a provider directory (Sec. 422.2267(e)(11)) and
make provider directories accessible on plan websites (Sec.
422.2265(b)(4)). However, while prospective enrollees can view this
information on individual plan websites, without a central repository
of provider directory information across all MA plans, it is not easy
for beneficiaries to compare networks among various MA plan choices. As
such, CMS notes that any redundancy is offset by the benefit of
complete and meaningful provider network comparisons made possible by
inclusion of this directory information in MPF, so that beneficiaries
may more readily consider and choose the best plan for their health
care needs.
Comment: Some commenters raised concerns regarding operational
guidance as it pertains to the timing and implementation of this
provision. A few commenters expressed their concerns about receiving
guidance early enough to allow ample time to prepare before MA
organizations are required to submit their provider directory data to
CMS. Additionally, a few commenters requested clearer guidance
pertaining to provider directory content and MA organization networks.
More specifically, a commenter requested that CMS clarify the provider
types that must be included in the provider directory and whether the
requirements will be consistent across plans. Another commenter
questioned whether the provider directory information that will be
included in MPF would pertain solely to providers in the plans' service
area or whether the information would also include providers covered
under travel benefits. Regarding the plan's network, a commenter
questioned if the plan-provided information to CMS supersedes the
delegated entity when inconsistencies in the plan's network arise.
Lastly, several other commenters inquired about the process for
updating submitted provider data and whether there will be a pilot
program to validate such submissions.
Response: To ensure that MA plans have sufficient time to implement
these provider directory requirements, CMS intends to issue an
operational guide soon after the publication of this final rule. CMS
anticipates that the operational guide will include technical
information about how MA plans will format and submit the provider
directory data files for purposes of this new regulatory requirement.
The January 1, 2026, applicability date is the date by which plans will
be required to conform with the new requirements in Sec. 422.111(m) by
making their provider directory data available to CMS; however, this
data may not be accessible to the public on MPF by January 1, 2026.
Additionally, CMS intends to offer technical support prior to January
1, 2026, as well as a testing period prior to having the new MPF
functionality available to Medicare beneficiaries, to provide technical
feedback to MA organizations in the period before they are expected to
comply with these new requirements. The testing period will allow the
parties to test that the directory data made available to Medicare
beneficiaries through MPF reflects the data that the MA organizations
provided.
With respect to the information regarding which providers are
considered network providers for the purposes of inclusion in the
provider directory and submitted to CMS, provider types required for
inclusion are outlined annually in the Medicare Advantage and Section
1876 Cost Plan Provider Directory Model and Instructions. For example,
the 2026 instructions can be found at https://www.cms.gov/medicare/health-drug-plans/managed-care-marketing/models-standard-documents-educational-materials. CMS also regularly provides MA plans with a
provider directory model that contains required content to ensure
consistency among plans. The current provider directory requirements at
Sec. Sec. 422.111(b)(3) and 422.2267(e)(11) do not include providers
outside of their network (for example, traveling providers); therefore,
the provider directory data that is submitted for publication online in
MPF should mimic these requirements and exclude out-of-network travel
providers.
Regarding the commenter's inquiry about whether plan-provided
information to CMS supersedes a delegated entity when inconsistencies
in the plan's network arise, CMS is interpreting this question to be
about discrepancies between an MA plan and a provider as it applies to
the accuracy of the provider network data required at Sec. Sec.
422.111 and 422.2262(a). CMS's focus is on accuracy as it applies to a
beneficiary enrolled in an MA plan being able to identify, contact, and
schedule an appointment with providers within that MA plan's network in
question. For example, if a provider office was not aware that they
were in the plan's network and were telling enrollees of the plan that
they cannot make an appointment, the ``who is right'' is irrelevant, as
the outcome is that the beneficiary is unable to make an appointment.
CMS views the MA organization's contracted provider to be a first-tier
entity, and hence the responsibility of the MA organization per Sec.
422.504(i)(1). Ultimately, it is up the MA organization to determine
how best to work with providers to meet the

[[Page 45144]]

