Spring 2026 Regulatory Updates

What Healthcare Organizations Need to Know the Rest of the Year

Healthcare organizations across the country are navigating one of the busiest regulatory periods in recent memory. From new payment rules to digital reporting requirements to brand-new care models, 2026 brings a wave of changes that will affect how providers get paid, how they report quality data, and how they deliver care. The good news: most of these changes are manageable if your team starts preparing now.

See the most important regulatory updates for the rest of 2026, learning what they mean in plain terms and exactly what your organization should be doing about each one.

SECTION 1: Happening Right Now — April 2026

1. Hospital Price Transparency — Enforcement Starts Now

For the past few months, hospitals have had time to update their pricing files without fear of being penalized. That grace period is over. As of April 1, 2026, CMS is actively enforcing new hospital price transparency rules.

What Changed: Hospitals must now post detailed pricing information online in a format that patients and researchers can actually use. This includes showing the middle (or median) price for a service, as well as the lowest 10% and highest 90% of prices charged. Hospitals must also name a senior leader who is responsible for making sure this information is accurate.

Think of it like a restaurant menu; patients have the right to know what something costs before they order it. These new rules make that information more detailed and easier to compare across hospitals.

What to Do: Check that your hospital’s machine-readable file (MRF) has been updated with all required data fields. Make sure a named executive has officially signed off on the accuracy of your posted prices. If your organization hasn’t completed this yet, act immediately. Penalties are now in play, though CMS does offer a 35% reduction in fines for hospitals that accept their determination without requesting a hearing.

---

2. MIPS 2026 Performance Year — You Are Being Scored Right Now

If your healthcare organization participates in Medicare’s Merit-based Incentive Payment System (MIPS), you are in the middle of your 2026 performance year, and every week counts. MIPS measures how well providers perform on quality, cost, EHR use, and certain improvement activities. Your score this year will directly affect your Medicare payments in 2028.

Important: Providers who score below 75 points face a 9% cut in Medicare payments. That is a significant financial hit — and it is entirely avoidable with proactive planning.

CMS made changes to the measure set for 2026: five new quality measures were added, thirty existing measures were updated, and some were removed altogether. This means your team needs to make sure you are tracking the right measures under the updated rules.

What to Do: Pull a mid-year MIPS performance report now. Look at each of the four categories — Quality, Cost, Improvement Activities, and Promoting Interoperability — and identify where you have gaps. Do not wait until the end of the year.

---

3. MIPS Value Pathways — Registration Is Open

MIPS Value Pathways, or MVPs, are a newer way to participate in MIPS that groups measures by specialty or clinical condition rather than allowing providers to choose freely from a large general list. The idea is that a cardiologist should be measured on heart-related outcomes, not general measures that have nothing to do with their patients.

MVP registration for the 2026 performance year opened April 1 and stays open through November 30, 2026. Six new MVPs were added this year, covering specialties including diagnostic radiology, neurology, pathology, podiatry, and vascular surgery.

Why This Matters Beyond 2026: CMS has signaled that it may make MVP participation mandatory as early as 2029, which means traditional MIPS could eventually go away. Healthcare organizations that start participating in MVPs now will have a significant head start.

What to Do: Determine which MVP applies to your specialty or clinical focus. Register through your QPP (Quality Payment Program) account before November 30. Even if you continue reporting traditional MIPS at the same time, you can register for an MVP — and CMS will give you the higher of the two scores.

---

SECTION 2: Coming Soon — Spring and Summer 2026

4. Prior Authorization — Faster Decisions, New Accountability

One of the most frustrating parts of healthcare for both patients and providers is waiting for insurance companies to approve treatments or medications. Starting in 2026, new CMS rules require much faster decisions.

Payers, including Medicare Advantage plans, Medicaid programs, and CHIP, must now approve or deny prior authorization requests within 72 hours for urgent cases and within seven calendar days for standard requests. They must also provide specific reasons when they deny a request, and they are required to publicly report their prior authorization data.

While these rules apply to insurance companies, they affect providers directly. Faster decisions mean faster care, but only if your prior authorization requests are complete and accurate when submitted. An incomplete request will still cause delays even when payers are required to respond faster.

What to Do: Review your prior authorization submission workflows. Train clinical and administrative staff on what documentation is needed upfront so that requests go out complete the first time.

---

5. June 1 — Prescription Drug Reporting Deadline

Under the Consolidated Appropriations Act, all employer-sponsored health plans are required to file an annual report with CMS about prescription drug costs and overall health spending. This is called the RxDC report, and the deadline is June 1 every year.

What to Do: Coordinate with your third-party benefits administrator or health insurance carrier now to confirm that data has been collected and will be submitted on time. This obligation can easily fall through the cracks without a clear internal owner.

