The Consolidated Appropriations Act, 2026, which was signed into law on February 3, 2026, includes new requirements affecting off-campus hospital outpatient departments. Previously, off-campus hospital outpatient departments could voluntarily submit an attestation to their Centers for Medicare & Medicaid Services (CMS) Regional Office (RO) declaring their compliance with the requirements Medicare provider-based status regulations at 42 C.F.R. 413.65. The new law makes these optional attestations mandatory and requires each off campus hospital outpatient department to obtain an independent National Provider Identifier (NPI).
Mandatory Attestations
As of January 1, 2028, an off-campus hospital outpatient department will not receive payment from CMS without having submitted an attestation declaring their compliance with the requirements Medicare provider-based status regulations at 42 C.F.R. 413.65. The statute requires two attestations: (1) an initial attestation submitted within the “[two]-year period ending on the date … services are so furnished” and (2) a subsequent attestation submitted within a timeframe to be specified by the Secretary. This means that to bill for services on or after January 1, 2028, a hospital must have submitted an initial attestation on or after January 1, 2026.
The new law states that CMS shall adopt regulations, via notice and comment rulemaking, defining the process for submitting and reviewing the attestations, as well as defining when subsequent attestations will be required.
Separate NPIs
Further, the new law requires that as of January 1, 2028, each off-campus hospital outpatient department must obtain and utilize a separate NPI from the NPI of the main provider with which it is associated.
What to Do
Here are some steps that can be undertaken now to prepare for required compliance on January 1, 2028:
- Catalog all of your off-campus hospital outpatient departments.
- Obtain separate NPIs for each of your off- campus hospital outpatient departments.
- Assess any potential deficiencies of your off-campus hospital outpatient departments with the provider-based status requirements of 42 CFR § 413.65.
- Begin compiling attestation documentation.
Gunster's Healthcare Law and Regulated Industries & Professions teams are here to help you navigate the new guidance. Please feel free to reach out to the contacts below with any questions:
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This publication is for general information only. It is not legal advice, and legal counsel should be contacted before any action is taken that might be influenced by this publication.
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