requirements for accurate provider directories.
Comment: Commenters provided technical input on how they believe
provider directory data should be formatted once it is incorporated
into MPF. Overall, commenters requested that CMS require the collection
of the provider directory data in a format similar to that which is
currently used. A few commenters requested that CMS build machine-
readable JavaScript Object Notation (JSON) files, which are currently
used by health plans on the Health Insurance Marketplace, while others
requested that CMS not establish additional reporting formats and
utilize only the application programming interface (API) specifications
used under the existing May 2020 Interoperability and Patient Access
final rule.
Other commenters provided more general comments pertaining to how
they would like provider directory data displayed in MPF. Some
commenters expressed that they want real-time updates that display
provider network comparisons on a simplified interface using basic
language and advanced filtering options to narrow down choices.
Response: CMS appreciates the input from commenters. As discussed,
CMS intends to develop and distribute an operational guide with details
such as file formatting so plans have the resources available in
advance to ensure compliance with this provision. Additionally, CMS
understands the preference for utilizing established reporting formats
like the API. As previously mentioned, the technical details for
implementation will be provided as a part of operational guidance. CMS
appreciates the suggestion that the provider directories on MPF include
real-time updates. CMS reiterates that Sec. 422.111(m)(3) of this
provision requires that the data being made available for use in
populating MPF be updated within 30 days of the date an MA organization
becomes aware of a change. As noted, this requirement mirrors existing
requirements for provider directories. Through operational guidance,
CMS will also provide more detail on how quickly those changes are
reflected on MPF.
After carefully reviewing and responding to all comments as they
pertain to proposed Sec. 422.111(m)(1) through (3), CMS is finalizing
these requirements as proposed.
In the December 2024 proposed rule (89 FR 99432) CMS noted that,
while publishing MA plan provider directory information on MPF is an
important step, doing so in a way that ensures that beneficiaries are
accessing accurate information is a critical part of improving the
Medicare beneficiary experience while using MPF. In order to enhance
the accuracy of the information that will be published online by CMS/
HHS on MPF, CMS proposed to add new Sec. 422.111(m)(4), which would
require an MA organization to attest in a format and manner and at
times determined by CMS/HHS, that all information submitted or
otherwise made available to CMS/HHS under paragraph (m) is accurate and
consistent with data submitted to comply with CMS's MA network adequacy
requirements at Sec. 422.116(a)(2)(i). Given the significance of the
choice that a beneficiary is making based on the information provided
by the MA organization, CMS asserted in the proposal that it was
critical to include this attestation requirement to ensure that the
information being submitted by MA organizations is accurate and
consistent with data submitted to comply with CMS's MA network adequacy
criteria when it is submitted to CMS for the purpose of incorporating
it into MPF. The December 2024 proposed rule stated that it was
imperative that MA organizations' provider directory data remains
consistent with the contracted provider network data submitted to CMS
to provide sufficient access to covered services (89 FR 99432).
However, regarding the attestation, because provider directory data
changes so frequently, CMS acknowledged in the December 2024 proposed
rule that it may be impractical to require an attestation with each
update. In the proposed rule, CMS stated that the agency was
considering how to best balance the need for accountability of accurate
data with the burden of the attestation. CMS stated that, if this
proposed rule was finalized, CMS would provide operational guidance
that would explain how the attestation process would be implemented.
CMS also stated in the December 2024 proposed rule that the agency
envisioned an attestation taking place when the data is first made
available to CMS, and then a yearly attestation thereafter (89 FR
99432). CMS requested feedback on the attestation process, including
the intervals for the attestation and received the following comments
in response.
Comment: Some commenters mentioned that the attestation requirement
would increase the accountability of MA organizations, which would
reduce inaccurate provider directories that have contributed to reduced
access to services. Another commenter believed that requiring an
attestation was a great first step in helping to eliminate ``ghost
networks''--providers listed in directories who were not actually
contracted with the MA plan. Other commenters did not support the
attestation requirement, citing that MA plans would be held accountable
for provider directory errors even though providers input the source
data. Commenters also feared that additional reporting requirements and
penalties could increase burden and compliance actions. As a result, a
commenter requested that CMS define accuracy and its parameters, as CMS
proposed to require an attestation to ensure that the information being
submitted by MA organizations was accurate and consistent with data
submitted to comply with CMS's MA network adequacy criteria. Several
other commenters offered suggestions on how to improve overall provider
directory accuracy. Some suggestions included allowing MA plans to
demonstrate the adequacy of their networks through provider claims data
and requiring MA plans to use an independent third-party verification
company to confirm their provider directory information met a minimum
accuracy threshold.
Response: CMS thanks commenters for their support regarding the
provider directory data attestation requirement. The agency also
acknowledges the concern expressed through comments regarding
additional burden and potential compliance problems. CMS notes that MA
plans are required to have accurate provider directories and maintain
compliance with existing regulatory accuracy requirements that include:
(1) disclosure requirements under Sec. 422.111(a)(2), which mandate
that MA organizations provide information in a clear, accurate, and
standardized format; (2) provider directory access requirements at
Sec. 422.120(b), which require MA organizations' APIs to maintain
complete and accurate directories of their contracted provider networks
updated within 30 calendar days of receiving provider directory
changes; (3) general communication requirements under Sec.
422.2262(a)(1)(i), ensuring that all provided information is neither
misleading nor inaccurate; and (4) required materials regulations at
Sec. 422.2267(c)(1) and (e)(11)(iv) that require MA organizations to
accurately convey essential information and promptly update provider
directory data upon becoming aware of any changes.
After careful consideration of all comments received associated
with the proposed attestation requirement under

[[Page 45145]]

