in effect
This is a final rule issued by the Centers for Medicare & Medicaid Services (CMS) that sets Medicare payment rates and program requirements for kidney dialysis facilities for calendar year 2026. It updates the bundled payment system dialysis facilities use to bill Medicare, adjusts a quality incentive program that ties facility payments to performance, and ends an experimental payment model that was testing ways to promote home dialysis and kidney transplants.
The base payment rate dialysis facilities receive per treatment rises from $273.82 to $281.71, a 2.1 percent increase driven by an inflation adjustment, resulting in roughly $180 million more in total Medicare payments to facilities in 2026. Dialysis facilities in Alaska, Hawaii, Guam, American Samoa, and the Northern Mariana Islands will receive a new add-on payment to account for higher non-labor costs not captured by the standard wage index. Three quality reporting measures — covering health equity commitment, social needs screening, and social needs screen-positive rates — are removed from the quality incentive program starting with payment year 2027, and the patient satisfaction survey used in the program will be shortened by 23 questions starting in payment year 2028. Starting January 1, 2028, a drug or device must have received FDA approval within the previous three years for a manufacturer to apply for a transitional add-on payment under the bundled payment system. The ESRD Treatment Choices Model, which had been running since 2021 to encourage home dialysis and transplants through payment incentives, is terminated effective December 31, 2025, because evaluations found it had no statistically significant impact on those outcomes.
Dialysis facilities — both freestanding clinics and hospital-based units — receive higher per-treatment payments and face updated quality reporting obligations, with facilities in non-contiguous U.S. territories receiving an additional geographic payment boost. Medicare beneficiaries with end-stage renal disease or acute kidney injury who receive dialysis will see a corresponding 2.2 percent increase in their coinsurance amounts, adding roughly $40 million in out-of-pocket costs collectively across all such patients in 2026. Drug and device manufacturers seeking transitional add-on payments for new products will face a tighter eligibility window tied to the date of FDA approval.