FAQ Directory

Here are some of the most frequently asked questions about NCQA’s various programs. If you don’t see what you are looking for in one of the entries below, you can  ask a question through My NCQA.

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9.15.2025 Public Reporting of the Blood Pressure Control for Patients With Diabetes (BPD-E) Measure Will the BPD-E measure which transitioned to ECDS reporting in MY 2026, be publicly reported for MY 2026?

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.

HEDIS 2026

9.15.2025 Public Reporting of Lead Screening in Children (LSC-E), Statin Therapy for Patients With Cardiovascular Disease (SPC-E), and Statin Therapy for Patients With Diabetes (SPD-E) Measures Will the LSC-E, SPC-E and SPD-E measures, which transitioned to ECDS reporting in MY 2026, be publicly reported for MY 2026?

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

HEDIS 2026

9.15.2025 Appendices Were some appendices removed from the Volume 2 publication?

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.

HEDIS 2026

9.15.2025 PCS Questions Do answers from the Policy Clarification Support system have an expiration date?

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.

HEDIS 2026

9.15.2025 CR Certification—File Review System: Prior Decision Date The self-assessment in the CR Certification File Review System asks for a current decision date and previous credentialing date to evaluate the current recredentialing cycle. Since the Certification standards do not require recredentialing or committee decisions, do organizations still need to enter those dates?

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.

CRPN 2025

9.15.2025 Ongoing Monitoring—“At least monthly” Policy Update Retraction In July, NCQA issued a Policy Update replacing “at least monthly” with “at least every 30 calendar days” under the “Time frame for reviewing sanctions, exclusions, limitations and expiration information.” Does this change mean NCQA now requires organizations to conduct reviews strictly every 30 calendar days?

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.

HP 2026

9.15.2025 Ongoing Monitoring—Adverse Events: All Practitioners May organizations limit monitoring of adverse events to primary care practitioners and high-volume behavioral healthcare practitioners?

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.

HP 2026

9.15.2025 Prioritizing Case Management Goals Updated Can multiple case management goals be assigned the same priority level; for example, “high”?

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

CM 2026

9.15.2025 Semiannual reporting and evaluation requirements if delegates are NCQA-Accredited and Certified Are NCQA-Accredited or Certified delegates required to provide semiannual reporting to organizations and are organizations required to evaluate semiannual reports from NCQA-Accredited or Certified delegates?

No. Effective immediately, organizations receive automatic credit for the delegation agreement semiannual reporting requirement and delegation oversight semiannual report evaluation requirements in Elements A and C, when an NCQA-Accredited or Certified delegate performs an NCQA-required activity. For example, UM 12, Element A, factor 3 and UM 12, Element C, factor 4 do not apply to a delegate that is NCQA-Accredited or Certified.

If a delegate is no longer NCQA-Accredited or Certified, the organization must immediately begin evaluating semiannual performance reports from the delegate.

CM 2026

8.15.2025 Executive Orders and NA Scoring Do organizations need to provide evidence about sexual orientation for HE 6, Element B, factor 3?

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

HEA 2024

8.15.2025 UM Information Integrity Audit File Universe The denial and appeal Information Integrity audit universe specifies decisions (based on the notification date) made during the look-back period. Does the audit include data (decision notifications) from outside the look-back period?

Yes. When an organization conducts its UM Information Integrity audit, the audit universe includes data from the most recent 12 months from the timing of the audit. So, although the audit occurs within the look-back period, data reviewed may  include decision notification files from outside the formal look-back window, depending on timing. 

HP 2026

8.12.2025 What is the role of a consultant during a virtual review or audit?

Unless a regular operational employee of the organization, a consultant is not to assume responsibility for generating or demonstrating the evidence for Recognition. While external consultants are welcome to be part of the virtual reviews or audit, these calls are led by the appropriate practice team members.  NCQA reserves the right to obtain contact information of consultants working with the practice as well as verify the identity of individuals present during the virtual review or audit.

PCMH