Sec. 422.111(m)(4), CMS is finalizing the portion of the attestation
proposal that requires MA organizations to attest, in a format and
manner and at times determined by CMS, that all information submitted
or otherwise made available to CMS/HHS under paragraph (m) be accurate.
CMS is finalizing this part of its regulation with one modification, to
make clear that at a minimum, MA organizations will be required to
attest at least annually. Additional details about the format, manner,
and timing/frequency of such attestation will be provided in the
operational guidance.
CMS has decided not to finalize the portion of the proposed
attestation requirement that would require MA organizations to attest
that their provider directory data is consistent with data submitted to
meet CMS's MA network adequacy requirements at Sec. 422.116(a)(2)(i).
CMS has determined it is more appropriate to distinguish provider
directory accuracy from network adequacy for this purpose. CMS notes
that MA organizations have separate obligations to ensure network
adequacy and already attest that they have an adequate network for
access and availability of a specific provider or facility type. CMS
believes that an attestation submitted at least annually and
specifically addressing the provider directory data would work in
conjunction with the existing regulatory accuracy requirements to
further strengthen data accuracy and enhance CMS's ability to ensure
reliable provider directory data for beneficiaries. In addition, to
strike a balance between burden and accountability, CMS intends to
collect the attestation at least annually, at a timeframe prior to the
AEP. Further details will be provided in the previously mentioned
operational guidance.
The provider directory data attestation will complement CMS's
existing regulatory accuracy requirements, oversight mechanisms, and
compliance monitoring through the current regulatory framework
established under Sec. Sec. 422.111, 422.2262(a), and 422.2267(e)(11),
all of which will allow CMS to maintain accountability for provider
directory accuracy, including addressing ``ghost networks'' and other
issues referenced by commenters. CMS encourages MA plans to continue
working with providers and exploring other options to maintain clear,
current, and accurate provider directories.
Comment: A few commenters provided comments associated with the
timing of the effective date and rollout of these requirements, as well
as when CMS is expecting the required data to be available to
beneficiaries on MPF. A few commenters suggested delaying
implementation of this provision due to timing and burden concerns.
Specifically, commenters stated that implementation of this provision
could require substantial financial and resource investments resulting
in financial burden. Additionally, another commenter mentioned the
administrative burden of having to attest with each data update while
implementing other provider directory requirements and rushing
implementation due to short timeframes. However, the commenters did not
provide any specifics to further elaborate on the concerns associated
with financial or administrative burdens associated with this rule.
Commenters did suggest alternative implementation dates from as early
as the 2027 AEP (October 15, 2026) to as late as July 1, 2028, which is
3 months before the 2029 AEP, to allow plans to fully comply.
Response: CMS appreciates the commenters' suggestions regarding the
effective date of the policy and alternative implementation dates. In
the December 2024 proposed rule, CMS stated that in order to
operationalize the proposed Format Provider Directories for Medicare
Plan Finder provision at Sec. 422.111(m), the agency anticipated that
2025 plan year provider directory data would need to be made available
online for testing purposes in the summer of 2025, and 2026 plan year
data would need to be available online on October 1, 2025. Therefore,
an applicability date of July 1, 2025, was proposed for this provision
(89 FR 99340). However, CMS has delayed the finalization of this
provision to allow for further consideration of the impacts and burden
on plans and providers. As such, because this provision was not
finalized in the April 2025 final rule, CMS notes that the anticipated
implementation timeline discussed in the preamble of the December 2024
proposed rule should also be adjusted. CMS is therefore finalizing an
applicability date of January 1, 2026, meaning this is the date by
which MA organizations will have to have directory data available to
CMS. As stated in a previous response to a comment regarding provider
directory formatting, CMS intends to publish an operational guide to
allow MA plans to familiarize themselves with formatting and technical
submission requirements before the implementation date. Therefore, CMS
does not anticipate that MA plans will need 2 years from the new
applicability date to fully comply with these requirements. Prior to
January 1, 2026, as well as prior to having the new MPF functionality
available to Medicare beneficiaries, CMS will also provide a period of
time where MA organizations can raise questions and where CMS will work
with MA plans to format their provider directory data as specified in
the operational guide. CMS will also provide time for MA organizations
to test their data with CMS. Additionally, proposed provisions at Sec.
422.111(m) will be finalized with one modification to exclude the
portion of the proposed attestation requirement within Sec.
422.111(m)(4) that required MA organizations to attest that provider
directory information is consistent with data submitted to comply with
CMS's MA network adequacy requirements at Sec. 422.116(a)(2)(i). This
modification is expected to decrease the administrative burden on MA
organizations relative to CMS's original proposal, as the modified
policy now requires MA organizations to only attest that their
submitted provider directory data is accurate.
Finally, CMS received a number of comments that touched on provider
directory data more generally, including provider directory data
accuracy. While not the focus of the December 2024 proposed rule,
accurate provider directories remain an important focus for CMS.
Comment: In an effort to ensure that provider directories are
comprehensive and include all providers available to beneficiaries,
some commenters recommended including additional health care providers
such as physician assistants (under the specialty in which they
practice), individuals providing supplemental benefits, and clinicians
and their affiliated clinic types. A commenter also requested that
provider capabilities specific to cultural competence be identified in
the provider directory. Alternatively, a few commenters suggested
excluding providers if they have given notice of their intent to
terminate their contractual relationship or if the MA organization
cannot verify their provider directory data or have no confidence in
the information they have obtained.
Response: CMS thanks commenters and acknowledges their
recommendations to ensure that provider directories reflect all
providers who are available to provide health care services for
enrollees of a given MA plan. CMS notes that existing regulations
require that an MA organization have written policies and procedures
for selecting and evaluating the contracted providers in its network,
including ensuring that these providers

[[Page 45146]]

