2026-22194·DEPARTMENT OF HEALTH AND HUMAN SERVICES

Medicare Program; CY 2027 Changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, Acute Kidney Injury (AKI) Dialysis Payment, and ESRD Quality Incentive Program

Final RuleFinal Rule

Published: Oct 30, 2026
Effective: Jan 1, 2027
Citation: 91 FR 68736
Docket: CMS-1846-F
Agencies: DEPARTMENT OF HEALTH AND HUMAN SERVICES, Centers for Medicare & Medicaid Services

Final rule.

Summary

The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued a final rule that revises the payment system for Medicare‑covered end‑stage renal disease (ESRD) services for calendar year 2027. The rule adjusts the prospective payment rates that dialysis facilities receive for treating ESRD patients, updates the separate payment rate for acute kidney injury (AKI) dialysis, and tightens the quality‑measurement requirements in the ESRD Quality Incentive Program (QIP). The changes are intended to reflect current clinical practice, control Medicare spending, and encourage higher‑quality care for people receiving dialysis. The regulation applies to all Medicare‑certified dialysis facilities, the clinicians who provide ESRD and AKI dialysis services, and the patients they serve. By modifying payment amounts and quality benchmarks, the rule influences how facilities bill Medicare, the resources they allocate for staffing and equipment, and the performance metrics they must meet to earn incentive payments. The rule was published in the Federal Register on October 30 2026 (91 FR 68736) and takes effect on January 1 2027. Because it is a final rule, the public comment period has already closed; comments on the earlier proposed rule were accepted through August 30 2026. CMS will now implement the new payment rates and QIP requirements beginning in the 2027 calendar year, and will monitor compliance and outcomes as the program rolls out.

AI-generated summary — verify against the Federal Register text.

Official abstract

This final rule updates and revises the End-Stage Renal Disease (ESRD) Prospective Payment System for calendar year 2027. This rule also includes updates to the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. In addition, this rule updates the requirements for the ESRD Quality Incentive Program.