The Centers for Medicare & Medicaid Services (CMS) has issued a final rule to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for services provided to Medicare beneficiaries starting January 1, 2026. This rule also revises the acute kidney injury (AKI) dialysis payment rate and updates requirements for the ESRD Quality Incentive Program (QIP).
For 2026, CMS will increase the ESRD PPS base rate to $281.71, expecting a total payment rise of approximately 2.2% for all ESRD facilities. The new rule introduces a payment adjustment for non-labor costs in Alaska, Hawaii, and U.S. Pacific Territories.
The In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems survey will be shortened to 39 questions by removing 23 questions. Additionally, three health equity reporting measures will be eliminated from the ESRD QIP.
Medicare expects to pay $6 billion to around 7,600 ESRD facilities in 2026. The updated base rate reflects adjustments including a wage index budget-neutrality factor and other economic factors.
Routine updates are being made to the wage index used for geographic payment adjustments. For pediatric beneficiaries, fixed dollar loss amounts will decrease significantly from previous years.
A new facility-level payment adjustment is being finalized for certain remote areas due to higher non-labor costs compared to contiguous U.S. regions. This adjustment could result in up to a 25% increase in payments for facilities in these areas.
CMS is updating the AKI dialysis payment rate as required by law, aligning it with the new ESRD PPS base rate of $281.71.
Changes are also being made to the ESRD QIP, including removing certain measures that were deemed costly without significant benefits. Facilities will not need to report data on these measures for Payment Year 2027.
CMS is reducing the ICH CAHPS clinical measure survey length beginning with PY 2028 due to concerns about patient burden and response rates.
Public comments were requested on health IT use and future measure concepts related to interoperability and well-being among others.
Finally, CMS plans to terminate the ESRD Treatment Choices Model by December 31, 2025, due to unsatisfactory results in home dialysis quality and transplant waitlisting improvements.
The full details of this final rule can be accessed through the Federal Register at https://www.federalregister.gov/d/2025-20681.
Information from this article can be found here.
