NCQA has clarified new requirements regarding Medicare and Medicaid sanctions and exclusions. For Medicaid, organizations must gather exclusion information from each source: the state Medicaid agency and the OIG’s List of Excluded Individuals and Entities. For Medicare, exclusion data may come from any source, including the Medicare exclusion database and the OIG list. Additionally, tracking for licensure loss, limitations, and expirations is now a required element for surveys conducted on or after July 1. These updates ensure greater compliance and oversight in credentialing processes.