meet applicable credential requirements (42 CFR 422.204). In accordance
with this requirement, through the subsequent operational guide, CMS
will provide the technical format that the provider directory data will
need to take to ensure that the required elements of the provider
directory under Sec. Sec. 422.111(b)(3) and 422.2267(e)(11) will be
accurately reflected in MPF. Additionally, CMS notes that existing MA
regulations at Sec. 422.111(b)(3)(i) require that MA organizations
disclose in provider directories each provider's cultural and
linguistic capabilities, including languages such as American Sign
Language, offered by the provider or a qualified medical interpreter at
the provider's office. With regard to comments that seek to exclude
providers due to an impending contract termination or lack of
verifiable data, CMS expects that the data provided to the agency will
be updated as necessary to ensure that MA organizations remain
compliant with provider directory accuracy requirements including
Sec. Sec. 422.111(a)(2), 422.120(b)(1), 422.2267(e)(11)(iv)(A), and
the requirement at Sec. 422.111(m)(3) newly finalized by this final
rule.
Comment: Commenters suggested that provider directory monitoring,
compliance, and enforcement include performing random provider
directory audits and secret shopper surveys, incorporating provider
directory attestation compliance in the Star Rating methodology, and
canceling MA plan contracts for non-compliance or imposing financial
penalties. Several commenters encouraged CMS to collaborate with
external stakeholders to ultimately improve provider directory accuracy
by focusing on public-private partnerships between the federal
government, providers, payers, and solutions vendors to streamline and
improve provider directory accuracy while also strengthening
transparency and enhancing data workflows through additional
collaborations with trade organizations and HL7.
Response: CMS believes that these comments are out of scope for
this rulemaking. However, CMS appreciates the commenters' suggestions
and will consider these and other recommendations during future
rulemaking. CMS acknowledges commenters' recommendations to collaborate
with external stakeholders as CMS recognizes the value in working
together to achieve a common goal of improving a beneficiary's
experience while using MPF, which will result in informed beneficiary
choice, transparency, and increased access to health care.
CMS thanks commenters for their suggestions on how the agency can
improve the overall accuracy of provider directories. CMS remains open
to receiving suggestions to improve provider directory accuracy and
will consider these recommendations for future rulemaking.
In summary, after carefully considering all of the comments, CMS is
finalizing the following provider directory requirements at Sec.
422.111(m) as proposed: that MA organizations must, for plan years
beginning on or after January 1, 2026, (1) make the information
described in Sec. 422.111(b)(3)(i) available to CMS/HHS for
publication online in accordance with guidance from CMS/HHS; (2)
submit, or otherwise make available, the information described in Sec.
422.111(b)(3)(i) to CMS/HHS in a format and manner and at times
determined by CMS/HHS; and (3) update the information subject to
paragraph (m) within 30 days of the date an MA organization becomes
aware of a change.
With regard to CMS's proposed regulation text at Sec.
422.111(m)(4), that MA organizations must attest in a format and manner
and at times determined by CMS/HHS, that all information submitted or
otherwise made available to CMS/HHS under paragraph (m) is accurate and
consistent with data submitted to comply with CMS's MA network adequacy
requirements at Sec. 422.116(a)(2)(i), for the reasons outlined
previously in this preamble, CMS will not be finalizing this
requirement as proposed. Instead, CMS is finalizing only the portion of
the proposed requirement that MA organizations must attest, in a format
and manner and at times determined by CMS/HHS, that all information
submitted or otherwise made available to CMS/HHS under paragraph (m) is
accurate. In addition, as discussed above, CMS is finalizing this
requirement with one modification to provide that this attestation must
occur at least annually.
As discussed previously in this final rule, the requirements
described herein are applicable to MA organizations beginning January
1, 2026. This means that MA organizations will be required to make
their directory data available to CMS by January 1, 2026, however, it
does not mean that the data will be available on Medicare Plan Finder
(MPF) for use by the public by January 1, 2026. CMS expects a period of
testing to take place to ensure that the directory data made available
to Medicare beneficiaries through MPF accurately reflects the data
provided by MA organizations. As noted earlier in this final rule, the
agency plans to release an operational guide soon after the publishing
of this final rule. The operational guide will outline technical
specifications and milestones by which MA organizations' provider
directory data will be made available for CMS so that it can later be
made available to beneficiaries by way of MPF.

II. Collection of Information Requirements

Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501 et
seq.), CMS is required to provide notice in the Federal Register and
solicit public comment before a ``collection of information,'' as
defined under 5 CFR 1320.3(c) of the PRA's implementing regulations, is
submitted to the Office of Management and Budget (OMB) for review and
approval. To fairly evaluate whether an information collection
requirement should be approved by OMB, 44 U.S.C. 3506(c)(2)(A) requires
that CMS solicit comment on the following issues:
The need for the information collection and its usefulness
in carrying out the proper functions of the agency.
The accuracy of the estimate of the information collection
burden.
The quality, utility, and clarity of the information to be
collected.
Recommendations to minimize the information collection
burden on the affected public, including automated collection
techniques.
In our December 10, 2024 (89 FR 99340) proposed rule (CMS-4208-P;
RIN 0938-AV40), CMS solicited public comment on a number of proposed
information collection requirements.
While a number of requirements were finalized on April 15, 2025 (90
FR 15792) under CMS-4208-F (RIN 0938-AV40), the proposed information
collection requirement in section VI.B.12 of the proposed rule (89 FR
99503) titled ``ICRs Regarding Formatting Medicare Advantage (MA)
Organizations' Provider Directories for Medicare Plan Finder (Sec.
422.120(c))'' was not included at that time. As indicated throughout
this preamble, this provision is being finalized in this rule.
CMS received a PRA-related comment on the proposed provisions,
which is summarized in section III.B. of this final rule.

A. Wage Data

For the purpose of the programming necessary to provide CMS with
the provider directory data, CMS estimates that a member of an MA
organization's Information Technology staff will require an average of
8 hours. This is a

[[Page 45147]]

one-time instance. For the purpose of completing the attestation, CMS
expects that an MA organization's plan officer will require 1 hour
annually. The hourly wage data for both these MA organizations' staff
persons are reflected in Table 2. The calculation of the one-time
burden estimates for the creation of the programming necessary to
provide CMS with provider directory data is in Table 3. The calculation
of the annual burden estimate for the plan officer attestation is in
Table 4.
To derive average (mean) costs, CMS is using data from the most
current U.S. Bureau of Labor Statistics' (BLS's) National Occupational
Employment and Wage Estimates for all salary estimates (https://www.bls.gov/oes/2024/may/oes_nat.htm), which, at the time of
publication of this final rule, provides May 2024 wages. In this
regard, table 2 presents BLS's mean hourly wage, CMS's estimated cost
of fringe benefits and other indirect costs (calculated at 100 percent
of salary), and CMS's adjusted hourly wage.

Table 2--National Occupational Employment and Wage Estimates
----------------------------------------------------------------------------------------------------------------
Fringe
Occupation Mean hourly benefits and Adjusted
Occupational title code wage ($/hr) other indirect hourly wage ($/
costs ($/hr) hr)
----------------------------------------------------------------------------------------------------------------
Computer Programmer............................. 15-1251 49.83 49.83 99.66
Plan Officer (CEO, CFO, COO, CTO)............... 11-1011 126.41 126.41 252.82
----------------------------------------------------------------------------------------------------------------

Adjusting CMS's employee hourly wage estimates by a factor of 100
percent is a rough adjustment that is used since fringe benefits and
other indirect costs vary significantly from employer to employer and
because methods of estimating these costs vary widely from study to
study. In this regard, CMS believes that doubling the hourly wage to
estimate costs is a reasonably accurate estimation method.

