12 of NCQA's 106 March 2026 updates modify a requirement

On March 30, 2026, the National Committee for Quality Assurance (NCQA) posted 106 updates to 9 sets of standards behind its accreditation and certification programs. Only 12 of the updates modify a requirement. Another 59 correct errors in the published standards and 35 clarify requirements already in force, and none is a regulatory change. Counted once each, the 12 policy changes come down to 6 distinct changes. The broadest extends credentialing checks to every state where a clinician practices.

Surveys now run on the March text. NCQA built the updates into its Interactive Review Tool, the online system organizations use for surveys. For Health Plan Accreditation, the 2026 standards year covers surveys conducted from July 1, 2026 through June 30, 2027. NCQA did not issue a July release this year, and its policy updates page lists November 2026 as the next one scheduled. Corrections and policy changes had to be in place within 90 calendar days of March 30, a window that by our count closed on June 28.

NCQA’s labels are a fair guide to most of the release but not to all of it. A correction in the UM Accreditation standards decides which files are held to a 7-day notice for some approvals, and a run of corrections rewrites how Health Outcomes Accreditation handles delegation. The entries that reach daily work cluster in credentialing, utilization management (UM), Health Outcomes and quality measurement.

Key takeaways

• 106 updates, 12 policy changes. The March 30, 2026 release holds 59 corrections, 35 clarifications and 12 policy changes across 9 documents. Health Outcomes and Community-Focused Care, with 42 entries, and Health Plan Accreditation, with 35, account for most of it.
• Credentialing checks follow the clinician. Organizations must monitor sanctions and license limitations in every state where a practitioner practices. The change appears 4 times, across the Health Plan, Behavioral Health and Credentialing standards.
• UM criteria have to be reachable where care is ordered. Health plans must show that their UM criteria are available electronically at the point of care. For surveys through June 30, 2027, a detailed implementation plan is accepted instead.
• A 7-day approval notice applies to UM files from July 1, 2026. In UM Accreditation, one notification time frame for approvals is 7 calendar days for files processed on or after that date and 14 for files processed before it.
• 2 Health Outcomes elements can no longer be delegated. Access to disability accommodations and the reduction of health care disparities now stay with the accredited organization.
• Measurement changes are narrow. One substance use follow-up measure leaves the Medicare measure list in Health Plan Accreditation, and NCQA specified that missing values are left out of a 3.0 average calculation.

Most of NCQA’s March updates correct or explain the standards

NCQA files every update under 1 of 4 types. A correction fixes an error in the published standards. A clarification explains a requirement that already exists, and a policy change modifies one. A regulatory change creates or modifies a requirement to align with federal regulations. The type sets the timing. Corrections and policy changes must be implemented within 90 calendar days of release unless NCQA specifies otherwise. Clarifications carry no such notice, because NCQA does not treat them as changes to existing requirements. The Health Plan document gives regulatory changes the same exemption, though the March release has none.

Counted from the 9 documents dated March 30, 2026 on NCQA’s policy updates page, 1 entry per table row. Updates first posted in earlier releases are excluded.

Health Outcomes leads the count, and most of its 30 corrections reset look-back periods or rewrite delegation language. Health Plan Accreditation comes second. Its document also restates 65 updates first posted on November 17, 2025, and those apply to 2026 surveys alongside the March entries.

2 of the documents cover the 2025 standards, for organizations still surveyed under them. They are short. The 2025 MBHO document adds 1 correction and the 2025 CR-PN document adds 2, and both restate earlier releases.

Grouped by substance, the 12 policy changes amount to 6.

The grouping is ours, from the policy change entries in the March 30, 2026 documents.

2 of the 6 are housekeeping in substance. The CM-LTSS option covered surveys from July 1, 2024 through June 30, 2025, a window that had already closed, and the medical home change marks 1 factor NA in an automatic credit table. The other 4 change what an organization does or which measures count.

