FAQ Directory

The July 1, 2025, date is incorrect. For the 2026 standards and guidelines, factor 7 is scored NA for appeal notifications issued before July 1, 2026.  

This applies to the following Programs and Years:

No. Effective immediately, NCQA changed its policy regarding Medicaid sanctions and exclusions. The State Medicaid agency is no longer a required source; it is now considered an optional source. 

For Medicaid sanctions, organizations may use any of the following sources: 

• State Medicaid agency. 
• AMA Physician Master File. 
• Federation of State Medical Boards (FSMB). 
• National Practitioner Data Bank (NPDB). 
• SAM.gov. 

For Medicaid exclusions, organizations may use any of the following sources: 

• State Medicaid agency. 
• List of Excluded Individuals and Entities (LEIE) maintained by the Office of Inspector General (OIG). 
• National Practitioner Data Bank (NPDB). 

Note: A related question was posted on July 15, 2025: “Obtaining Sanction and Exclusion information from the State Agency“. This FAQ replaces that post. 

This applies to the following Programs and Years:

No. Effective immediately for delegation oversight standards, organizations receive automatic credit for the delegation agreement semiannual reporting requirement in Element A, and for the delegation oversight semiannual report evaluation in Element C, when an NCQA-Accredited/Certified delegate performs an NCQA-required activity.  

For example, in Health Plan Accreditation, NET 6, Element A, factor 3 and NET 6, Element C, factor 3 receive automatic credit for an NCQA-Accredited/Certified delegate. 

This applies to all products. 

Note: This updated FAQ replaces the original version published on September 15, 2025. 

This applies to the following Programs and Years:

No. BPD-E will not be publicly reporting for MY 2026; NCQA will allow voluntary ECDS reporting for BPD-E. The administrative and hybrid version of the BPD measure will continue to be publicly reported for MY 2026.

This applies to the following Programs and Years:

Yes. The LSC-E, SPC-E and SPD-E measures will be publicly reported for MY 2026.

This applies to the following Programs and Years:

Yes. Some appendices were removed from the publication. This approach for HEDIS MY 2026 reduced redundancy, considered the broader product changes and whether users might prefer to engage with information outside the publication.

For example, as an alternative to Appendix 2: Technical Considerations for New Measures, clinical guideline recommendations for each measure are included directly in the measure specifications. NCQA also updated the State of Health Care Quality Report to reflect the latest HEDIS measure set release, including new measures for MY 2026. The State of Health Care Quality Report is publicly available at NCQA.org.

NCQA is committed to supporting stakeholders who use HEDIS, and we welcome feedback as we continue to evolve HEDIS.

This applies to the following Programs and Years:

Organizations may not use PCS responses that are over 3 years old. Questions that relate directly to a measure specification or general guideline that was revised from a previous measurement year should be resubmitted rather than using the previous answer in PCS.

This applies to the following Programs and Years:

Although the “Prior Decision Date” field appears to be required, it does not apply to Credentialing Certification file reviews. For now, users should enter the same date used in the “Date Reported” (the date reported to the client) field. This is a temporary fix due to system limitations, and the field is expected to be removed by the end of 2025. Until then, using the same date ensures files can be completed successfully.

This applies to the following Programs and Years:

In response to customer feedback, we are retracting the Policy Update issued on July 28, 2025.

Organizations must review sanctions, exclusions, limitations and expiration information at least monthly (once per month), or within 30 calendar days of receiving a new alert, if subscribed to a monitoring service. For example, an organization might conduct a review on September 1, and conduct another on October 15, 2026.

This update applies to applicable products for both the 2025 and 2026 standard years. NCQA will accept processes that follow a monthly schedule or a 30-day interval. 

We appreciate your ongoing feedback and support.

Applicable Standards:
HPA: CR 5, Element A, factors 1-3.
MBHO: CR 5, Element A, factors 1-3.
CRPN: CRA 5, Element A, factor 3; CRC 12, Element C, factors 1-3.

This applies to the following Programs and Years:

Under the 2025 standards and beyond, organizations must monitor adverse events for all practitioners. Limiting monitoring to primary care practitioners and high-volume behavioral healthcare practitioners is no longer acceptable.

This is a change from the 2024 standards.

Applicable Standards:
HPA: CR 5, Element A, factor 5.
MBHO: CR 5, Element A, factor 5.
CRPN: CRA 5, Element A, factor 5.

This applies to the following Programs and Years:

Yes, multiple goals can be assigned the same priority level (e.g., “high”), but the organization must still clarify the relative importance of each goal within the same assigned level. The intent of prioritization is to show how goals compare to one another in terms of urgency or importance.

For example, if three goals are all marked “high,” the organization must indicate which of those is the highest priority, second highest, and so on.

Update Notice:
This FAQ is being updated to clarify implementation expectations.
Organizations will have 90 days to implement the guidance outlined in this FAQ.
This means that organizations must adhere to the updated FAQ for surveys conducted on or after January 1, 2026.
Prior to January 1, 2026, organizations may continue to prioritize goals and reporting frequencies as they have in the past.

Applicable Standards:

HPA: PHM 5, Element E
MBHO: QI 8, Element I
CM: CM 4, Element B
CM-LTSS: LTSS 3, Element C

This applies to the following Programs and Years:

No. Organizations should not provide any documentation for HE 6, Element B, factor 3. The entire factor 3 requirement is NA for all surveys through June 30, 2026

This applies to the following Programs and Years: