Navigating Regulatory Changes Impacting Care Coordination in 2026

Healthcare compliance is a critical consideration for practices of all sizes. In 2026, several regulatory changes may impact the way you store or provide access to patient data, and, therefore, the systems you leverage across your organization.

Take a look at these regulatory changes affecting interoperability standards and healthcare data sharing, and how they may impact effective care coordination.

Key Regulatory Changes Impacting Care Coordination

Healthcare practices face a number of challenges in 2026, ranging from staff shortages to rising drug costs. Regulatory changes can feel like another obstacle to circumvent. But many of the new or adjusted regulations focus on improving patient outcomes via improved interoperability standards and care coordination, which may have numerous benefits for organizations.

CMS Interoperability Standards and Prior Authorization for Drugs Proposed Rule

Improving prior authorization processes expedites patient treatment journeys, leading to better outcomes. This proposed rule requires shorter timelines for prior authorization and increased transparency, specifically for drug authorizations.

Alongside this, the rule proposes adopting Fast Healthcare Interoperability Resources (FHIR) for HIPAA-compliant electronic data exchange.

Organizations may want to consider getting ahead of the curve by working toward optimized authorization workflows and upgrading systems to include FHIR APIs. Mirth Connect, for example, is available as part of the NextGen suite of tools and utilizes FHIR for seamless, secure patient data transfer.

Medicare Physician Fee Schedule Final Rule

Changes to Medicare payment models outlined in late 2025 will come into effect in 2026. These include changes to the Physician Fee Schedule (PFS). Affected areas include:

• Telehealth

• Therapy services

• Evaluation and management (E/M) visits

• Behavioural services

• Advanced primary care management (APCM) services

Changes include new codes, efficiency adjustments, and adjustments to the categories that certain procedures or treatments fall under. Practice managers or administrators will need to ensure that their templates and electronic practice management (EPM) tools are updated to reflect the new codes and altered categories, where relevant.

Medicare Shared Savings Program Changes: Impact on Accountable Care Organizations (ACOs)

ACOs are health providers, ranging from individual physicians to hospitals, who collaborate to provide high-quality, well-coordinated care to people supported by Medicare. Many ACOs apply to join the Shared Savings Program, which encourages better patient outcomes that save money.

Changes to the Shared Savings Program announced in July 2026 indicate that ACOs will receive additional incentives to further streamline spending and make services more efficient. Effective care coordination can help practices achieve these goals, and accurate quality reporting will ensure reimbursement is made in full. 

State-Level AI Regulations in Healthcare

AI in healthcare offers various benefits, from early cancer detection to drug development. However, some states have decided that using generative AI to potentially mislead patients, even inadvertently, isn’t just ethically wrong, but illegal.

• California has stated that healthcare providers must disclose when they have used generative AI to produce written or verbal communication containing clinical data. AI systems may not indicate any type of medical licensing. For example, an AI bot in California cannot use terms like M.D. or R.N.

• Nevada has prohibited AI vendors from offering services relating to mental or behavioral health. That also applies to schools that might have previously used AI tools for counseling or other psychological services.

• Illinois has completely prohibited AI from making clinical decisions related to therapeutic treatment, or even interacting with patients to make recommendations.

Practices can still utilize the analytical AI tools found in EPMs that help organize and analyze data, and automate repetitive tasks. Limiting the use of generative AI will ensure practices don't fall foul of increasing regulations surrounding the use of AI. 

Strategy Recommendations for C-suite Executives and Analysts

Developing your compliance strategy now helps you anticipate future regulatory changes. The healthcare technology systems and tools you invest in can have a major impact on how compliant you remain. Secure systems that promote swift patient data exchange are the key to interoperability, one of the major factors in effective care coordination.

Invest in staff training on both the systems themselves and the impact of data governance, data protection, and promoting better patient outcomes. When personnel understand the impact of the processes they follow daily, they’re more likely to be engaged and motivated.

How TempDev Helps You Stay Compliant

TempDev’s Next Gen consultants can help you assess your regulatory strategy and ensure you remain compliant, despite rapidly shifting federal and state laws. Talk to our team about upgrading to systems that support effective care coordination and interoperability, to future-proof your practice against further changes.

Contact TempDev online or call 888.TEMP.DEV.