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NCQA PCMH 2026 annual requirements: Where practices should focus

NCQA PCMH 2026 annual requirements

The 2026 NCQA PCMH annual reporting landscape 

The National Committee for Quality Assurance (NCQA) released significant updates to the Patient-Centered Medical Home (PCMH) standards and the associated 2026 annual reporting requirements. These changes require enhanced practice procedures and expectations across nearly every concept area. 

If your practice plans to maintain or achieve PCMH recognition, understanding these updates — and preparing early — is critical for success. It is essential for practices to maintain and monitor the PCMH Standards and Guidelines ongoingly in order to seamlessly report each year. The annual requirements do vary each year but will always stem from the core  criteria of the PCMH Standards and Guidelines. 


Key changes from 2025 to 2026 

Compared to 2025, NCQA’s 2026 standards updates require: 

  • more robust documentation across all six concept areas; 

  • new audit expectations — multi-site organizations must ensure every location is compliant, as any site can be selected for review; 

  • reliance on the latest PCMH Standards and Guidelines (printed July 2025), which should be downloaded in both January and July for reference. 

Pro tip: Use our free PCMH Workflow Sustainability Tracker to keep your reporting organized across teams and sites. 


Concept area changes for 2026 

1. Team-Based Care (TC) 

Practices must provide stronger evidence of team integration: 

  • documented care team huddles; and 

  • proof of staff involvement in quality improvement (QI) initiatives. 


2. Knowing and Managing your patients (KM) 

Reporting requirements are now more data-driven: 

  • maintain an up-to-date problem list or report top conditions by the practice; 

  • provide a patient language breakdown; and 

  • meet the new over 90% threshold for medication reconciliation reporting. 


3. Access and Continuity (AC) 

Access remains a major focus in 2026: 

  • conduct a qualitative patient access survey or similar feedback method; 

  • provide documented action plans addressing feedback; and 

  • submit proof and protocols for accessibility outside business hours. 


4. Care Management (CM) 

NCQA raises expectations for risk-based care planning: 

  • risk stratification reports and protocols; 

  • reports on percentage of patients enrolled in care management; 

  • care plan documentation audit report; and 

  • reporting on care plans delivered to patients. 


5. Care Coordination (CC) 

Practices must demonstrate improved communication across the care continuum: 

  • reports on lab and imaging results received; 

  • unplanned admission and ED visit tracking with documented protocols; and 

  • protocols and examples of how clinical information is shared with receiving facilities. 


6. Quality Improvement (QI) 

Expanded measurement and performance expectations for 2026 include: 

  • five clinical quality measures; 

  • one cost measure; 

  • one coordination measure; 

  • one patient experience measure; 

  • a goals and actions workbook based on reported measures; and 

  • evidence of sharing performance insights with the practice. 

Need help sustaining recognition? Download our free NCQA PCMH Sustainability Guide for practical strategies. 


How DataGen supports your NCQA PCMH success  

Annual reporting for 2026 comes with more requirements, tighter documentation standards and a higher audit risk. DataGen helps practices: 

  • stay compliant with NCQA’s evolving standards; 

  • streamline reporting with tools and resources; and 

  • navigate complex workflows with expert insights. 

For a look back at 2025 reporting requirements, visit our blog on NCQA PCMH Annual Reporting 2025. 

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Location: New York, NY, USA

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