B. Information Collection Requirements (ICRs) Regarding Formatting MA
Organizations' Provider Directories for Medicare Plan Finder (Sec.
422.111(m))

The proposed rule inadvertently indicated (89 FR 99503) that the
proposed collection of information request (CMS-10906) would be
submitted to OMB for review. This rule corrects that statement which
should have indicated that the collection of information request (CMS-
10906, OMB control number 0938-TBD) will be made available for public
review and comment using the standard non-rule PRA process which
consists of publishing 60- and 30-day notices in the Federal Register
before the collection of information request is submitted to OMB for
their review/approval. CMS expects that the initial 60 day notice will
publish sometime after the final rule. The PRA package associated with
this burden will include a supporting statement, a clearance sheet, the
language CMS expects to use for the attestation process, and further
detail on the guidance that will instruct plans on how to
operationalize CMS access the plan's provider data.
As indicated in section II. of this final rule, CMS is finalizing
proposed requirements at Sec. 422.111(m) for MA organizations to
submit MA provider directory data to CMS/HHS for use in MPF. Under this
provision, MA organizations are required to: (1) make the information
described in Sec. 422.111(b)(3)(i) available to CMS/HHS for
publication online in accordance with guidance from CMS/HHS; (2)
submit, or otherwise make available, the information described in Sec.
422.111(b)(3)(i) to CMS/HHS in a format and manner and at times
determined by CMS/HHS; (3) update the information subject to Sec.
422.111(m) within 30 days of the date an MA organization becomes aware
of a change; and (4) Attest at least annually, in a format and manner
and at times determined by CMS/HHS, that all information submitted or
otherwise made available to CMS/HHS under paragraph (m) is accurate.
CMS believes this would further the agency's objective to promote
informed beneficiary choice, efficiency, and transparency.
Even though the reporting of provider directory data and updated
directory data by MA organizations to CMS is ongoing, it is part of an
automated process that is expected to take 8 hours at $99.66/hr for a
computer programmer for each plan to create the functionality within
their system.
In aggregate, CMS estimates a one-time burden of 5,600 hours (700
plans * 8 hr./plan) at a cost of $558,096 (5,600 hr. * $99.66/hr). This
is a measure of the burden of the programming changes necessary to
provide CMS access to the provider directory data.

Table 3--One-Time Initial Burden Estimates
--------------------------------------------------------------------------------------------------------------------------------------------------------
Regulation section(s) under Responses (per Time per Labor cost ($/
title 42 of the CFR Respondents respondent) Total responses response (hr) Total time (hr) hr) Total cost ($)
--------------------------------------------------------------------------------------------------------------------------------------------------------
422.111(m)..................... 700 1 700 8 5,600 99.66 558,096
--------------------------------------------------------------------------------------------------------------------------------------------------------
CMS further estimates an annual burden of 700 hours (700 plans * 1 hr./plan) at a cost of $176,974 (700 hr. * $252.82/hr.). This is a measure of the
burden of the attestation requirement.

Table 4--Annual Burden Estimates
--------------------------------------------------------------------------------------------------------------------------------------------------------
Regulation section(s) under Responses (per Time per Labor cost ($/
title 42 of the CFR Respondents respondent) Total responses response (hr) Total time (hr) hr) Total cost ($)
--------------------------------------------------------------------------------------------------------------------------------------------------------
422.111(m)..................... 700 1 700 1 700 252.82 176,974
--------------------------------------------------------------------------------------------------------------------------------------------------------

[[Page 45148]]

In the December 2024 proposed rule, CMS used 2024 data which
reflected 761 plans, including local and regional CCP, MSA, and PFFS
plans. CMS also used the adjusted hourly rate of $103.60/hr, based on
BLS' May 2023 mean hourly wage for a computer programmer. In this final
rule, the agency is updating the number of plans to 700 and the
adjusted hourly wage to $99.66/hr, based on the most currently
available data. As a result, the total cost estimate has decreased by
$72,621 (from $630,717 to $558,096).
The 700 plans include local and regional CCP, MSA, and PFFS plans
and is based on the publicly available CMS data on plan type counts
accessible at: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-contract-and-enrollment-summary-report/contract-summary-2025-05.
Medicare Cost plans have been excluded from the count since the
ultimate goal of the provision is a display in MPF, and MPF does not
currently list Medicare Cost plans.
As the agency is including an attestation requirement for the rule,
CMS calculates that an officer at each of the 700 plans mentioned
previously will have to spend one hour attesting to the accuracy of the
plan's provider directory data. BLS's National Occupational Employment
and Wage Estimates indicate an hourly wage of $126.41 adjusted per the
calculations mentioned earlier in this section to $252.82. To this end,
700 respondents x 1 hour per respondent x an hourly wage of $252.82
equals $176,974 in annual burden for the plan officer annual
attestation. As noted, in response to the December 2024 proposed rule
CMS received the following comment regarding the estimates provided.
Comment: A commenter questioned CMS's proposed level of effort for
programmers responsible for submitting provider directory data as
required by this provision. The commenter stated that 8 hours for
programming is lower than what is required for simple updates and much
less than what is required for the generation of new reports in most IT
departments.
Response: Thank you for your comment. Given that the commenter did
not include any additional data or updated timeframes provided in
support of their claim of inadequate programming hours, combined with
CMS not receiving any other comments expressing such concerns, the 8-
hour programming time will remain unchanged. Additionally, CMS's May
2020 Interoperability and Patient Access final rule, which establishes
some of the groundwork for this requirement previously established the
estimated costs associated with putting provider directory data in an
electronic format. Moreover, CMS expects the ongoing cost associated
with this requirement to be negligible given that MA organizations are
currently required to provide and maintain accurate electronic provider
directories, which must be updated, as required at Sec.
422.2267(e)(11)(iv), within 30 days of learning of a change.
After considering the comment received, CMS is not making any
additional changes to these estimates.

