Structure, Scoring, and What Has Been Retired

Estimated read time: 5 minutes

Here’s the thing about annual NCQA standard updates: most years, you’re adjusting a few paragraphs, clarifying some language, maybe tweaking a factor or two. You know the drill. You’ve done it before.

This is not one of those years.

NCQA has released its 2026 Utilization Management Accreditation Standards and Guidelines, and for organizations that know the 2025 framework, the changes are significant. We’re talking about the most substantial restructuring of the UM Accreditation program in years—touching how the program is organized, how surveys are scored, which standards still exist, and what new requirements you’ll need to prepare for.

This is the first of two blogs walking through those changes. Part 1 covers the structural overhaul: the shift to modular accreditation, the new scoring model, and the retirement of UMA 2. Part 2 will cover what has moved, what is genuinely new, and the policy changes that require action before your next survey.

Let’s dig in.

One Program Becomes Six: Modular Accreditation

The most consequential structural change in 2026 is this: UM Accreditation is no longer one unified designation. It’s a modular system built around six distinct Evaluation Options.

Under 2025, organizations pursued UM Accreditation as a whole. Under 2026, you select the option—or options—that match the functions your organization actually performs.

The six Evaluation Options are:

• Non-Behavioral Health Decisions
• Behavioral Health Decisions
• Pharmacy Decisions
• Pharmaceutical Management
• Appeal Decisions
• Recommendations/Approvals

Each option has its own dedicated UMA standard—UMA 1 through UMA 6—and organizations earn Accreditation status within the options they pursue, rather than against a single unified benchmark.

This modular approach enhances transparency on NCQA Report Cards and more precisely signals to clients and consumers exactly which functions a given organization has been evaluated on.

The practical implication? You need to carefully assess which evaluation options apply to your operations and register accordingly. A vendor that handles appeals but not pharmaceutical management will pursue a different combination of options than one managing a full pharmacy benefit.

Getting this assessment right at the outset determines which UMA standards apply and which do not. Don’t skip this step.

Scoring Gets Simpler: Met, Partially Met, Not Met

Alongside the structural change, NCQA has replaced the points-based scoring system with a streamlined threshold model that is finally in sync with what health plans have been using for several years now.

Under 2025 (and since the inception of the standards), elements were scored on a nuanced percentage-based scale—100%, 80%, 50%, 20%, and 0%—and organizations accumulated points across elements to achieve tiered Accreditation statuses. That system is gone.

In 2026, every element is evaluated against one of three outcomes:

• Met: All eligible factors in an element are satisfied.
• Partially Met: Roughly half of eligible factors are satisfied.
• Not Met: No eligible factors are met.

This change is designed to improve clarity—for organizations going through surveys and for consumers reviewing NCQA Report Cards.

NCQA has also eliminated the two-year Accreditation status option and introduced a new Provisional Accreditation status—a meaningful shift for organizations at earlier stages of the accreditation process. This also corresponds to how NCQA has reported health plans for several years and brings UMA into alignment.

What does this mean for your team? Update your internal compliance tracking tools, audit templates, and readiness scorecards now to reflect the new threshold model rather than the prior points framework. Do this before your next survey cycle begins.

UMA 2 Has Been Retired—All Six Elements

The single most significant retirement in the 2026 standards is the complete elimination of UMA 2: Agreement and Collaboration With Clients.

In 2025 and since inception of the standards, this standard comprised six elements governing the formal relationship between the UM organization and its clients: the delegation document, submission of documents for oversight, routine reporting to clients, cooperation with client QI efforts, medical record access, and communication to practitioners.

Every one of those elements is gone.

NCQA confirmed the retirement through a formal Policy Clarification Support inquiry in December 2025, after organizations asked whether the standard had been accidentally omitted. The answer was unequivocal: this was intentional. There is no 2026 equivalent, and there is no transition provision creating parallel requirements under a different number.

I’ll be honest—I’m not sad to see it go. UMA 2 was a difficult standard to meet. More often than not, elements came back NA, and organizations spent considerable time and energy trying to substantiate non-applicability both internally and for surveyor review. It had become, frankly, make-work. The retirement makes sense and I’m sure we’ll all rejoicing!

⚠ IMPORTANT FOR ORGANIZATIONS STILL UNDER 2025 SURVEYS 

Organizations currently being evaluated under the 2025 standards are still expected to meet UMA 2 requirements in full. NCQA confirmed via a Policy Clarification Support (PCS) question that organizations under 2025 surveys will not receive NA credit for UMA 2 elements simply because those requirements no longer exist in 2026.

For organizations working under the 2026 framework, this retirement removes a meaningful compliance burden. Ensure your internal compliance inventories reflect this change. Don’t allocate resources to maintaining evidence for requirements that no longer exist.

What This Means Before Part 2

The structural changes in 2026 require some foundational decisions before anything else:

• Which evaluation options apply to your operations?
• How do your compliance tracking tools need to be updated for the new scoring model?
• Which prior documentation obligations can now be stood down?

Once those foundations are settled, the more detailed compliance work begins—mapping existing programs to reorganized standards, building infrastructure for genuinely new requirements, and acting on the policy changes that carry hard deadlines. That’s the territory covered in Part 2.

Organizations that treat the 2026 transition as a structured project—starting with the architecture, then working through the details—will be far better positioned than those who try to absorb every change at once.

Look for Part 2: What Moved, What’s New, and What Requires Action Before Your Next Survey.

© Managed Healthcare Resources, Inc.

Sources: NCQA UM Accreditation 2025 Standards and Guidelines; NCQA UM Accreditation 2026 Standards and Guidelines; NCQA PCS (December 15, 2025). This blog is for informational purposes and should be read alongside the official NCQA standards publications.