Requiring a Separate Identification Number and an Attestation for Each Off-Campus Outpatient Department of a Provider
Section 6225 · Sec. 6225 ·
What this chapter is about
This part says an outpatient department away from a hospital campus must have its own provider number. From January 1, 2028 no payment is made without it, and without signed statements that the site follows the rules. Twenty million dollars is put behind the review process.
The document says “may not”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 6225 in the PDF
What the document says
“such department has obtained, and such items and services are billed under, a National Provider Identifier that is separate from such identifier for such provider;”
Section 6225 adds a new paragraph (23) to section 1833(t) of the Social Security Act. No payment may be made for items and services furnished on or after January 1, 2028 by an off-campus outpatient department of a provider unless the department has its own National Provider Identifier, separate from the provider's, and bills under it.
What the document actually says
“such department has obtained, and such items and services are billed under, a National Provider Identifier that is separate from such identifier for such provider;”
That sentence, in plain words
The site must get its own provider number. The bills for its care must go out under that number. The number is not the same as the parent one.
What this is about
A hospital can own clinics far from its main campus. Billing them all under one number hides where care was given. A separate number makes the site visible.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “may not”Who acts: Secretary of Health and Human ServicesHow: statuteSec. 6225 in the PDF
What the document says
“such provider has submitted to the Secretary, during the 2-year period ending on the date such items and services are so furnished, an initial provider-based status attestation that such department is compliant with the requirements described in section 413.65 of title 42, Code of Federal Regulations (or a successor regulation)”
The new paragraph also requires that the provider have submitted, within the two years ending on the date the items and services were furnished, an initial attestation that the department complies with section 413.65 of title 42 of the Code of Federal Regulations, and that it have submitted a later attestation within the timeframe the Secretary specifies. Until the Secretary sets up the new process, an attestation under the existing regulation may be used.
What the document actually says
“such provider has submitted to the Secretary, during the 2-year period ending on the date such items and services are so furnished, an initial provider-based status attestation that such department is compliant with the requirements described in section 413.65 of title 42, Code of Federal Regulations (or a successor regulation)”
That sentence, in plain words
The parent must have filed a signed statement in the past two years. The statement says the site follows the rules for a site of that kind.
What this is about
An attestation is a signed claim that something is true. A later one has to follow. That way the claim does not go stale.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Secretary of Health and Human ServicesHow: ruleSec. 6225 in the PDF
What the document says
“The Secretary shall, through notice and comment rulemaking, establish a process for each provider with an off-campus outpatient department of a provider to submit an initial and subsequent attestation”
The new paragraph requires the Secretary, through notice and comment rulemaking, to set up a process for submitting the initial and later attestations, and for the Secretary to review each one and decide whether the department complies, through site visits, remote audits or other means the Secretary finds appropriate.
What the document actually says
“The Secretary shall, through notice and comment rulemaking, establish a process for each provider with an off-campus outpatient department of a provider to submit an initial and subsequent attestation”
That sentence, in plain words
The health chief must set up a way for these statements to be filed. It must be done through a rule with public notice and comment.
What this is about
The agency must also check the statements. It may visit a site. It may audit from a distance. Or it may find another way.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Centers for Medicare & Medicaid ServicesHow: statuteSec. 6225 in the PDF
What the document says
“there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026, out of any amounts in the Treasury not otherwise appropriated, $20,000,000, to remain available until expended, for purposes of carrying out this subparagraph.”
The new paragraph appropriates $20,000,000 to the Centers for Medicare and Medicaid Services Program Management Account for fiscal year 2026, in addition to amounts otherwise available, to remain available until expended, to carry out the submission and review process.
What the document actually says
“there is appropriated to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2026, out of any amounts in the Treasury not otherwise appropriated, $20,000,000, to remain available until expended, for purposes of carrying out this subparagraph.”
That sentence, in plain words
Twenty million dollars goes to one account for 2026. It may be held until it is spent. It pays for the work of this part.
What this is about
Site visits and audits cost money. This is the largest sum in this title. Funds that stay available do not lapse at year end.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“``(i) on the campus (as defined in such section) of such provider; or
``(ii) within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section).''.”
The new paragraph defines the term as a department of a provider, as section 413.65 of title 42 of the Code of Federal Regulations defines that, which is not on the provider's campus and is not within the distance described in that definition of campus from a remote location of a hospital facility.
What the document actually says
“``(i) on the campus (as defined in such section) of such provider; or
``(ii) within the distance (described in such definition of campus) from a remote location of a hospital facility (as defined in such section).''.”
That sentence, in plain words
The site is not on the parent's campus. It is also not within the set distance of a far-off hospital site.
What this is about
A campus has a set edge under an older rule. Anything past that edge is off campus. The rules here cover only those sites.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Inspector General of the Department of Health and Human ServicesHow: statuteSec. 6225 in the PDF
What the document says
“an analysis of the process established by the Secretary of Health and Human Services to conduct the reviews and determinations described in section 1833(t)(23)(B) of the Social Security Act, as added by subsection (a) of this section; and”
Subsection (b) of section 6225 requires the Inspector General of the Department of Health and Human Services to submit to Congress, by January 1, 2030, an analysis of the review process the Secretary set up, together with recommendations based on it as the Inspector General finds appropriate.
What the document actually says
“an analysis of the process established by the Secretary of Health and Human Services to conduct the reviews and determinations described in section 1833(t)(23)(B) of the Social Security Act, as added by subsection (a) of this section; and”
That sentence, in plain words
The report must look at the way the health chief checks these statements.
What this is about
It is due by January 1, 2030. It goes to Congress. The watchdog may add what it thinks should change.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The main things the section does: bar payment from January 1, 2028 without a separate National Provider Identifier and initial and later attestations, require rulemaking to set up the submission and review process, appropriate funding for it, define off-campus outpatient department of a provider, and require an Inspector General analysis by January 1, 2030.
Nothing else in the section.
The section amends the Social Security Act and points at section 413.65 of title 42 of the Code of Federal Regulations. Neither is indexed here, so what those compliance requirements are is not recorded on this site.
