Upcoming Medicare Regulations for Off-Campus Outpatient Departments

Mississippi hospitals with off-campus outpatient departments should prepare for the upcoming Medicare payment regulations effective January 1, 2028. These changes stem from a proposal by the Centers for Medicare & Medicaid Services (CMS) on July 7, 2026, as part of the Consolidated Appropriations Act, 2026. Stakeholders have until August 31, 2026, to submit comments on the proposal.

Starting in 2028, Medicare payments under the Outpatient Prospective Payment System (OPPS) will necessitate off-campus departments to hold their own National Provider Identifier (NPI) and submit claims accordingly. Additionally, the primary provider must ensure compliance with 42 C.F.R. § 413.65 standards through an attestation process.

The rule targets off-campus outpatient departments not within 250 yards of a hospital's main campus. Hospitals need to pinpoint relevant facilities subject to these new requirements. Larger hospital systems may need to evaluate their adherence to current regulatory compliance requirements due to the lack of redefined terms and regional variations in the proposed rule's distance criteria.

CMS deadlines require initial attestation submissions for off-campus units offering services as of January 1, 2028, by December 31, 2027. Departments starting service post-January 1, 2028, must file attestations within two years prior to billing services. Subsequent attestations will be mandated at least every five years.

The CMS proposal introduces a standardized attestation form alongside a centralized electronic submission platform. Critical steps also include obtaining separate NPIs for each department and updating the Provider Enrollment, Chain, and Ownership System (PECOS). Furthermore, CMS aims to standardize reviews, audits, and site visits.

The rule offers flexibility for new departments to commence billing immediately upon submitting required attestations. However, without final CMS approval, there remains a repayment risk if later found non-compliant. Hospitals must conduct thorough reviews of provider-based departments, verify on-campus versus off-campus statuses, confirm NPI and PECOS details, and ensure full compliance before the deadline.