Volume 26.03
In the CY 2027 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule (“Proposed Rule”), posted on July 7, 2026, the Centers for Medicare and Medicaid Services (“CMS”) proposes to implement new requirements for provider-based departments (“PBDs”) established by statutory provisions in Section 6225 of the Consolidated Appropriations Act, 2026 (“CAA of 2026”). CMS’s Proposed Rule provides further detail on the form, timing, and verification process it will use to review newly mandatory provider-based attestations (“PBAs”).
Section 1833(t)(23)(A) of the Act, as added by section 6225 of the CAA, 2026, specifies that no payment may be made under that subsection (or under an applicable payment system pursuant to paragraph (21) of section 1833(t) of the Act) for items and services furnished on or after January 1, 2028, by an off-campus outpatient department of a provider, unless that department has obtained authorization, and the items and services are billed under an NPI that is separate from the NPI of the main provider. The new section of the Act also modifies the definition of an off-campus outpatient department.
Under the Proposed Rule, starting January 1, 2028, Medicare will no longer make payments under the OPPS for services billed by off-campus outpatient departments unless two conditions are satisfied:
(1) The department bills under its own separate National Provider Identifier (NPI), and
(2) The main provider has submitted an attestation (within the preceding two years) confirming the department meets the provider-based requirements at 42 C.F.R. § 413.65.
Compliance with these requirements, unless modified in any Final Rule, will be a prerequisite for Medicare payments to provider-based departments beginning January 1, 2028. Providers should submit comments on the feasibility of these proposals and assess those steps required for compliance now.
To receive Medicare reimbursement for services furnished on and after January 1, 2028, CMS proposes that off-campus PBDs must satisfy the following requirements:
1. Apply for and begin billing under a PBD-specific NPI. CMS proposes that, prior to submitting a PBA, main providers must obtain a separate NPI for each off-campus PBD and update the Provider Enrollment, Chain, and Ownership System (PECOS) to reflect the new NPI. Each current off-campus PBD must obtain its own NPI before January 1, 2028, and all items and services furnished by that department under the OPPS must be billed under the PBD-specific NPI rather than the NPI of the main provider.
2. Submit an initial PBA for each off-campus PBD on behalf of the main provider. CMS proposes to establish a standardized attestation form that would replace current Medicare Administrative Contractor (“MAC”)-specific templates. The attestation would include identifying information for the main provider and the PBD (such as name, address, and NPI), along with a list of the requirements at § 413.65(d), (e), (g), and (h) that must be individually affirmed by checkbox, and a certifying statement affirming compliance, signed by an authorized official of the main provider as identified in PECOS.
Providers should be aware that CMS is proposing to use program integrity mechanisms available to CMS (now or in the future) to evaluate compliance with provider-based requirements and identify attestations requiring additional oversight. Failure to submit requested documentation within the timeframe specified by CMS may result in a determination of noncompliance and recovery of payments.
CMS is seeking public comment on its proposed policies and processes to implement Section 6225 of the CAA, 2026. Specifically, CMS is seeking feedback from stakeholders regarding feasibility, operational impact, implementation considerations, potential burden, and any unintended consequences associated with these proposals. Comments must be received by CMS by August 31, 2026.
LAS VEGAS HOSPICE PROGRAM FILLING RAPIDLY
The 2026 “Hospice Financial & Compliance Management Conference” is now available for registration. Early registration discounts are available. Space at this program is limited to enhance the quality of the program and networking opportunities for the attendees. The two-day program is being held at the Paris Las Vegas on October 1-2, 2026.
As always, this annual program offers the most extensive hospice financial coverage available. The integration of finance and compliance is critical to the survival and success of any hospice. This year, compliance and the associated financial risks are critical. Initial information and registration information is available here. Discounted room rates are available here or by calling (877) 603-4389. Make certain to inform Paris Las Vegas that you are attending The Health Group program. See you in Las Vegas.
The Health Group, LLC is a registered sponsor with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. State Boards of Accountancy have the final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of Sponsors through its website https://www.nasbaregistry.org/