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1.15.2026 Availability of UM Criteria: Documentation and Look-Back Period for 2026 Surveys For 2026 surveys, will NCQA accept an implementation plan for making UM criteria available at the point of care, and will NCQA shorten the look-back period for making UM criteria available at the point of care?

Yes. For the 2026 standard year only (surveys conducted between July 1, 2026, and June 30, 2027), NCQA will allow organizations to submit a detailed implementation plan.

The plan must include: 

  • A description of actions to make UM criteria available electronically at the point of care.
  • A timeline for implementation on or before June 30, 2027.

Look-Back Period: Effective immediately, the look-back period for the entire Element B for First Surveys and Renewal Surveys has changed from six months to “prior to the survey date.” 

This approach provides flexibility and additional time for organizations to meet requirements.

Applicable Standards:

  • Health Plan Accreditation: UM 2, Element B.
  • Behavioral Health Accreditation: UM 2, Element B.
  • UM Accreditation: UM 4, Element B.

This applies to the following Programs and Years:
HP 2026|UM 2026|BHA 2026