CMS Proposes Mandatory Attestations for Off-Campus Outpatient Departments

CMS proposes standardized attestations for off-campus outpatient departments under OPPS.

On July 7, 2026, the Centers for Medicare & Medicaid Services (CMS fact sheet) proposed a new rule requiring all off-campus outpatient departments to submit attestations through a standardized electronic system to qualify for payment under the Hospital Outpatient Prospective Payment System (OPPS). This rule implements Section 6225 of the Consolidated Appropriations Act of 2026, which mandates provider-based attestations to confirm billing under a separate National Provider Identifier (NPI).

Existing off-campus outpatient departments need to submit initial attestations between January 1, 2026, and December 31, 2027. Departments initiating services after January 1, 2028, must provide attestations within two years prior to beginning operations. These deadlines ensure compliance before mandatory separate NPI billing takes effect on January 1, 2028.

CMS will replace the current decentralized system—where Medicare Administrative Contractors use individual forms—with a unified, centralized electronic attestation platform. This change aims to streamline submission workflows, ease administrative burdens on health systems managing multiple outpatient locations, and reduce repetitive documentation.

To enforce compliance, CMS intends to apply a risk-based oversight framework that includes automated validation technology, targeted documentation reviews, remote audits, and on-site inspections. The agency invited public comments through August 31, 2026, particularly requesting input on whether providers with previous status determinations should submit new attestations or if simpler reaffirmations are appropriate.

CMS officials stress the rule’s role in combating suspected fraud, addressing billing inconsistencies, and increasing payment transparency. CMS Administrator Dr. Mehmet Oz said in a statement, "We are advancing our mission to protect Medicare and its beneficiaries, fight fraud, and empower patients with access to the latest innovations, all while holding providers accountable" (CMS press release). Chris Klomp, Deputy Administrator and Director of the Center for Medicare, highlighted the reforms' potential to simplify billing and promote transparent pricing.

Health law experts observe that these changes will require legal and compliance teams to revise internal procedures and closely monitor the attestation process to avoid payment denials and penalties. "Centralizing attestations introduces operational efficiencies but also demands vigilance in documentation accuracy," said Laura Jenkins, a healthcare compliance attorney with Smith & Associates (Health Law Journal).

Yes, but: While CMS seeks to reduce fraud and improve transparency, some providers warn the new attestation process may impose additional administrative burdens and raise compliance costs, especially for smaller outpatient facilities.

What's next: CMS is accepting public comments on the proposed rule until August 31, 2026, before finalizing the attestation requirements.