APA WF # 25-12 Clinic Services Updates (Four Walls)

The proposed policy changes are being promulgated as Permanent Rules.

The proposed policy revisions implement the mandatory “four walls” exception for Clinic Services when provided by Indian Health Service (IHS) clinics and Tribal clinics, as required by the 2024 Outpatient Prospective Payment System final rule. Off-site services furnished by an IHS or Tribal clinic, outside of the “four walls” of the clinic, had previously been covered under a temporary exemption to the 42 CFR 440.90 Clinic Services location requirements. The 2024 OPPS final rule codified this exemption.

Please view the draft regulatory text here and submit feedback via the comment box.

Pursuant to 75 O.S. §303(D), a rule impact statement will be posted here beginning December 30, 2025. Individuals may also request a copy using the comment box, and the statement will be provided on December 30, 2025.

Proposed Policy Timeline

Circulation Date: 12/15/2025

Medical Advisory Committee: 1/8/2026

Comment Due Date: 1/15/2026

Public Hearing: 1/15/2026

Board Meeting: 1/21/2026

After you submit your comment, you should be re-directed to a confirmation page. If you are not, please submit your comment through e-mail to federal.authorities@okhca.org.

Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.