CMS to Launch Federal Medicare Advantage Directory
The Centers for Medicare & Medicaid Services (CMS) is preparing to launch a federal directory of hospitals and physicians for Medicare Advantage plans. The tool is designed to streamline provider lookups for patients. This new infrastructure could eventually support better interdisciplinary care coordination and referral efficiency.
- The push for a federal directory stems from widespread inaccuracies in individual Medicare Advantage plan directories, a problem often called "ghost networks," where listed providers are not actually in-network or are not accepting new patients. - A 2018 Centers for Medicare & Medicaid Services (CMS) report found that nearly 52% of provider listings in Medicare Advantage directories had at least one inaccuracy, creating significant barriers to care. - This initiative is part of a larger effort driven by the Consolidated Appropriations Act of 2021, which requires health plans to verify their provider directory information at least every 90 days to protect patients from unexpected out-of-network costs. - For 2026, CMS will use third-party data to populate an interim directory before transitioning in 2027 to data submitted directly by the Medicare Advantage plans themselves. - Inaccurate directories can create significant hurdles for pregnant individuals seeking in-network maternal care providers, such as nurse-midwives, potentially delaying or preventing access to necessary prenatal and postpartum care. - While Certified Nurse-Midwives (CNMs) are a mandatory provider type for Medicaid, they often face challenges with inclusion and accurate listing in managed care networks, which a centralized and verified directory could help alleviate. - This directory initiative aligns with broader CMS efforts to improve maternal health outcomes, such as the Transforming Maternal Health (TMaH) Model, which aims to expand access to providers like midwives and doulas for Medicaid beneficiaries. - Should a beneficiary enroll in a plan based on incorrect directory information, CMS has established a special election period allowing them to switch plans if they discover within the first three months that their provider is not in-network.