IV. Regulatory Impact Analysis

A. Statement of Need

B. Overall Impact Analysis

CMS has examined the impacts of this rule as required by Executive
Order 12866, ``Regulatory Planning and Review''; Executive Order 13132,
``Federalism''; Executive Order 13563, ``Improving Regulation and
Regulatory Review''; Executive Order 14192, ``Unleashing Prosperity
Through Deregulation''; the Regulatory Flexibility Act (RFA) (Pub. L.
96-354); section 1102(b) of the Act; and section 202 of the Unfunded
Mandates Reform Act of 1995 (Pub. L. 104-4).
Executive Orders 12866 and 13563 direct agencies to assess all
costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select those regulatory approaches that
maximize net benefits (including potential economic, environmental,
public health and safety, and other advantages; distributive impacts.).
Section 3(f) of Executive Order 12866 defines a ``significant
regulatory action'' as any regulatory action that is likely to result
in a rule that may: (1) have an annual effect on the economy of $100
million or more or adversely affect in a material way the economy, a
sector of the economy, productivity, competition, jobs, the
environment, public health or safety, or State, local, or Tribal
governments or communities; (2) create a serious inconsistency or
otherwise interfere with an action taken or planned by another agency;
(3) materially alter the budgetary impact of entitlements, grants, user
fees, or loan programs or the rights and obligations of recipients
thereof; or (4) raise novel legal or policy issues arising out of legal
mandates, or the President's priorities.
A regulatory impact analysis (RIA) must be prepared for a
regulatory action that is significant under section 3(f)(1) of E.O.
12866. This final rule does not meet the threshold required to be
considered significant under section 3(f)(1) of E.O.12866.
As outlined in the preamble, the regulatory changes in this final
rule will further promote informed beneficiary choice and transparency
found in online resources, empowering people with Medicare to make
informed choices

[[Page 45149]]

about their coverage. CMS is finalizing a new requirement that will
increase beneficiaries' access to provider data when comparing plans in
the MPF tool, which will contribute to the beneficiaries' ability to
make more informed decisions about their health care. This will allow
MPF users to have access to MA plans' provider directory data when
comparing MA plan information on MPF and for that comparison to be
meaningful. As a result, MPF users will save the time they would have
used going to multiple MA organization websites to access provider
directories. CMS believes that the cost for MPF users undertaking
administrative and other tasks on their own time is a post-tax wage of
$29.80/hr. The Valuing Time in U.S. Department of Health and Human
Services Regulatory Impact Analyses: Conceptual Framework and Best
Practices identifies the approach for valuing time when individuals
undertake activities on their own time. To derive the costs for MPF
users, a measurement of the usual weekly earnings of wage and salary
workers of $1,192, divided by 40 hours to calculate an hourly pre-tax
wage rate of $29.80. CMS used this figure to estimate the benefit of
this final rule regarding time saved by MPF users from using the new
functionality of MPF rather than going to multiple websites to collect
provider directory information.

Table 5--MPF User Wages
----------------------------------------------------------------------------------------------------------------
Fringe benefits
Occupational title Occupation code Mean hourly wage and other indirect Adjusted hourly
($/hr) costs ($/hr) wage ($/hr)
----------------------------------------------------------------------------------------------------------------
Average Beneficiary............. 00-0000 29.80 N/A 29.80
----------------------------------------------------------------------------------------------------------------

Table 6--Benefit to MPF Users
--------------------------------------------------------------------------------------------------------------------------------------------------------
Responses (per Time per Labor cost ($/
Benefit Respondents respondent) Total responses response (hr) Total time (hr) hr) Total cost ($)
--------------------------------------------------------------------------------------------------------------------------------------------------------
MPF User Benefit............... 4,000,000 1 4,000,000 0.5 2,000,000 24.73 -49,460,000
--------------------------------------------------------------------------------------------------------------------------------------------------------

While CMS did not receive any comments on the impact on
beneficiaries in the December 2024 proposed rule, the purpose of the
rule implies that there is an additional reduction in burden to the
beneficiary. Because each beneficiary's experience using MPF is unique,
calculating the time saved using MPF to compare MA plans using provider
names as search criteria can be done in the abstract, using estimates.
CMS data shows that approximately 8 million unique users accessed
MPF in 2023, which resulted in about 2 million MA enrollments. For the
purpose of this rule, CMS estimates 4 million MPF users visited
individual plan websites to compare provider directory data for at
least one provider. Furthermore, the time saved can be estimated at
approximately 30 minutes (0.5 hours) per MPF user. In this final rule,
the agency is using BLS's National Occupational Employment and Wage
Estimates to establish a base wage of $24.73. The base wage of $24.73 x
0.5 hours x the number of users (4,000,000) equals a savings of
$49,460,000.

C. Alternatives Considered

One possible alternative to requiring plans to make their provider
directory data available to CMS/HHS to publish online would be to
purchase that same data from a third-party vendor who has collected
that data. As discussed in the August 25, 2025 ``Updates to the
Contract Year 2026 Medicare Plan Finder and Medicare.gov'' Health Plan
Management System memorandum,\1\ CMS has adopted this alternative as a
short-term solution to provide Medicare beneficiaries provider
directory data on MPF for the 2026 calendar year. However, the agency
does not see this as a viable long-term solution. MA organizations are
under no obligation to provide their provider directory data to a
third-party vendor, nor is there a requirement that they attest to the
data's accuracy when providing it to a third-party. The requirements
finalized in this rule will provide CMS direct access to comprehensive
provider directory data for all MA organizations, including an
attestation to its accuracy for CMS to then publish online.
Additionally, having the provider directory data provided directly to
CMS from MA organizations is a more cost-effective solution to getting
this important information published online on MPF.
---------------------------------------------------------------------------

\1\ https://www.cms.gov/about-cms/information-systems/hpms/hpms-memos-archive-weekly/updates-contract-year-2026-medicare-plan-finder-and-medicaregov.
---------------------------------------------------------------------------

