CMS has proposed regulations implementing Section 6225 of the Consolidated Appropriations Act, 2026 in its newly released (CY) 2027 Proposed Rule for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System.
Beginning January 1, 2028, OPPS payment for off-campus HOPDs would be conditioned on two requirements:
- Each off-campus HOPD must bill under a separate NPI; and
- The main provider must submit a provider-based attestation confirming compliance with 42 C.F.R. § 413.65.
Key takeaways from the CMS proposal include:
CMS is proposing an electronic, standardized attestation process.
Hospitals would submit attestations through a centralized CMS electronic system rather than MAC-specific forms. The attestation would identify the main provider and each off-campus HOPD, including addresses, provider numbers, NPIs, and applicable provider-based/acquisition dates. CMS also proposes to allow MACs to issue provider-based determinations under the new process, eliminating the historical dual review pathway under which MACs recommended approval and CMS issued the final determination.
NPIs must be in place before filing.
Hospitals must obtain separate NPIs for off-campus HOPDs and update PECOS before submitting the attestation. Providers may continue using the traditional attestation process before the new CMS template and portal are available.
CMS is not requiring a full documentation package for every site up front.
The proposed process appears to rely on a streamlined electronic submission, with CMS using automated validation, data analysis, and risk-based screening to identify sites requiring additional review. For example, sites that cannot be systematically validated as located within the applicable 35-mile radius of the main hospital will likely be selected to provide documentation supporting compliance with a location exception.
But all sites still need to be ready.
CMS states it may conduct sample reviews from each hospital’s off-campus HOPD universe. Any site could be selected for targeted review, extended review, remote audit, investigation, or site visit. Although CMS may not require a complete set of supporting documentation for each location at the time of filing, hospitals must be prepared to provide this information upon request.
The proposed response window is short.
CMS indicates providers generally would have no more than 60 days to respond to documentation requests. That is not enough time to build a full provider-based file from scratch, especially for large health systems or legacy locations. Advis therefore recommends that hospitals build complete support files for each HOPD location in advance so they are prepared to respond timely if selected for review.
Prior CMS determinations may receive a simplified pathway.
CMS is seeking comment on whether off-campus HOPDs that received a CMS provider-based determination before January 1, 2026 could satisfy the initial mandatory attestation through an authorized official letter, with the prior CMS determination attached, affirming continued compliance with § 413.65.
Determinations would carry appeal rights.
CMS proposes that determinations issued through the standardized process would constitute initial determinations for purposes of CMS appeal regulations. This is important because adverse determinations would not merely be informal portal results; they would carry formal appeal rights and could create payment and compliance implications for affected locations.
Additional operational guidance is still forthcoming.
CMS has not yet finalized all operational details for the new process. Key standards, including specific review criteria, validation protocols, documentation expectations, sampling methodology, and portal mechanics, are expected to be addressed through future CMS guidance. Hospitals should therefore prepare for the rule’s core requirements now while recognizing that implementation details may continue to evolve.
CMS expects a broad national filing universe.
For purposes of estimating administrative burden, CMS assumes approximately 1,832 main providers will submit attestations, with an average of nine attestations per provider, for a total of approximately 16,488 responses. This estimate is useful context for anticipating CMS and MAC processing volume, potential backlog, and the importance of timely submissions.
The proposal is more administratively workable than requiring full traditional attestation packages for every HOPD at the front end. However, it does not eliminate the need for full provider-based readiness.
Hospitals should assume that any off-campus HOPD could be selected for follow-up review. Systems should inventory all off-campus HOPDs, obtain and validate NPIs, reconcile PECOS and enrollment records, identify locations with prior CMS determinations, and develop and maintain current provider-based compliance support files for all sites.
Reach out to Advis today learn how we can support your organization’s regulatory, financial, and compliance needs.
Published July 7, 2026