Credentialing checks now follow the clinician across state lines

The policy change with the widest reach appears in 4 places, in the Health Plan and Behavioral Health standards and twice in the 2026 Credentialing and Provider Network standards. Each adds the same paragraph to NCQA’s guidance on sources for licensure sanctions. The organization monitors sanctions and license limitations “for all states in which the practitioner practices,” even states outside its service area and states where the practitioner does not treat its members.

The gap it closes is easy to picture. Say a clinician holds licenses in 4 states to provide telehealth, and a plan in one of them checks only its own state’s board between recredentialing cycles. A suspension in another state could go unseen by that plan until the next full review. Under the March text, the plan watches all 4. The work grows with the network, since every license each practitioner holds becomes something to monitor. Our June analysis walks through what that means for a credentialing operation.

The other credentialing entries are smaller. Both CR-PN documents clarify what NCQA reviews under CR 1, Element F. For factors 2 and 3, surveyors look for reports or materials showing how the organization protects and recovers credentials data. When backup and recovery are outsourced, they also review an executed contract describing the vendor’s security mechanisms. The 2025 MBHO document corrects the note on malpractice history, holding files processed on or after July 1, 2025 to the 120-calendar-day verification limit and earlier files to 180. The 2025 CR-PN document deletes an exception in CR 1, Element C for organizations not seeking Credentialing or Provider Network accreditation.

Most of the 106 entries fix the text of the standards. The few that change the work follow a clinician’s licenses across state lines and put UM criteria where care is ordered.

The UM changes reach criteria access and notice clocks

For health plans, the one UM policy change is about where criteria can be read. Under the revised scope of review for UM 2, Element B, NCQA looks for evidence that a plan makes its UM criteria available electronically through an EHR, portal or website. Acceptable evidence includes system reports or screenshots showing how criteria are reached at the point of care. A clarification posted in November 2025 had already said that plans need not distribute full proprietary criteria sets when licensing agreements restrict them, but that individual criteria must be available electronically and promptly on request. The March change adds a transition. For the 2026 standards year only, covering surveys from July 1, 2026 through June 30, 2027, a plan may submit a detailed implementation plan, with its actions and a timeline, instead.

UM Accreditation carries the same requirement under UM 4, Element B. NCQA’s proposal for those standards presented criteria at the point of care, rather than criteria sent on request, as a way to support faster prior authorization.

Most of the other Health Plan UM entries rework UM 1, which covers the UM program and how it is evaluated. Elements C and D become NA when every purchaser of the plan’s services carves out behavioral health care or pharmaceutical management, respectively, and factors 2 and 3 of Element F follow the same carve-outs. The committee overseeing the program can be the UM committee or the QI committee, with a senior-level physician and a designated behavioral health practitioner taking part. A pharmacy and therapeutics committee may review pharmaceutical rates. When the plan evaluates its UM program, it now considers member and practitioner experience data. Element H asks the plan to implement, or plan to implement, at least one committee recommendation for the program and one for its rates. Either factor goes NA only when reports or minutes show the committee found no opportunities.

Timing changes sit in UM Accreditation, NCQA’s program for organizations that perform UM for clients, which has no policy changes in this release. For nonbehavioral and behavioral approval decisions, NCQA scores notification timeliness against the time frames in factors 1 to 5 of UMA 6, Elements B and C. A correction sets the transition for factor 4. Files processed on or after July 1, 2026 are held to 7 calendar days, and files processed earlier to the previous 14. A companion correction lists the time frames for pharmacy decisions. They run from 24 hours, for urgent concurrent decisions and for nonurgent Medicaid preservice decisions, to 30 calendar days for postservice decisions.

The 7-day figure matches the clock that the Interoperability and Prior Authorization final rule (CMS-0057-F) set for standard prior authorization requests in Medicare Advantage and Medicaid from January 2026. NCQA’s proposal cited that rule when it suggested shortening nonurgent preservice time frames from 14 calendar days to 7. The March document does not say which decision type factor 4 covers, and NCQA’s full standards are licensed documents that were not reviewed here.

