FAQ Directory: Health Plan Accreditation

Filter Results
  • Save
  • Email
  • Print

You are viewing a single FAQ from your previous search. Clear Search

expand all

10.15.2025 NCQA Policy Change: Medicaid Sanctions and Exclusions Verification Requirements For verification and ongoing monitoring of Medicaid sanctions and exclusions, does NCQA require organizations to use the State Medicaid agency and an additional source stated in the standards?

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:
HP 2025, 2026|CRPN 2025|MBHO 2025