In June 29, 2026, comments submitted to the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS), LeadingAge offers recommendations and highlights concerns related to implementation of the Requiring Enhanced and Accurate Lists (REAL) of Health Providers Act. Our primary recommendation encourages CMS to use its existing provider databases such as Provider Enrollment, Chain and Ownership System (PECOs) as a single source of truth and push that data out to Medicare Advantage (MA) plans for their directory updates rather than requiring providers to submit quarterly recertifications to MA plans.