NCQA updates PCMH standards for 2027: What practices need to know

The National Committee for Quality Assurance (NCQA) released updates to its Patient-Centered Medical Home (PCMH) Standards and Guidelines on July 1, 2026. These changes will take effect on Jan. 1, 2027, and apply to practices pursuing PCMH and PCMH-recognized practices.

A critical reminder for all PCMH-recognized sites: practices are always held accountable to the most current version of the standards and guidelines, regardless of the version under which recognition was originally earned. Practices should download the latest PCMH Standards and Guidelines and ensure workflows, policies and reporting processes are aligned with NCQA expectations. Sites looking to strengthen their long-term compliance strategy may also benefit from DataGen's guide to sustaining NCQA PCMH recognition.

Most changes impact care management

The most significant updates are within the care management (CM) concept area, impacting patient identification, CM enrollment and care plan documentation. These updates expand flexibility for certain practices while also introducing more specific documentation requirements. They build on recent updates to the PCMH program and reinforce NCQA's continued focus on meaningful CM and patient-centered outcomes. For a broader look at prior reporting-related changes, read our analysis of NCQA PCMH Version 11.1 key changes for 2026 reporting.

CM 01: New flexibility for pediatric practices

NCQA has reduced the minimum CM category requirement for pediatric specialty sites. Previously, all practices were required to identify patients in at least three of five CM categories. Beginning Jan. 1, pediatric practices may include just two of the five categories to establish a complete CM panel.

This change recognizes the unique challenges pediatric practices face when identifying appropriate patients for CM.

CM 02: Alternative threshold for active CM patients

Practices must still maintain a minimum number of patients actively enrolled in CM. However, NCQA has added new flexibility by allowing sites to meet the requirement through one of two thresholds:

• 30 active CM patients or

• 1% of the site's total patient population.

NCQA will use whichever number is smaller and more appropriate for the practice.

This adjustment may be particularly beneficial for smaller practices that have historically struggled to meet the fixed 30-patient requirement.

CM 04: Expanded care plan documentation requirements

NCQA also updated the required components of documented care plans. Going forward, care plans must include:

• a problem list;

• a medication list;

• expected clinical outcomes and a patient treatment goal or SMART goal (either option is now accepted); and

• a return date or timeframe for reviewing and updating the care plan.

The addition of SMART goals as an accepted alternative provides greater flexibility while maintaining a focus on measurable, patient-centered outcomes.

What practices should do now

Although these updates do not take effect until Jan. 1, practices should begin preparing today. Review your current CM workflows, update policies and procedures as needed, review functionality in your EMR to accommodate the documentation standards and assess whether reporting capabilities can support the new requirements.

Most importantly, download the latest version of the PCMH Standards and Guidelines and ensure your annual reporting processes align with the newest criteria. Early preparation can help prevent compliance gaps, streamline annual reporting and protect your organization's PCMH recognition status.

For additional guidance, explore DataGen's resources on sustaining NCQA PCMH recognition and understanding NCQA PCMH 11.1 reporting changes. These resources can help practices proactively address compliance risks and maintain recognition success.