NCQA Programs Public Comment

NCQA invites public comment on Health Plan Accreditation (HPA), Patient-Centered Medical Home (PCMH) Recognition, Utilization Management Accreditation (UM), Managed Behavioral Health Organization Accreditation (MBHO), and Long-Term Services and Supports (LTSS) Distinction in Health Plan Accreditation, and industry feedback on artificial intelligence as part of our ongoing efforts to ensure transparency, inclusion and community input in the decision-making process. We value the perspectives of health care industry professionals, patients, health plan stakeholders and state agencies, that play a critical role in shaping policies that directly impact public health and well-being. Your feedback will be instrumental in guiding our next steps and helping to ensure that our actions align with the needs and concerns of the communities we serve. Submit your comments by March 25 at 11:59pm (ET), and help us continue to improve health care for all.

• Reviewers are asked to submit comments in writing through the My NCQA portal by 11:59 pm (ET), Tuesday, March 25, 2025.

To learn more about NCQA’s Public Comment process and the programs up for comment, register here for a complimentary webinar led by our team of experts on Tuesday, March 4th, from 1:00-1:45pm ET.

FEATURED SPEAKER:
Assistant Vice President, Product Management
NCQA

PROPOSED PROGRAM Updates

Health Plan Accreditation

NCQA accredits over 1,200 health plans that provide coverage to more than 180 million lives across the United States. Payers work in a dynamic environment that demands increased collaboration with providers, adoption of alternative payment models to bend the cost curve and improve outcomes, digital transformation and a focus on earning member trust and engagement. Toward that end, NCQA proposes updates to Health Plan Accreditation 2026 in the following areas:

• • Data exchange and usability (QI).
  • Payer–practitioner collaboration (PHM).
  • Alternative payment model adoption (PHM).
  • Utilization management and prior authorization. (UM).

• Behavioral health network adequacy (NET).

Your feedback will play a vital role in shaping the future of this program and help us work to ensure that it promotes the highest standards of care, service and consumer protection. We encourage all comments and suggestions that can enhance the transparency, effectiveness and inclusivity of the Accreditation process.

MBHO Accreditation 2026

A core challenge facing Americans is a high demand for, and a lack of access to, effective behavioral care. For example, in 2021, only 47% of adults with mental illness and 65% of adults with serious mental illness received treatment.^[1] Almost half of psychiatrists do not take insurance, creating an additional barrier to care.^[2] To support payer and regulator response to this crisis, NCQA proposes updates to MBHO Accreditation. Specifically, NCQA proposes to create a separate category for Network Adequacy; integrate Care Coordination into Quality Improvement; create a Population Health Management category; and develop a “Member Experience” category from “Members’ Rights and Responsibilities” for greater alignment across our payer programs and to increase accountability in critical areas for organizations that pay for behavioral healthcare.

Utilization Management (UM) Accreditation 2026

NCQA’s standards provide a strong foundation for organizations to establish and maintain a UM program that evaluates timeliness of decisions, key aspects of denial letters, appeal processes and appropriate professionals involved in UM decisions and in other areas.

In the context of recent state and federal regulations, and acknowledging NCQA’s mission to enable appropriate and timely care within the scope of patients’ benefits plans, NCQA proposes to align UM standards across programs (Health Plan Accreditation, MBHO Accreditation, UM Accreditation) to continue our work to enable strong automatic credit opportunities, patient protections and risk mitigation across all entities accountable for UM functions.

PCMH Recognition 2026

Patient-Centered Medical Home (PCMH) Recognition, released in 2008, recognizes primary care practices that focus on improved communication and coordination in the medical neighborhood. To ensure both program relevance and program integrity, NCQA proposes the following modifications to PCMH Recognition:

• Add 9 new elective criteria to the program that focus on virtual care.
• Retire 9 criteria from the program.
• Align the program with Health Plan Accreditation.
• Add 46 cadence thresholds to existing criteria.

LTSS Distinction—Measure Inclusion

To create a more robust data set for HEDIS^®[3] LTSS measures, and to support states’ efforts in LTSS measure reporting, NCQA proposes to require organizations that have earned LTSS Distinction in Health Plan Accreditation to annually submit data four HEDIS LTSS measures. NCQA proposes to include language in the 2026 Health Plan Accreditation Policies and Procedures as advance notice to organizations that will seek LTSS Distinction in Health Plan Accreditation.  

Artificial Intelligence

NCQA recognizes the gap in measuring and evaluating how organizations demonstrate that they monitor their use of artificial intelligence effectively and responsibly, with a focus on quality improvement, outcomes and patient safety. NCQA proposes a set of survey questions to further evaluate AI use.

Documents

• PCMH Recognition 2026_Overview Memo and Proposed Standards Updates
• UM Accreditation 2026_Overview Memo
• UM Accreditation 2026 _Proposed Standards Updates
• MBHO Accreditation 2026_Overview Memo
• MBHO Accreditation 2026_Proposed Standards Updates
• Health Plan Accreditation 2026_Overview Memo
• Health Plan Accreditation 2026_Proposed Standards Updates
• LTSS Distinction in 2026 HPA _Overview Memo
• Artificial Intelligence Survey Questions
• Full list of Public Comment Questions Across All Programs

About Public Comment

The public comment system is integrated with NCQA’s single-sign-on platform. If you have access to any of the systems listed here, you can use the same credentials to log in and submit comments:

• Interactive Data Submission System (IDSS)
• Health Organization Questionnaire (HOQ)
• Download Center
• Recognition Program Online Application
• Quality Compass
• My NCQA

Note: The Forgot Password feature will change the password for all NCQA systems to which you have access. If you do not have access to any system listed above, click Create an Account and complete the entire form. Retain the password for your records.

SUBMITTING COMMENTS

Submit all comments through the My NCQA portal. NCQA does not accept comments by mail, email or fax.

NCQA reviews all feedback submitted during the public comment period. To submit comments:

1. Go to My NCQA and enter your email address and password.
2. Once logged in, scroll down and click Public Comments.
3. Click Add Comment to open the comment box.
4. Click to select one or more programs from the drop-down box:

• • Experience with NCQA’s Public Comment
    • Updates to PCMH Recognition 2026
    • Updates to UM Accreditation 2026
    • Updates to BH Accreditation (Formerly MBHO) 2026
    • Updates to Health Plan Accreditation 2026
    • Updates to LTSS Distinction 2026
    • Questions on Artificial Intelligence

5. Click to select the Topic and Element (question) on which you would like to comment.
6. Click to select your support option (Support, Do not support, Support with modifications).

• • If you choose Do not support, include your rationale in the text box.
  • If you choose Support with modifications, enter the suggested modification in the text box.

7. Enter your comments in the Comments
   Note: There is a 2,500-character limit for each comment. We suggest you develop your comments in Word to check your character limit; use the “cut and paste” function to copy your comment into the Comments box.
8. Use the Submit button to submit more than one comment. Use the Close button to finish leaving comments. You can view all submitted comments in the Public Comments

Reviewers are asked to submit comments by 11:59 p.m. (ET) on Tuesday, March 25.

To learn more about NCQA’s Public Comment process and the programs up for comment, register here for a complimentary webinar led by our team of experts on Tuesday, March 4th, from 1:00-1:45pm ET.

FEATURED SPEAKER:
Assistant Vice President, Product Management
NCQA

QUESTIONS?

Contact NCQA Customer Support at 888-275-7585, Monday–Friday, 8:30 a.m.–5:00 p.m. (ET).