The UM Accreditation clarifications mostly settle who is in scope. Appeal-only organizations that process no initial requests for any client are exempt from factor 1 of UM 3, Element E. Organizations accredited only for recommendations or approvals get narrower reviews under UM 3, Elements G and H, and UM 6, Element B does not apply to organizations that only make approval decisions or recommendations. NCQA also states that UM 1 and UM 8, the delegation standard, may not be delegated. An organization that adds UM activities to a delegation agreement within the look-back period must evaluate the delegate for them before the amended agreement takes effect.

The Behavioral Health document has its own criteria entry. It removes a summary-of-changes note for UM 2, Element A that had described a new requirement to make UM criteria electronically available to practitioners. The entry removes only the note, and the document does not say whether the requirement appears elsewhere in the Behavioral Health standards.

Health Outcomes keeps 2 functions with the accredited organization

NCQA’s November 2025 updates replaced Health Equity and Health Equity Plus with Health Outcomes and Community-Focused Care in the program lists of its other standards. The same release removed the definition of “equity” from an appendix to the Health Plan standards. It also retitled QI 1, Element E as “Trainings to Improve Care or Service Delivery” and dropped that element’s factor on promoting diversity in recruiting and hiring. Earlier, in an April 30, 2025 memo citing “recent executive orders,” NCQA had said that requirements identified in its guidance would not be scored for surveys between February 12, 2025 and June 30, 2026.

The March release is the first set of fixes to the 2026 Health Outcomes standards, and all 3 of its policy changes concern delegation. HO 4, Element A, on access to disability accommodations, and HO 7, Element A, on reducing health care disparities, may no longer be delegated. Both now sit on the appendix list of activities that may not be delegated, beside 2 factors in HO 5, the standard on how responsive a practitioner network and its care sites are. The program’s name changed, but its disparities element stayed, and the organization now has to do that work itself.

Most of the 30 corrections are mechanical, but they change what a surveyor asks to see. Several set renewal look-back periods at 24 months. Under HO 8, the delegation standard, the agreement must describe all delegated health outcomes activities, and a generic policy statement does not meet the intent. The organization reviews each delegate’s health outcomes program annually and performs a predelegation evaluation for any activities it adds to an agreement. HO 7, Element B is scored Partially Met at 2 to 3 factors. For factor 4 of HO 2, Element D, surveyors review reports from NCQA’s Interactive Data Submission System (IDSS) for the most recent reporting year of the Healthcare Effectiveness Data and Information Set (HEDIS).

The clarifications define terms the exceptions rely on. A care delivery organization is now defined as one that provides or facilitates direct patient care, such as a health system, accountable care organization, hospital, primary or specialty care practice or Federally Qualified Health Center. Several exceptions apply only to such organizations, for example when they provide no in-person care. Automatic credit for HO 2, Element D, granted when an organization accredited in Health Outcomes delegates to another, is available only for delegates surveyed on or after July 1, 2027.

Related data guidance moved in 2 other programs. In Behavioral Health Accreditation, a clarification to LTSS 1, Element D says an organization may roll up race and ethnicity data to either the 1997 or the 2024 categories of the Office of Management and Budget (OMB). It may also ask the questions another way if the answers can be aggregated to OMB categories. NCQA notes that OMB now recommends a single combined question, while the 2-question format still aligns with the 1997 standard and current electronic data standards. In CM-LTSS, NCQA removed the expired option to submit an implementation plan for collecting race/ethnicity and language data in place of a documented process and reports.

Measurement and survey integrity changes are narrow

The quality measurement changes in the Health Plan document are small. In QI 3, Element B, NCQA removed the 7-day total rate of Follow-Up After High-Intensity Care for Substance Use Disorder (FUI) from the Medicare measure list, the release’s only policy change to a measure. A correction to the same element says missing values are “not included in the 3.0 average calculation.” For Exchange products, under QI 3, Element D, surveyors look for the CMS Proof Sheets that show the plan reported the required measures. A plan may submit its IDSS reports instead, except for the Coordination of Care measure, which still requires the Proof Sheet.

