cHaNGesarecomiNGtoProvider-BasedstatusattestatioNs
Health care law section Co-Chairs: BlayneMiley – MoffittCancerCenter & JessicaAndrews – JohnsonPopeBokorRuppelBurns
Hospitalsthatutilize provider-basedstatusfor off-campusoutpatient departmentsshouldmonitor thefinalrule.
Provider-based status is a Medicare designation that allows departments that are separate from a hospital to bill Medicare as part of the hospital, provided certain requirements are met. As a result, the departments may receive facility fee payments that result in higher reimbursement than would occur without provider-based status.
The Consolidated Appropriations Act of 2026 changed the Provider- Based Status Attestation( PBSA) process for off-campus outpatient departments. Previously, providers could voluntarily submit a PBSA along with substantial supporting documentation to their Medicare Administrative Contractor( MAC). The MAC would conduct an initial review, possibly requesting supplemental documentation, and then forward the submission to the Centers for Medicare &
Medicaid Services( CMS) for a final determination. Approval of a PBSA gave providers some assurance against adverse billing determinations and related penalties.
Under the new law, off-campus outpatient departments must satisfy the following requirements to receive hospital-level reimbursement as of January 1, 2028:
• Departments must bill under their own separate National Provider Identifier( NPI);
• Departments must submit a PBSA within the two-year period preceding January 1, 2028; and
• After January 1, 2028, departments must submit subsequent PBSAs within the timeframe specified by CMS. On July 7, 2026, CMS issued a proposed rule that, among other things, implements the Consolidated Appropriations Act of 2026
provisions regarding provider-based off-campus outpatient departments. The proposed changes include:
• Replacing the MAC-specific attestation forms with a standardized national attestation form that is submitted electronically.
• Modifying the review process so that either CMS or the MAC conducts the review, rather than both.
• Requiring provider-based off-campus outpatient departments to obtain separate NPIs prior to submitting the attestation form.
• Allowing the attestation form to be submitted without supporting documentation.
• Permitting approval of attestations without supporting documentation. However,
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