Among the many healthcare provisions in the Consolidated Appropriations Act, 2026, Congress enacted new requirements that will affect off-campus hospital outpatient departments (HOPDs), effective January 1, 2028. These include a required provider-based attestation and a separate National Provider Identifier (NPI) for each HOPD. Details of these requirements can be found in Section 6225 of the legislation, beginning on page 510.
This article explores what hospitals should know about the new requirements and what they can do now to prepare.
What Are the Attestation Requirements for Off-Campus HOPDs?
Effective January 1, 2028, hospitals must submit a provider-based attestation for each off-campus department. The law defines a department as “a department of a provider not located on (1) the campus of the provider and (2) not on the campus of a remote location of a hospital.” Historically, hospitals have voluntarily completed provider-based attestations by physical location, and it is reasonable to expect CMS to continue interpreting the definition of department in this manner.
As with prior CMS regulations, hospitals are expected to validate addresses down to the suite level. This raises important questions about how full-building provider-based locations currently listed on the CMS-855A enrollment form will be treated under the new requirements.
What Are the NPI Requirements for Off-Campus HOPDs?
Also effective January 1, 2028, hospitals will be required to obtain a separate NPI for each off-campus department. This NPI must be distinct from the hospital’s main NPI and issued at the physical location level.
How Should Hospitals Prepare for New Off-Campus HOPD Requirements?
While the effective date of these requirements is calendar year 2028, it is critical to note that hospitals must obtain the new NPIs and submit the provider-based attestations prior to this date. Failure to meet these requirements by January 1, 2028, will result in suspension of Medicare payments for the affected departments.
Given the operational complexity and the potential financial impact, hospitals should begin preparing now for compliance well in advance of the effective date. Recommended next steps include:
- Confirming you have a complete and accurate inventory of all off-campus locations, organized by physical address.
- Conducting a gap assessment to confirm current compliance with provider-based requirements.
- Beginning preparation of provider-based attestations as early as possible. Although the attestation itself is a checklist affirming compliance, it requires substantial supporting documentation. Common attachments include policies and procedures, signage photographs, floor plans, general ledger documentation, and other supporting materials. Collecting and validating these items can take several months.
- Meeting with IT and revenue cycle teams to determine the timing and system changes needed to bill by service location using separate NPIs. Hospitals should establish a clear timeline for obtaining NPIs and having them fully operational in billing systems on or before January 1, 2028.
What Are the Next Steps for Off-Campus HOPD Policies?
We anticipate that CMS will issue notice-and-comment rulemaking to provide additional clarity on the attestation process and submission frequency. There has been discussion in committee of a potential biennial attestation cycle, though this was included in prior bills that did not pass. If CMS does not issue separate guidance earlier, these requirements are likely to be addressed in the 2027 Outpatient Prospective Payment System (OPPS) proposed rule, typically released in July.
Notably, the law includes $20 million in funding for implementation and enforcement, suggesting increased scrutiny of provider-based designations through audits, desk reviews, and inquiries from CMS and the Office of Inspector General (OIG).
How Forvis Mazars Can Help
Forvis Mazars is closely monitoring these developments and is prepared to assist with inventory development, gap assessments, provider-based attestations, NPI strategy, and system readiness. Please reach out to a professional on our team if you would like support navigating these upcoming requirements or planning next steps.