Provider-Based Attestations: Key Takeaways from CMS’s Proposed Rule
On July 2, 2026, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed Calendar Year 2027 Hospital Outpatient Prospective Payment System (“OPPS”) and Ambulatory Surgical Center Payment System Rule (CMS-1850-P). While the proposed rule includes a variety of payment and policy updates, one provision is particularly important for hospitals operating off-campus provider-based outpatient locations.
What Is Changing?
The proposed rule implements Section 6225 of the Consolidated Appropriations Act of 2026, which requires a formal provider-based attestation process for off-campus outpatient departments. We previously discussed Section 6225 and its implications for provider-based departments in our earlier article, “Return of Provider-Based Attestations: What It Means and How to Prepare.” Beginning January 1, 2028, an off-campus outpatient department would no longer be eligible for payment under the OPPS unless:
- The department bills Medicare under its own National Provider Identifier (NPI); and
- The hospital submits an attestation confirming that the department meets Medicare’s provider-based requirements.
Proposed Attestation
Under the proposal, hospitals will be required to certify that each off-campus department complies with the provider-based requirements found at 42 C.F.R. § 413.65, including:
- Licensure;
- Clinical integration;
- Financial integration;
- Public representation;
- Hospital outpatient department obligations;
- Ownership and control;
- Reporting relationship; and
- Geographic proximity to the main provider.
To support this process, CMS has also released a proposed standardized national form that hospitals would use to make these certifications.
Opportunity to Comment
CMS is accepting public comments on the proposed rule through August 31, 2026. Hospitals and health systems may want to review the proposed attestation form and related requirements carefully and consider whether to submit comments before the deadline.
