For skilled nursing facilities, this enforcement gap means MA plans can quietly narrow their post-acute networks with minimal regulatory consequence. SNFs should document network-access complaints through state channels and CMS grievance processes, since federal intervention has historically been rare.
Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
But government documents obtained by KFF Health News show the agency overseeing Medicare Advantage does little to enforce long-standing rules intended to ensure about 35 million plan members can see doctors in the first place. In response to a Freedom of Information Act request covering the past decade, the Centers for Medicare & Medicaid Services produced letters it sent to only five insurers from 2016 to 2022 after seven of their plans failed to meet provider network adequacy requirements — lapses that could, in some cases, harm patient care.
— KFF Health News, November 20, 2025
Jaffe, Susan. “Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.” KFF Health News, 20 Nov. 2025. https://kffhealthnews.org/news/article/medicare-advantage-insurance-network-adequacy-standards-cms-federal-enforcement/.
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
