Mississippi hospitals with provider-based off-campus outpatient departments should start preparing now for new Medicare requirements that could affect payment beginning January 1, 2028. On July 7, 2026, CMS proposed a rule implementing Section 6225 of the Consolidated Appropriations Act, 2026, and comments are due August 31, 2026. The basic point is this: for items and services furnished on or after January 1, 2028, Medicare will bar Outpatient Prospective Payment System (“OPPS”) payments unless the off-campus outpatient department has its own National Provider Identifier (“NPI”) and bills under it, and the main provider has submitted a provider-based attestation that the department complies with 42 C.F.R. § 413.65.
This is not aimed at every clinic or every off-campus site. The proposed rule focuses on “off-campus outpatient departments of a provider,” generally meaning provider-based departments that are not on the main provider’s campus and are not within 250 yards of a hospital remote location. That distinction matters because hospitals should first identify which locations actually fall within the proposed requirement.
For larger hospital systems, that first step may require a closer look at the existing provider-based “campus” rules. The proposed rule does not appear to rewrite the current campus definition or answer every question about locations near, but outside, the 250-yard line. For example, it does not define a hospital’s “main buildings” or explain when a location beyond 250 yards may still be treated as part of the hospital’s campus based on a CMS Regional Office’s case-by-case determination. But it makes the answers more important.
The timeline is more urgent than it may look. CMS proposes that off-campus outpatient departments furnishing services on or before January 1, 2028, must submit initial attestations by December 31, 2027. Departments that begin furnishing services after January 1, 2028, would need an attestation within the two (2) years preceding the delivery of billed services. CMS also proposes later attestations at intervals it will specify, not to exceed five (5) years.
CMS is also proposing a standardized attestation form and a centralized electronic submission process. Before submitting an attestation, the main provider must obtain a separate NPI for each provider-based department and update the Provider Enrollment, Chain, and Ownership System (“PECOS”). CMS also proposes moving away from the current MAC-specific process and adopting standardized reviews, audits, and site visits. Providers may not need to submit all supporting documentation with the initial attestation, but they must maintain it and provide it if CMS or its contractors request it. CMS anticipates giving providers up to sixty (60) days to submit requested documentation.
The proposal may give hospitals some flexibility, but it does not eliminate repayment risk. For new off-campus provider-based departments after January 1, 2028, CMS appears to contemplate that billing may begin after the required attestation is submitted, without waiting for final CMS approval. But if CMS later determines the department did not meet the provider-based requirements, the hospital could face payment recovery.
For Mississippi hospitals and clinics, the practical next step is to inventory provider-based departments, confirm which are on-campus or off-campus, review current NPI and PECOS information, and identify any gaps in § 413.65 compliance before the deadline closes.
If you have questions about the proposed rule, provider-based compliance, or how these changes may affect your hospital or clinic, please contact a member of Butler Snow’s healthcare practice.
