All hospitals operating off-campus outpatient provider-based departments (“HOD”) must be aware of and prepare for upcoming new requirements imposed by Section 6225 of the Consolidated Appropriations Act of 2026 (“CAA”). Specifically, under the CCA, as of January 1, 2028, Medicare will no longer make payments for services furnished in HODs unless (a) the HOD has a NPI that is separate and distinct from the hospital’s NPI, and (b) the hospital submits at attestation confirming the HOD’s compliance with the Medicare provider-based requirements.
The CCA directed CMS to issue new regulations to establish a process for: (a) providers with HODs to submit attestations confirming compliance with the Medicare provider-based requirements, and (b) CMS to review each attestation and determine through site visits, remote audits and other means whether the HOD is in compliance with the Medicare provider-based requirements. With these new requirements, submission of a provider-based attestation for each HOD, which currently is a voluntary and not a required process, will be mandatory and failure to comply can result in nonpayment by Medicare for services provided in the HOD.
While it is uncertain what processes CMS will implement for submission of attestations, given multiple HODs that hospitals may operate, the labor-intensive and time-consuming process involved in preparing attestations and significant reimbursement and operational implications for noncompliance, it is prudent for hospitals to start taking proactive steps now to prepare for the upcoming changes. Some of the primary preparation steps include:
- Making an inventory of all HOD locations;
- Obtaining a separate NPI for each HOD;
- Confirming that each HOD location meets Medicare provider-based requirements outlined in 42 CFR § 413.65 and addressing any deficiencies before submitting a provider-based attestation;
- Implementing a process for gathering documentation for, preparing and submitting provider-based attestations;
- Establishing procedures for tracking submission and status of each attestation;
- Monitoring each HOD’s continued compliance with the Medicare provider-based requirements.
For more information about the new requirements or if you have questions about compliance with Medicare provider-based requirements, please contact Milada Goturi at Thompson Coburn LLP.
