Updated: Includes the additional Network Adequacy and Provider Validation Requirements announced by CMS in May 2025.

Prepare for the Plan Year 2026 QHP Certification Updates

Staying compliant with the latest CMS guidelines is essential for health issuers seeking QHP certification. Plan Year 2026 brings notable changes, including new network adequacy time and distance standards and updated provider validations.

To help you navigate these updates, we’ve compiled a concise executive summary that covers all the key changes. Whether you’re applying through Federally-facilitated Exchanges (FFE), State-based Exchanges (SBE), or State-based Exchanges on the Federal Platform (SBE-FP), this guide provides crucial insights to keep your certification process on track.

What's Inside the Policy Brief

Updates for the Federally-facilitated Exchanges

New Network Adequacy Geographic Distance Methodology
Alternative Time and Distance Standards Introduced
Three Additional Provider Specialty Types Added to the Network Adequacy Template
New & Updated Provider Validations

Updates for the State-based Exchanges and State-based Exchanges on the Federal Platform (SBE-FPs)

Key Changes to State Requirements for Network Adequacy and QHP Certification

Download Your Executive Summary Now to stay informed and position your application for success.

Quest Enterprise Services® (QES®) for QHP Certification

Compliance isn’t our name, but it sure is our game! Learn how we can assist your efforts to make your provider data accurate and network adequate. Book a complimentary strategy session with a Quest Analytics expert to get started on your quest for success.