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The Centers for Medicare & Medicaid Services is proposing a new provider-based attestation rule that would require all off-campus outpatient departments to submit provider-based attestations through a new centralized electronic system before they can receive Hospital Outpatient Prospective Payment System payment. Providers with existing CMS provider-based status determinations may be able to use a simplified attestation path. The proposed rule, published today, also signals a broader shift toward risk-based oversight and reduced documentation burden across the outpatient billing process.
The Legal Basis Behind the Provider-Based Attestation Rule
Section 6225 of the Consolidated Appropriations Act of 2026, enacted on February 3, 2026, bars OPPS payment beginning January 1, 2028, for services furnished by an off-campus outpatient department unless the department bills under a separate National Provider Identifier and the main provider has submitted an attestation that the department satisfies the provider-based requirements at 42 C.F.R. § 413.65. CMS published this provider-based attestation rule specifically to implement those statutory requirements.
Comment Deadline for the Proposed Rule
Comments on the proposed rule are due by August 31, 2026, giving affected hospitals and health systems a defined window to weigh in before the requirements take effect.
Submission Timing Under the Provider-Based Attestation Rule
For off-campus outpatient departments furnishing services on or before January 1, 2028, initial attestations would be due between January 1, 2026, and December 31, 2027. Providers who submit an initial attestation during this two-year window would be treated as satisfying the CAA 2026 requirement under the provider-based attestation rule, even if CMS has not issued a determination by January 1, 2028.
Requirements for Departments Starting Later
Departments that begin furnishing services after January 1, 2028, would need to submit an attestation during the two-year period before services are furnished. Subsequent attestations would be required at intervals set by CMS, not to exceed five years, establishing an ongoing compliance cycle under the rule.
A Lighter Path for Existing Determinations
CMS is seeking comment on whether departments that received a provider-based status determination before January 1, 2026, should be required to submit a new initial attestation under the provider-based attestation rule. One approach under consideration would allow a provider’s authorized official to submit a letter to CMS attaching evidence of the prior determination and affirming continued compliance, potentially a lighter lift than a full attestation.
A New Standardized Electronic Form
CMS proposes a standardized provider-based attestation form submitted through a central electronic system, replacing the current patchwork of Medicare Administrative Contractor-specific forms. CMS says this change would result in a reduction in administrative burden for providers and a more efficient review process. While the new system is in development, providers may continue submitting attestations to their assigned MACs.
Review Process Changes Under the Provider-Based Attestation Rule
CMS proposes shifting from the current multilayer MAC-to-CMS approval process to a contractor-led review under the provider-based attestation rule. Review activities could include automated validation, data analysis, targeted documentation review, and procedures designed to support consistent national implementation across all reviewing contractors.
A Risk-Based Approach to Verification
CMS proposes a layered, risk-based approach to verification. Attestations that pass automated validation would be processed for initial determination, while those flagged for compliance risk would undergo targeted documentation review, remote audits or site visits. CMS notes that reviewing a sample of each provider’s departments would provide meaningful insight into whether compliance standards are being upheld across all departments.
Reduced Documentation Burden Under the Rule
CMS signals that documentation requirements may be lightened under the provider-based attestation rule. System enhancements could allow providers to submit documentation that applies to multiple locations only once, rather than resubmitting the same materials for each department separately.
Open Questions for Public Comment
CMS is also seeking comment on whether any documentation categories should be revised, consolidated or removed entirely, giving stakeholders a direct opportunity to shape how the final documentation requirements take shape.
What Providers Should Do Next
With the comment deadline set for August 31, 2026, and phased attestation deadlines running through 2027, hospitals and health systems operating off-campus outpatient departments should begin reviewing their current provider-based status documentation now. Understanding how the provider-based attestation rule applies to existing versus newly established departments will be critical for maintaining uninterrupted OPPS payment eligibility once the January 1, 2028, deadline takes effect.