The RFA, as amended, requires agencies to analyze options for
regulatory relief of small businesses if a rule has a significant
impact on a substantial number of small entities. For purposes of the
RFA, small entities include small businesses, nonprofit organizations,
and small governmental jurisdictions.
CMS believes this final rule will have a direct economic impact on
beneficiaries and MA plans. Based on the size standards set by the
Small Business Administration (SBA) effective March 17, 2023, (for
details, see the Small Business Administration's website at https://www.sba.gov/document/support-table-size-standards), Direct Health and
Medical Insurance Carriers, classified using the NAICS code 524114,
have a $47 million threshold for ``small size.'' Many Medicare
Advantage plans (about 30 to 40 percent) are not-for-profit,
automatically classing them as ``small entities'' by the definitions
found in the RFA. The SBA categorizes firms with 1,300 employees or
fewer in this industry as small. Again, we believe the vast majority of
businesses operating in this field would be considered small.\2\
---------------------------------------------------------------------------

\2\ The estimates of firms within the size thresholds described
in this paragraph comes from a review of data from: US Census
Bureau, ``2022 SUSB Annual Data Tables by Establishment Industry,''
<https://www.census.gov/data/tables/2022/econ/susb/2022-susb-annual.html>, accessed on July 25, 2025.
---------------------------------------------------------------------------

The analysis in this rule provides descriptions of the statutory
provisions, identifies the policies, and presents rationales for our
decisions. The analysis discussed in this section and throughout the
preamble of this final rule constitutes our RFA analysis. The RFA does
not define the terms ``significant economic impact'' or ``substantial
number.'' The SBA advises

[[Page 45150]]

that this absence of statutory specificity allows what is
``significant'' or ``substantial'' to vary, depending on the problem
that is to be addressed in the rulemaking, the rule's requirements, and
the preliminary assessment of the rule's impact. Nevertheless, HHS
typically considers a ``significant economic impact'' to be 3 to 5
percent or more of the affected entities' costs or revenues, and a
``substantial number'' to mean 5 percent or more of affected small
entities within a given industry. Individuals and states are not
included in the definition of a small entity.
To explain the agency's position, we will first note certain
operational aspects of the MA program. Section 1851(d)(1) of the Act
states that the Secretary shall provide for activities to broadly
disseminate information to current and prospective Medicare
beneficiaries on MA plan coverage options to promote an active,
informed selection among such options. Specifically, per section
1851(d)(2)(A)(ii) of the Act, at least 15 days before the beginning of
each annual coordinated election period, the Secretary shall provide
MA-eligible individuals with a list identifying the MA plans that are
(or will be) available to residents of the areas in which they reside,
including certain information concerning such MA plans, presented in a
comparative form. This information is described in section 1851(d)(4)
of the Act and includes plan benefits, premiums, service area, quality
and performance indicators, and supplemental benefits. Section
1851(d)(4)(A)(vii) of the Act, also sets forth that information
comparing MA plan options must specifically include the extent to which
an enrollee may select among in-network providers and the types of
providers participating in the plan's network. In addition, section
1851(d)(7) of the Act provides that MA organizations shall provide CMS
with such information about the MA organization and each MA plan that
it offers, as may be required for the preparation of the information
for Medicare Open Enrollment described in section 1851(d)(2)(A) of the
Act.
Section 1852(d)(1) of the Act requires access to services for MA
enrollees and states that MA organizations offering an MA plan may
select the providers from whom the benefits under the plan are provided
if the MA organization complies with several conditions, including
access to appropriate providers (section 1852(d)(1)(D) of the Act).
Specifically, network-based MA plans must demonstrate an adequate
contracted provider network that is sufficient to provide access to
covered services in accordance with the access standards at section
1852(d)(1) of the Act. Section 422.116(a)(2) further clarifies this
obligation by providing network adequacy access requirements for MA
plans. Section 422.116(a)(2)(i) requires that MA organizations must
attest that they have an adequate network for access and availability
of a specific provider or facility type that CMS does not independently
evaluate in a given year.
Section 1852(c)(1)(C) of the Act further requires MA plans to
disclose the number, mix, and distribution of plan providers, among
other disclosures. Based on this statutory requirement, CMS has
implemented regulations at Sec. 422.111(b)(3)(i) that require MA plans
to disclose the number, mix, and distribution (addresses) of providers
from whom enrollees may reasonably be expected to obtain services.
These regulations establish the overarching requirements for the MA
provider directory content.
The Medicare and Medicaid Programs; Patient Protection and
Affordable Care Act; Interoperability and Patient Access for Medicare
Advantage Organization and Medicaid Managed Care Plans, State Medicaid
Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of
Qualified Health Plans on the Federally-Facilitated Exchanges, and
Health Care Providers (85 FR 25510) (hereinafter referred to as the
``May 2020 Interoperability and Patient Access final rule'') became
effective on June 30, 2020, and required MA organizations, beginning on
January 1, 2021, to make standardized information about their provider
networks accessible through a Provider Directory Application
Programming Interface (API) that conforms with CMS/HHS technical
standards at Sec. 422.119(c). The May 2020 Interoperability and
Patient Access final rule also included in Sec. 422.120 that the
Provider Directory API must be accessible via a public-facing digital
endpoint on the MA organization's website to ensure that this
information is viewable and accessible to prospective and current
enrollees as well as third-party application developers, who can create
services to help patients find providers for care and treatment.
Requirements at Sec. 422.120 further specify that the MA plan's
directory of contracted providers must be complete and accurate and
include names, addresses, phone numbers, specialties and (as applicable
for MA-PDs) the number of pharmacies in the network and mix of pharmacy
types. MA organizations must ensure this information is updated within
30 calendar days of receiving updated provider directory information.
Provider Directory API technical standards were also modified for more
specificity in the February 2024 Medicare and Medicaid Programs;
Patient Protection and Affordable Care Act; Advancing Interoperability
and Improving Prior Authorization Processes for Medicare Advantage
Organizations, Medicaid Managed Care Plans, State Medicaid Agencies,
Children's Health Insurance Program (CHIP) Agencies and CHIP Managed
Care Entities, Issuers of Qualified Health Plans on the Federally-
Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS)
Eligible Clinicians, and Eligible Hospitals and Critical Access
Hospitals in the Medicare Promoting Interoperability Program Final Rule
(89 FR 8758), which was effective on April 8, 2024.
CMS implemented MPF as an online resource where current and
prospective beneficiaries and their caregivers can explore their
Medicare coverage options. On MPF, individuals can look for MA and Part
D plans and make informed choices based on the information provided,
such as plan benefits, premiums, deductibles, and Star Ratings, to name
a few. While CMS has implemented improvements to MPF over the years to
incorporate more data, MPF does not currently include information on MA
plans' contracted provider networks, such as the specific providers
with which a plan contracts and from which an enrollee may receive
health care services.
In addition to creating MPF, CMS has implemented regulations that
require each MA organization to disclose or otherwise make available
certain required information, including hardcopy and electronic
provider directory requirements under Sec. 422.2267(e)(11), as well as
a searchable online directory as required under Sec. 422.2265(b)(4).
Through these requirements, the provider directory information is made
available to prospective and existing MA plan enrollees so they may
view MA plans' in-network providers and other relevant information as
required under Sec. 422.111(b)(3)(i), such as the provider's specialty
and location in the MA organization's online PDF or a printable copy of
their provider directory (Sec. 422.2265(b)(3)). However, using MPF
while also searching multiple plan websites to determine a provider's
network status can be cumbersome. Prospective and current MA plan
enrollees must toggle between different MA plan websites and MPF to
find and review the plans' provider directories to

