Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65 (CMS-R-240)

Section 413.65(b)(3) states that a provider which is seeking a determination of provider-based status for a facility not located on the provider's campus must submit an attestation of compliance with applicable provider-based requirements and must supply documentation supporting its attestation at the time the attestation is made. Section 413.65(a)(1)(ii) establishes a listing of specific facilities for which determinations for provider-based status for payment purposes are not made. As CMS removed certain CAH-based facilities from this list, such facilities are allowed to apply for provider-based determination and are required to meet all provider-based requirements before billing for hospital or CAH based services.

The latest form for Prospective Payments for Hospital Outpatient Services and Supporting Regulations in 42 CFR 413.65 (CMS-R-240) expires 2022-03-31 and can be found here.