No. The requirement is that organizations verify Medicare sanctions from any of those sources, but there is no requirement to verify sanctions from all of them.
HP 2025
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.
NCQA will remove the RAND table from the Guidelines for Calculations and Sampling with the release of the HEDIS MY 2025 Technical Update on March 31, 2025. Future releases of the HEDIS Volume 2: Technical Specifications for Health Plans publication will not contain a RAND table.
Beginning MY 2025, NCQA will use an alternative timeline and approach to distribute RAND numbers for HEDIS reporting. This information will be released in the NCQA store for purchasers of HEDIS Volume 2 in the November before production of systematic samples for hybrid reporting (e.g., November 2025, for MY 2025).
Organizations participating in NCQA’s Measure Certification program will receive separate guidance on how NCQA will accommodate this change for certification of systematic sampling logic.
HEDIS 2025
Common themes include:
Another arrangement that may exist includes workflows where providers (e.g., NPs, PAs) contact a plan’s membership annually to assess a member’s medical history, including when they received their last cancer screenings. It is unclear if a singular touchpoint by the NP/PA indicates that the provider has clinical accountability for the member’s care. Organizations are not allowed to call members to collect data.
HEDIS 2025
HEDIS Volume 2 provides guidance in several places:
HEDIS 2025
Example: During a new-patient office visit, the patient reports receiving a colonoscopy in the previous year to their primary care provider. During the discussion, the provider documents the details (when and where the procedure occurred, findings) in the office visit progress notes in the patient’s EHR.
This example represents the intent behind the HEDIS guidelines because:
HEDIS 2025
Yes. For Initial Surveys scheduled on or between July 1, 2024, and June 30, 2026, the organization may submit a detailed implementation plan that includes a timeline as evidence for applicable factors.
Implementation plans may be submitted for Initial Surveys for the following requirements until June 30, 2026:
HE 2, Element A.
HE 2, Element D.
HE 2, Element E.
HE 2, Element G.
HE Plus 3, Element C.
HE Plus 5, Element B.
HE Plus 5, Element E.
HEA 2024
For commercial, Medicare and Medicaid organizations to be able to calculate an average rating for QI 3, Element B, they must receive a Health Plan Ratings scoresheet. Only organizations that have complete data receive a rating and scoresheet. Therefore, organizations that do not receive an HPR scoresheet will be scored NA in QI 3, Elements B and C.
The organization must demonstrate that it meets the requirements in QI 3, Element A, and will not be eligible for NA for that element.
Similarly, if an Exchange organization either does not report QRS data to CMS or receives NR for the Exchange product line because it does not have a valid rate for any required QRS measure in Element D, it must demonstrate data exchange in QI 3, Element A.
HP 2025
For Health Plan Accreditation 2025, the organization is only required to take action on one measure for Health Plan Ratings for which it received a 0 or 1 for QI 3, Element C, and one measure required for QRS in QI 3, Element D. However, if the organization chooses to address more than one measure in its improvement plan, the guidance regarding using one action to address all measures applies but NCQA will only score taking action on one measure for the 2025 standards year.
HP 2025
NCQA makes disaster accommodations on a case-by-case basis during the accreditation survey process.
The organization must document the events from the disaster that prohibited your organization from meeting the standard/element. During the accreditation survey, the surveyor will document all findings which will be reviewed by our Review Oversight Committee (ROC) to determine if any accommodations or exceptions should be granted.
The organization should communicate with the assigned ASC if accommodations are requested.
HEA 2025