2026 NCQA PCMH 11.1 explained: Standards, workflows and reporting

The NCQA Patient-Centered Medical Home (PCMH) program continues to evolve and 2026 brings meaningful updates that practices cannot afford to ignore. 

With the release of PCMH Standards and Guidelines Version 11.1 on Jan. 1, NCQA has refined several core criteria requirements, adjusted performance thresholds and retired or introduced elective criteria. For practices with PCMH recognition or those actively pursuing it, aligning workflows, documentation and reporting to the latest standards is critical. 

This article focuses on the core criteria changes in version 11.1, what they mean operationally and how practices should think strategically before making changes that could undermine performance, patient experience or team engagement. 

Why PCMH version 11.1 matters for 2026 reporting

NCQA requires practices to mirror their workflows and reporting to the most current version of the PCMH standards at all times. That means: 

• past compliance does not guarantee future compliance; 

• retired criteria may no longer earn credit; 

• performance thresholds may be higher than in previous years; and 

• documentation expectations may shift, even if the intent remains the same. 

Important: While standards change, outcomes still matter. If a workflow is demonstrably improving patient satisfaction, closing care gaps or reducing cost, practices should think carefully before dismantling it solely to meet a minimum requirement. 

A critical reminder about elective criteria 

Version 11.1 includes multiple elective criteria for additions and retirements. 

Practices that previously earned credit through elective criteria must: 

• download the latest PCMH standards and guidelines; 

• confirm whether any pursued electives have been retired;  

• select and implement replacement electives if needed; and 

• ensure earned credits still apply toward recognition. 

Elective criteria management is a practice responsibility. 

Core criteria updates in PCMH version 11.1 

Below are the most important core criteria changes practices must address for 2026 annual reporting. 
 

TC 06: Individual patient care meetings and communication 

What changed in version 11.1 

• Care team huddles are still required; 

• daily huddles are no longer mandatory; and 

• practices must conduct huddles at least twice per week. 

 
Before you change your workflow 

Many practices are choosing not to reduce huddle frequency, even though the requirement has loosened. That’s because daily huddles often: 

• close gaps in vaccines, screenings and testing; 

• improve care coordination before patient arrival; 

• ensure providers see patients with complete, up-to-date charts; and 

• reduce downstream errors and rework. 

If your huddles are driving measurable value, reducing frequency may create risk, not relief. 

TC 09: Medical home information 

What changed in version 11.1 

• Practice orientation materials are no longer required; and 

• NCQA will not request documentation or policy for this criterion.  
   

Before you eliminate orientation materials 

Orientation materials still: 

• educate patients on how to engage with your practice; 

• set expectations around access, care coordination and communication; 

• differentiate your practice from competitors; and 

• improve patient confidence and satisfaction. 

Think of these materials as your practice’s front door, not just a compliance artifact. 

KM 09: Diversity and drivers of health disparities 

What changed in version 11.1 

• Practices must now assess at least one driver of health outcome disparities; and 

• reporting on multiple drivers is no longer required. 

Examples include: 

• disability status; 

• veteran status; 

• socioeconomic status; and 

• race or ethnicity. 
   

Strategic consideration 

While reporting requirements are lighter, understanding more than one driver may better equip your team for culturally responsive care, stronger patient relationships and more meaningful interventions. 

Minimum compliance ≠ maximum impact. 

KM 14 & KM 15: Medication reconciliation and medication lists 

What changed in version 11.1 

Both measures now require 90.1% compliance, up from 80.1%: 

• KM 14: Medication reconciliation after care transitions. 

• KM 15: Maintaining an up-to-date medication list. 
   

What practices should do now 

Practices should: 

• run baseline performance reports immediately; 

• identify breakdowns in documentation workflows; 

• standardize responsibility across care team members; and 

• tighten post-transition reconciliation processes. 

These measures are often lost to process gaps with EMR documentation, not clinical oversight. 

CM 04: Person-centered care plans 

What changed in version 11.1 

Care plans must now be documented at least twice per year and include: 

• problem list; 

• medication list; 

• clinical outcome or prognosis goal; 

• patient personal goals; 

• patient-focused self-management strategies; 

• timeframe for reassessment; and 

• must be shared with the patient (printed or electronic). 
   

Documentation guidance that matters 

NCQA is emphasizing: 

• care plans written in the patient’s voice; 

• collaborative, non-clinical language; and 

• clear ownership and follow-up. 

This is not a checkbox exercise; it’s a patient engagement strategy. 

QI 15: Reporting performance within the practice 

What changed in version 11.1 

Practices must now share performance results at least annually, including: 

• one clinical quality measure; 

• one cost or care coordination measure; and 

• one patient experience measure. 
   

Why this matters 

How and what you share internally can: 

• reinforce aim statements; 

• strengthen an outcomes-focused culture; 

• drive meaningful quality improvement; and 

• encourage staff buy-in and adaptability. 

Data transparency is now explicitly tied to PCMH expectations. 

What practices should do next 

To prepare for 2026 PCMH annual reporting under version 11.1: 

1. download the latest PCMH standards and guidelines; 
2. review all core and elective criteria; 
3. validate current workflows against updated thresholds; 
4. identify where outcomes justify maintaining stronger practices; 
5. run performance reports early, especially for medication measures; and 
6. ensure documentation language aligns with NCQA intent. 

Final takeaway: Compliance is the floor, not the ceiling 

PCMH version 11.1 reflects NCQA’s continued shift away from rigid process checks and toward meaningful, outcome-driven care. 

Practices that succeed in 2026 will: 

• align reporting with the latest standards; 

• preserve workflows that demonstrably improve outcomes; 

• use data to guide (not replace) clinical judgment; and 

• treat PCMH as a framework for excellence, not just recognition. 
  
  

How DataGen can assist 

If you want help translating these updates into efficient reporting workflows, clean documentation and audit-ready submissions, this is the moment to act before reporting deadlines create unnecessary risk.  

DataGen’s patient-centered medical home solution can provide hands-on practice transformation support to streamline annual reporting, strengthen workflows and improve patient-centered care.