cHaNGesarecomiNGtoProvider-BasedstatusattestatioNs
Health care law section
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attestations that indicate incompleteness, inconsistency, or elevated compliance risk will be flagged for targeted documentation review. Providers will have 60 days to submit the requested documentation. Failure to submit requested documentation may result in a determination of non-compliance and recovery of payments.
• Authorizing CMS or the MAC to conduct site visits, remote audits, investigations, or supporting documentation requests at any time to verify compliance with provider-based status requirements.
• Specifying that subsequent attestations after January 1, 2028, shall be submitted within 5 years. The supporting documentation that CMS or the MAC can request includes the categories covered by the requirements of 42 CFR 413.65( d),( e),( g), and( h):
• Licensure
• Clinical Services
• Financial Integration
• Public Awareness
• Hospital Obligations
• Ownership and Control
• Administration and Supervision
• Location
As a result, providers will need to be able to produce supporting documentation addressing the same categories that currently are submitted with a PBSA. The primary change is procedural: supporting documentation would be submitted on an as-requested basis rather than included with the PBSA.
The public comment period for the proposed rule concluded on August 31, 2026. Hospitals that utilize provider-based status for off-campus outpatient departments should monitor the final rule, because it will impact the process to comply with the PBSA mandate of the Consolidated Appropriations Act of 2026. n
Author: Blayne Miley – Moffitt Cancer Center s e P- O C T 2 0 2 6 | H C B A L A W Y e R
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