CMS proposes mandatory attestation process for off-campus hospital outpatient departments
Hospital compliance teams must secure separate NPIs and prepare provider-based attestations for every off-campus PBD before the January 1, 2028 Medicare payment cutoff.
CMS’s proposed CY 2027 OPPS rule implements Section 6225 of the Consolidated Appropriations Act, 2026, by adding 42 C.F.R. § 419.23 and standardizing how hospitals demonstrate provider-based status for off-campus outpatient departments. Main providers must obtain a location-specific NPI for each off-campus PBD, update PECOS, and submit an initial attestation between January 1, 2026 and December 31, 2027; subsequent attestations are required at intervals not exceeding five years. Timely submission satisfies the statutory requirement even if CMS has not issued a determination by January 1, 2028, providing relief from anticipated processing backlogs. CMS will use risk-based screening, with automated initial reviews and extended reviews—including documentation requests, site visits, and remote audits—for attestations flagged for incompleteness or elevated compliance risk across seven regulatory categories. Hospitals have 60 days to produce supporting documentation, and failure to comply may trigger repayment of OPPS claims. Comments are due August 31, 2026; providers should audit PBD inventories now and confirm documentation of clinical, financial, and organizational integration.