---

6. June 30 — Hospital Readmissions Performance Period Closes

The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals that have higher-than-expected rates of patients returning to the hospital within 30 days of being discharged. The program tracks six specific conditions: heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease (COPD), hip and knee replacement, and coronary artery bypass surgery.

An important change took effect this year: CMS shortened the look-back period from three years to two years. That means your FY 2027 payment adjustment will be based entirely on performance from July 1, 2023 through June 30, 2026, and that window closes at the end of June.

What to Do: Pull your current readmission rates for each of the six conditions now. If any are running high, focus your care transitions team on those patients immediately. Strong discharge planning, follow-up calls, and timely outpatient appointments are your most effective tools for bringing rates down before the window closes.

---

7. Promoting Interoperability — The Bar Got Higher

The Promoting Interoperability (PI) category in MIPS measures how well providers use EHRs to share information, support patient access, and coordinate care. This year, the passing score increased from 70 points to 80 points out of 100.

In addition, hospitals are now required to complete an annual self-assessment using eight specific safety guides called SAFER Guides. These guides help hospitals identify and address risks related to how their EHR systems are set up and used.

There is also a new optional bonus measure: hospitals that share data with public health agencies through a national data exchange network called TEFCA can earn additional points toward their PI score.

For healthcare organizations that participate in MIPS, your EHR system must be certified under 2026 standards for a minimum of 180 consecutive days during the year. For most organizations, this means your EHR upgrade should already be in place or happening very soon.

What to Do: Complete the eight SAFER Guide self-assessments, and document your results. Verify that your EHR is 2026-certified. Track your PI category score throughout the year and identify any gaps before year-end.

---

SECTION 3: A Major New Program — The ACCESS Model

One of the most significant new developments in healthcare regulation this year is the launch of the ACCESS Model, Advancing Chronic Care with Effective, Scalable Solutions. This is a 10-year federal program that fundamentally changes how providers get paid for managing patients with certain chronic conditions.

What Is the ACCESS Model?

The ACCESS Model is built around a straightforward idea. Instead of paying providers for each individual service they perform, Medicare will pay a recurring fee tied to whether patients actually get better. If your patient’s blood pressure drops, their diabetes moves under control, or their chronic pain improves, your organization gets paid. If patients don’t reach those targets, payments are reduced.

The model launched its first cohort on July 5, 2026, focusing on four groups of conditions:

• Early Cardio-Kidney-Metabolic: High blood pressure, prediabetes, high cholesterol, and obesity
• Cardio-Kidney-Metabolic: Diabetes, chronic kidney disease, and cardiovascular disease
• Musculoskeletal: Chronic pain in muscles, joints, and bones
• Behavioral Health: Depression and anxiety

How Payment Works: In the first year, your organization earns full payment if at least 50% of your enrolled patients meet their clinical improvement targets. That threshold increases each year as the program matures.

How Technology Fits In

The ACCESS Model is specifically designed around technology-supported care. Participants are expected to use tools like telehealth visits, remote patient monitoring devices, digital health coaching apps, and other technology to support patients between office visits. Providers must also use FHIR-based APIs to report patient outcome data and share clinical updates with other providers.

What Healthcare Organizations Should Do

If you missed the first cohort deadline (April 1, 2026), applications for a January 1, 2027 start are open on a rolling basis. Use the time now to assess your patient population across the four tracks, build your technology infrastructure, and prepare your care management team.

If you enrolled in the first cohort, your performance period is now live. Confirm your outcome measurement workflows are capturing the right data, your EHR is documenting care updates correctly, and your team understands what clinical targets patients need to reach for your organization to earn full payment.

---

SECTION 4: Later in 2026 — Fall and Year-End

8. The Inpatient-Only List Is Getting Shorter

For years, Medicare maintained a list of surgical procedures that could only be performed in a hospital inpatient setting, which meant patients had to be formally admitted. CMS is now phasing out this list entirely over a three-year period.

In 2026, 285 procedures were removed from the inpatient-only list. They were mostly orthopedic and musculoskeletal procedures like hip and knee surgery. At the same time, CMS expanded the list of procedures that can be performed in ambulatory surgical centers (ASCs), adding 560 new procedures to that list.

This is a major strategic shift. Care that used to require a hospital stay can now be performed in a same-day surgery center. That is good for patients who recover faster in outpatient settings, but it also creates competitive pressure and revenue implications that hospitals need to plan.

What to do: Surgical service lines, particularly orthopedics, spine, and general surgery, should assess which high-volume procedures are now eligible for ASC settings. Finance and strategy teams should model the reimbursement implications and evaluate whether ASC expansion is the right move for your organization.

