CMS Proposes Mandatory Attestation Process for Off-Campus Outpatient Departments

The Centers for Medicare & Medicaid Services (CMS) is proposing to 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 (OPPS) payment. Providers with existing CMS provider-based status determinations may be able to use a simplified attestation path. The proposed rule published by CMS today also signals a shift toward risk-based oversight and reduced documentation burden.

Section 6225 of the Consolidated Appropriations Act of 2026 (CAA 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 the proposed rule to implement such requirements under the CAA 2026. Comments to the proposed rule are due by August 31, 2026.

Key Proposals in the Proposed Rule

• What You Must Submit – and When: 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 attestation requirement even if CMS has not issued a determination by January 1, 2028. Departments that begin furnishing services after January 1, 2028, would need to submit an attestation during the two-year period before the services are furnished. Subsequent attestations would be required at intervals set by CMS not to exceed five years.
• Potential Good News for Providers with 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. 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.
• New Standardized Form and Electronic Submission: CMS proposes a standardized provider-based attestation form submitted through a central electronic system, replacing the current patchwork of Medicare Administrative Contractor (MAC)-specific forms. CMS says this 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. A sample of the proposed attestation format is available for comment.
• Streamlined Review Process: CMS proposes shifting from the current multilayer MAC-to-CMS approval process to a contractor-led review. Review activities could include automated validation, data analysis, targeted documentation review and procedures designed to support consistent national implementation.
• Risk-Based Oversight: CMS proposes a "layered, risk-based approach" to verification. Attestations that pass automated validation would be processed for initial determination, and 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: CMS signals that documentation requirements may be lightened. System enhancements could allow providers to submit documentation that applies to multiple locations only once. CMS is also seeking comment on whether any documentation categories should be revised, consolidated or removed.

Holland & Knight Can Help

Holland & Knight is available to help address any questions or assist with preparing attestations. Please contact the authors for more information.