All states and Managed Care Organizations are required to maintain publicly accessible provider directories for both Medicaid fee-for-service (FFS) and managed care organizations (MCOs). The Centers for Medicare & Medicaid Services (CMS) has released final rules and guidance that expand the information these provider directories must cover, increase the frequency of information updates, require provider information to be accessible via a Fast Healthcare Interoperable Resource (FHIR) API, and add a separate requirement for health plan quality rating system information to be made available to the public.
- Effective July 1, 2025, Medicaid provider directories must include not only the provider’s name and address but also information about the provider’s cultural and linguistic capabilities, their acceptance of new patients, accommodations for physical disabilities, website, and telehealth services. All information must be updated at least quarterly.
- Effective January 1, 2027, provider directories must support a FHIR API to ensure public access to detailed information about a payer’s network of contracted providers. State Medicaid Fee-for-Service (FFS) programs, State Children’s Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) are required to comply with this mandate. The provider directories should include affiliated networks or contracted plans, along with the network participation status (in-network or out-of-network).
- By 2028, states are required to implement the Medicaid and CHIP Quality Rating System (MAC QRS). This system will offer quality information about Medicaid and CHIP managed care plans on a state-run public website, assisting beneficiaries in comparing and choosing plans that best meet their needs.
