QUESTION:
Is it true that significant changes are coming to the rules for provider-based status locations?

ANSWER FROM HORTYSPRINGER ATTORNEY NICHOLAS CALABRESE:
Yes, it’s true.  Many hospitals operate outpatient clinics, among other things, off-site from the main hospital campus.  If these sites qualify for “provider-based status” under federal regulations, they can bill as part of the hospital and receive a higher level of reimbursement.  Basically, CMS treats an off-site location as a department of the hospital instead of a freestanding facility if it has provider-based status.

Currently, hospitals voluntarily submit a formal declaration, known as an “attestation,” to its Medicare Administrative Contractor stating that it is in compliance with all provider-based requirements (licensure, financial integration and other requirements), and bill under the hospital’s National Provider Identifier (“NPI”).

However, on February 3, 2026, the 2026 Consolidated Appropriations Act (“CAA”) became law.  Section 6225 of the CAA requires hospitals to submit mandatory attestations confirming compliance with Medicare’s provider-based regulations for all off-campus hospital outpatient departments and to obtain distinct NPIs for each such location.  Hospitals that fail to meet both requirements by January 1, 2028, will lose eligibility for that higher level of reimbursement.

CMS has issued proposed regulations and is accepting public comments until August 31, 2026.

If you have a quick question about this, e-mail us at info@hortyspringer.com.