Impact of Consolidated Appropriations Act of 2026 on Medicare Reimbursements
The Consolidated Appropriations Act of 2026 introduces significant changes affecting Medicare reimbursements for hospital off-campus provider-based departments. Effective January 1, 2028, these facilities must meet two newly established requirements: obtaining a unique organizational National Provider Identifier (NPI) and maintaining a current provider-based attestation. Failure to comply will result in ineligibility for Medicare payments.
Hospitals are advised to initiate preparations immediately due to the multi-departmental coordination needed, involving legal, compliance, reimbursement, enrollment, IT, and operations teams. Current regulations make submission of a provider-based attestation optional. However, the CAA 2026 mandates these as necessary compliance elements to mitigate liability for overpayments if the Centers for Medicare & Medicaid Services (CMS) later identifies non-compliance with provider-based standards.
Moreover, while hospitals have historically had discretion in obtaining separate NPIs for various operational reasons, the act now makes a distinct NPI per off-campus location a payment requirement. This change applies to all off-campus departments, including those that are grandfathered under full OPPS reimbursement and those under different payment systems like the MPFS.
The act makes no exceptions for most off-campus locations, although there could be specific exemptions yet to be detailed in CMS guidelines. As the statute requires each facility to be tied to its own NPI, hospitals may need to update their Medicare enrollment documentation accordingly, potentially amending their CMS-855A forms.
Hospitals should be aware of the broader implications beyond Medicare reimbursement. Using separate NPIs could influence 340B program qualifications, managed care contracts, state licensing, facility designations, Medicaid enrollment, and agreements with commercial payers.
Hospitals that have previously filed provider-based attestations should plan for updates. According to the new law, only those affirmations dated on or after January 1, 2026, will meet the compliance criteria. This necessitates resubmission of attestations that predate 2026. Additionally, CMS will likely provide upcoming guidance regarding the frequency of submission required for these attestations through new regulations.
As the compliance deadline approaches, hospitals must ensure each off-campus department secures a unique organizational NPI and officially records an updated provider-based attestation. This regulatory change represents a pivotal move in Medicare's scrutiny over hospital outpatient departments, demanding proactive planning from affected healthcare institutions.