[[Page 45151]]

determine if the providers they currently see are in the various plans'
networks, as well as review the information provided by MPF.
As its measure of significant economic impact on a substantial
number of small entities, HHS uses a change in revenue of more than 3
to 5 percent. We do not believe that this threshold will be reached by
the requirements in this final rule. Therefore, the Secretary has
certified that this final rule will not have a significant economic
impact on a substantial number of small entities.
As outlined in the preceding Collection of Information Requirements
section of this regulation, we have quantified a one-time burden cost
of $558,000, based on analysis of 700 entities, which results in a per-
entity cost of $797. Furthermore, we have determined the annual ongoing
burden cost to be $176,974, yielding a per-entity cost of approximately
$253. Both the initial per-entity cost of approximately $797 and the
annual ongoing cost of $253 are substantially below the 3 to 5 percent
threshold that HHS typically uses when determining if a rule will have
a significant impact on a substantial number of small entities.
Therefore, the Secretary has certified that this final rule will not
have a significant economic impact on a substantial number of small
entities.

D. Unfunded Mandates Reform Act (UMRA)

Section 202 of the Unfunded Mandates Reform Act of 1995 (UMRA) also
requires that agencies assess anticipated costs and benefits before
issuing any rule whose mandates require spending in any 1 year of $100
million in 1995 dollars, updated annually for inflation. In 2025, that
threshold is approximately $187 million. This final rule would not
impose a mandate that will result in the expenditure by State, local,
and Tribal Governments, in the aggregate, or by the private sector, of
more than $187 million in any one year.

E. Federalism

Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a final rule that imposes
substantial direct requirement costs on state and local governments,
preempts state law, or otherwise has Federalism implications. This
final rule does not impose substantial direct requirement costs on
state and local governments, preempt state law, or otherwise elicit
Federalism implications.

F. E.O. 14192, ``Unleashing Prosperity Through Deregulation''

Executive Order 14192, titled ``Unleashing Prosperity Through
Deregulation'' was issued on January 31, 2025, and requires that ``any
new incremental costs associated with new regulations shall, to the
extent permitted by law, be offset by the elimination of existing costs
associated with at least 10 prior regulations.'' This final rule is
neither an E.O. 14192 regulatory action (nor an E.O. 14192 deregulatory
action) because it imposes no more than de minimis costs.
Mehmet Oz, Administrator of the Centers for Medicare & Medicaid
Services, approved this document on September 16, 2025.

List of Subjects in 42 CFR Part 422

Administrative practice and procedure, Health facilities, Health
maintenance organizations (HMO), Medicare, Penalties, Privacy,
Reporting and recordkeeping requirements.

For the reasons set forth in the preamble, the Centers for Medicare
& Medicaid Services amends 42 CFR part 422 as set forth below:

PART 422--MEDICARE ADVANTAGE PROGRAM

0
1. The authority for part 422 continues to read as follows:

Authority: 42 U.S.C. 1302, 1306, 1395w-21 through 1395w-28, and
1395hh.

0
2. Section 422.111 is amended by adding paragraph (m) to read as
follows:

Sec. 422.111 Disclosure requirements.

* * * * *
(m) Increasing consumer transparency. For plan years beginning on
or after January 1, 2026, MA organizations must do all of the
following:
(1) Make the information described in paragraph (b)(3)(i) of this
section available to CMS/HHS for publication online in accordance with
guidance from CMS/HHS.
(2) Submit, or otherwise make available, the information described
in paragraph (b)(3)(i) of this section to CMS/HHS in a format and
manner and at times determined by CMS/HHS.
(3) Update the information subject to this paragraph (m) within 30
days of the date an MA organization becomes aware of a change.
(4) Attest at least annually, and in a format and manner and at
times determined by CMS/HHS, that all information submitted or
otherwise made available to CMS/HHS under this paragraph (m) is
accurate.

Robert F. Kennedy, Jr.,
Secretary, Department of Health and Human Services.
[FR Doc. 2025-18236 Filed 9-18-25; 4:15 pm]
BILLING CODE 4120-01-P