CMS Finalizes Rule Raising Dialysis Payments by $240 Million

fact_check Facts

1. The Centers for Medicare & Medicaid Services finalized a rule updating the End-Stage Renal Disease Prospective Payment System, acute kidney injury dialysis payment, and the ESRD Quality Incentive Program.

2. The calendar year 2027 end-stage renal disease prospective payment system base rate is set at $297.52.

3. The calendar year 2026 end-stage renal disease prospective payment system base rate was $281.71.

4. Beneficiary coinsurance payments are estimated to increase by approximately $50 million in calendar year 2027.

5. Medicare payments for renal dialysis services furnished to individuals with acute kidney injury will increase by approximately $5 million.

6. The home and self-dialysis training add-on payment adjustment increases to $138.00 from $95.60.

7. The pediatric outlier fixed dollar loss amount increases from $162.43 to $229.49.

8. The adult outlier fixed dollar loss amount increases from $14.80 to $90.60.

9. The economic impact of the performance year 2029 end-stage renal disease quality incentive program is estimated at approximately $133.2 million.

10. The performance year 2029 end-stage renal disease quality incentive program includes an estimated $114.5 million in information collection costs.

11. The regulations are effective on January 1, 2027.

12. The rule incorporates phosphate binders into the end-stage renal disease prospective payment system base rate.

13. The rule makes budget neutral changes to the low-volume payment adjustment, case mix adjusters for pediatric end-stage renal disease patients, and the home and self-dialysis add-on payment adjustment.

14. The rule updates the payment rate for renal dialysis services furnished by an end-stage renal disease facility to individuals with acute kidney injury.

15. The rule updates the requirements for the end-stage renal disease quality incentive program.