---

9. FY 2027 IPPS Proposed Rule — Watch for It in April or May

Every spring, CMS releases a proposed rule that sets next year’s Medicare payment rates and quality program requirements for inpatient hospitals. The FY 2027 proposed rule is expected in April or May 2026, with a public comment period that typically closes in mid-June.

Based on where CMS has been heading, the FY 2027 rule is expected to continue the push toward digital quality reporting, expand the use of FHIR-based electronic measure reporting, and remove the remaining COVID-19 exclusions from all quality measures beginning in FY 2027.

What to Do: Assign someone on your quality or compliance team to monitor the Federal Register for the release. Review the proposed changes and consider submitting public comments on provisions that could significantly affect your organization. The public comment process is your opportunity to provide direct input before the rule is finalized.

---

10. Year-End: Close Out MIPS Strong

December 31, 2026 is the last day of the MIPS performance year. Every quality measure, improvement activity, and Promoting Interoperability attestation must be completed by then. There are no extensions.

Given that your 2026 MIPS score will determine your 2028 Medicare payment adjustment, the stakes are real. Starting your fourth-quarter performance review no later than October gives you time to act on gaps before the year closes.

What to Do: Set a calendar now for an October MIPS performance review. Identify which measures still need documentation, which improvement activities haven’t been fully completed, and whether your PI attestation is on track.

---

11. Interoperability Mandate — Get Ready for 2027

Starting in 2027, a key set of federal interoperability requirements will move from optional guidance to mandatory compliance. These rules require healthcare organizations to electronically share patient data across systems. This means when a patient sees multiple providers, their health information should follow them seamlessly.

2026 is the preparation year. Healthcare organizations that are not yet connected to the national data exchange network (TEFCA), do not have FHIR-ready APIs, or have not updated their EHR workflows to support data sharing will be in a difficult position next year.

True interoperability isn’t just a technology upgrade. It is a change in how your clinical and operational teams work every day. Providers need to understand how to access, interpret, and act on patient data that comes from outside their own systems.

What to Do: Map your current interoperability gaps against 2027 requirements. Confirm if your EHR vendor is on track with their own compliance updates and begin preparing clinical teams for the data-sharing workflows they will need to use.

---

SECTION 5: Looking Further Ahead — Planning for 2027 and Beyond

The Digital Quality Measure Transition

One of the biggest long-term shifts in healthcare regulation is the move from paper-based and manual quality reporting to fully digital reporting. By 2030, all HEDIS measures (a widely used set of healthcare quality metrics) must be submitted digitally through Electronic Clinical Data Systems (ECDS).

That sounds far off, but the transition is already underway. In 2025, nine HEDIS measures became digital submission requirements. That number will grow every year. And there is a catch: the data fields your EHR normally captures don’t always match what these digital quality measures require. Healthcare organizations that wait to address this gap will find themselves scrambling to pull together compliant data on an ever-growing list of measures.

What to Do: Work with your EHR vendor and quality team now to understand which digital quality measures are already being captured correctly, along with which fields have gaps. Include digital quality measure readiness in your 2027 strategic and technology planning.

---

MVPs Will Likely Become Mandatory by 2029

CMS has signaled that traditional MIPS — where providers can choose from a broad menu of quality measures regardless of whether they relate to their specialty — will eventually go away. MVPs are the intended replacement. CMS is expected to make this mandatory as early as 2029.

That gives healthcare organizations only a few performance years to learn about the new system, identify what works, and provide feedback to CMS before MVPs become the only way to avoid MIPS penalties.

What to Do: If you haven’t started MVP reporting, 2026 is the year to begin, even if you continue reporting traditional MIPS at the same time. CMS will take your higher score, and you will gain valuable experience with a system that is almost certainly your future.

---

---

The Bottom Line

2026 is not a quiet year for healthcare regulation. Between new payment models, tightening quality reporting requirements, the launch of a major new chronic care program, and the ongoing march toward fully digital reporting, there is a lot on every compliance officer’s plate.

The healthcare organizations that will navigate this well are the ones that treat regulatory compliance as an ongoing operational priority, not a once-a-year scramble. That means assigning clear ownership of each deadline, building quality data review into your regular operations, and training clinical and administrative staff on what these changes mean for their daily work.

Regulatory compliance is not just a legal requirement — it is directly tied to your reimbursement, your reputation, and your ability to deliver high-quality care. The work you put in now will show up in your payment adjustments and quality scores for years to come.

Use the calendar above as a starting point. Assign an owner to each deadline. And if you have questions about any of these requirements, reach out to your quality reporting partner before the deadline, not after.

---

Sources: CMS.gov | Federal Register | eCQI Resource Center | MRO Corp | Healthcare IT Today | Becker’s Hospital Review | Advisory.com | Lockton Benefits Compliance

This article is intended for informational purposes. Consult your legal, compliance, and regulatory advisors before making program participation or compliance decisions.