WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services has proposed increasing payments to dialysis providers by about 1.1% in 2027 and overhauling several quality measures, changes that would affect approximately $6.2 billion in annual Medicare spending on care for patients with end-stage renal disease.
Under the proposed rule, CMS would raise the End-Stage Renal Disease Prospective Payment System base rate to $299.55 per treatment, up from $281.71 in 2026.
The increase includes a $15.96 adjustment reflecting the incorporation of phosphate binders into the bundled dialysis payment system. CMS projects the changes would increase total payments to hospital-based dialysis facilities by 2% and to freestanding facilities by 1.1%.
Medicare expects to pay approximately 7,600 dialysis facilities for providing renal dialysis services in 2027.
The proposal also includes changes to payments for low-volume facilities, pediatric dialysis patients and home dialysis training programs.
CMS is proposing to increase the threshold for the Low-Volume Payment Adjustment from 4,000 to 8,000 annual treatments and expand the number of payment tiers from two to six. The agency stated that the change would better align payments with costs because smaller facilities generally incur higher expenses.
The proposal would reduce the ESRD base rate by about 1.1%, or approximately $3 per treatment, on a budget-neutral basis.
CMS also proposed increasing the payment for home and self-dialysis training to $138.22 from $95.60 and extending the add-on payment to the first four months of dialysis treatment, when the adjustment is not currently available.
For pediatric patients, the agency proposed updating case-mix adjusters and extending low-volume payment adjustments to facilities that treat children with end-stage renal disease.
The rule would also update payments for acute kidney injury dialysis services, raising the payment rate to $299.55, matching the proposed ESRD base rate.
On quality reporting, CMS proposed replacing the Hypercalcemia reporting measure with a new clinical measure focused on chronic hyperphosphatemia beginning in payment year 2029.
The agency argued that the proposed measure would better assess patient outcomes and could encourage interventions aimed at reducing cardiovascular complications, hospitalizations and mortality.
CMS also proposed eliminating the Medication Reconciliation and COVID-19 Vaccination Coverage Among Healthcare Personnel reporting measures, concluding that their costs or diminished clinical relevance outweigh their value in the quality program.
In addition, the agency proposed updating benchmarks and risk adjustment methods for its bloodstream infection measure and restructuring how quality domains and measure weights are calculated.
CMS is seeking public comment on potentially adding the Dialysis Facility Discussion of Patient Life Goals Patient-Reported Outcome Performance Measure, which would evaluate whether dialysis providers discuss patient goals and incorporate them into treatment planning.
The proposed rule is scheduled to take effect Jan. 1, 2027, if finalized. The full proposal is available through the Federal Register at https://www.federalregister.gov/d/2026-12925.
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