The Ten-Year Records Clause Coming to Every MA Contract
CMS filed a 265-page Medicare Advantage proposed rule at 4:15 Friday afternoon. Buried in it is the directory audit the agency ran three times and never published: 44.29 percent of listings wrong. The fix adds two terms to every MA provider contract, one of which outlives the contract by a decade.
Between June 2022 and June 2024, CMS audited the online provider directories of 142 Medicare Advantage organizations.
Three rounds, 11,360 providers, 18,852 listed locations.
Reviewers pulled each listing, called the office, and wrote down whether the directory was telling the truth.
Nobody ever published the findings.
They surfaced Friday afternoon, on page 39 of a 265-page proposed rule: 44.29 percent of the location listings carried at least one deficiency.
The provider was not at the address. The phone number was wrong. The office did not take the plan, or the listing could not be verified at all.
The rule says it plainly, in the middle of a methodology discussion: "While CMS has published a report for the MA online provider directory reviews in the past, CMS did not publish a report for these most recent reviews."
The last time the agency did publish, in November 2018, the number was 48.74 percent. Six review rounds now run from February 2016 to June 2024, and the share of bad listings has never come in under 43 percent (chart below). CMS notes that minor methodology changes keep the rounds from being strictly comparable, which is fair. Across eight years and nearly 56,000 reviewed locations, the shape does not move.
What Landed Friday
CMS-4214-P went on public inspection at 4:15pm Eastern Friday, scheduled for the Federal Register on October 20. It implements three sections of the Consolidated Appropriations Act, 2026: the Part D generic copay drop from $1 to $0 for full-benefit duals, a set of PBM remuneration rules, and the one that reaches you, section 6220, the Requiring Enhanced and Accurate Lists of Health Providers Act.
The directory half applies to contract year 2028 forward, for any network-based MA plan and any private fee-for-service plan that meets its access standards through a network.
Comments close 5pm Eastern on December 15. Worth noting before you calendar it: both the press release and the fact sheet say the rule is open "for 60 days following publication in the Federal Register." December 15 is 60 days from Friday's filing and 56 days from the October 20 publication date. The caption in the document governs, and it is four days earlier than the press materials read.
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