2 population health clarifications put numbers on existing requirements. In complex case management, the initial assessment begins within 30 calendar days of identifying a member and is completed within 60. A late start costs only factor 12, and the other factors are not marked down. Under PHM 3, Element C, the alternative payment model (APM) worksheet shows at least one APM arrangement for each product line over a continuous 12-month period.

In Physician and Hospital Quality certification, the 4 entries adjust how 2 elements are scored and sampled. A clarification says NCQA scores PQ 2, Element C once for the program, from a random sample of physicians’ requests for corrections or changes, open or closed, received before the survey starts.

The Health Plan document also spells out what happens when an organization misleads NCQA. A first offense of fraud or falsification in information submitted for accreditation risks immediate loss of accreditation. If accreditation is revoked, the organization cannot reapply for at least 24 months. A second offense can mean permanent loss and a permanent bar.

NCQA holds its own surveys to a line its standards draw for health plans. The November 2025 release, restated in the same document, says the AI in NCQA’s survey tool recognizes evidence in submitted documents but does not identify issues or generate scores. Surveyors verify the evidence and make preliminary scoring determinations. NCQA’s Review Oversight Committee issues the final decision, and organizations may submit only de-identified information. The 2025 CR-PN document restates NCQA’s earlier note that its standards require appropriately licensed professionals, not AI, to make medical necessity denials. In NCQA’s own surveys and in the plans it accredits, software can find the evidence, and people make the decision.

About this analysis

Basis. The 9 documents are NCQA’s corrections, clarifications and policy changes for the 2026 Behavioral Health, Health Plan, Health Outcomes and Community-Focused Care, Credentialing and Provider Network, CM-LTSS, UM Accreditation and Physician and Hospital Quality standards, and for the 2025 Credentialing and Provider Network and MBHO standards. Each is dated March 30, 2026 and linked from NCQA’s policy updates page. NCQA’s full standards are licensed documents and were not reviewed, so elements and factors are described only as far as the update documents describe them.

Counting. Each row of an update table counts as 1 entry, under the type NCQA assigned. Rows NCQA lists as previously posted are excluded. 2 rows carry other dates in the release date column, March 26, 2026 in the Health Plan document and “03/26/30” in the UM Accreditation document, and both are counted with the March release. The grouping of the 12 policy changes into 6 is ours.

Dates. June 28, 2026, the end of the 90-day window, is our count from NCQA’s stated rule. Other dates are the documents’ own. NCQA’s 2026 UM proposal describes changes put out for public comment through March 25, 2025, and the final standards may differ from it.

Sources.

• NCQA, Policy updates
• NCQA, March 30, 2026 updates to the 2026 Health Plan, Health Outcomes and Community-Focused Care, UM Accreditation, Behavioral Health, Credentialing and Provider Network, CM-LTSS and Physician and Hospital Quality standards
• NCQA, March 30, 2026 updates to the 2025 Credentialing and Provider Network and MBHO standards
• NCQA, UM Accreditation 2026 overview memo, public comment through March 25, 2025
• NCQA, Scoring modifications memo, April 30, 2025

Frequently asked questions

What did NCQA’s March 2026 policy updates change?

NCQA posted 106 updates to 9 sets of standards on March 30, 2026, of which 59 are corrections, 35 are clarifications and 12 are policy changes. The broadest policy change requires monitoring of sanctions and license limitations in every state where a practitioner practices.

When did organizations have to implement the March 2026 updates?

NCQA requires corrections and policy changes within 90 calendar days of release unless it says otherwise, a window that by our count ended June 28, 2026. Clarifications carry no 90-day notice.

What is NCQA Health Outcomes Accreditation?

It is the program NCQA’s standards now list in place of Health Equity Accreditation, with Community-Focused Care in place of Health Equity Plus. In March 2026, NCQA barred delegation of its elements on disability accommodation access and on reducing health care disparities.

When is NCQA’s next policy update release?

NCQA’s policy updates page lists November 2026 as the next scheduled release, after no release in July 2026.