What CMS Is Proposing for Dialysis in 2027 and Why Your Comments Matter

The Centers for Medicare & Medicaid Services (CMS) has proposed significant changes to dialysis payments and quality measures for 2027. Among them are higher payments for dialysis treatments that now include phosphate binders and home dialysis training, and several changes to the ESRD Quality Incentive Program (QIP).

Comments are due by 11:59 p.m. ET on August 24, 2026, so now is the time to make your voice heard.

CMS published the proposed rule on June 24, 2026. The announcement was also included in the August Home Dialysis Central Newsletter, which you can subscribe to on the newsletter page.

Some of the proposals are described in a CMS Fact Sheet and the 92-page proposed rule in the Federal Register.

Proposed ESRD payment changes

Higher base payment rate

CMS proposes increasing the ESRD Prospective Payment System (PPS), often called the “dialysis bundle,” to $299.55 per treatment in 2027. This payment covers dialysis services, ESRD-related drugs, and ESRD-related labs.

Payment for phosphate binders

CMS proposes adding $15.96 to the ESRD PPS base rate to cover phosphate binders, which were added to the dialysis bundle on January 1, 2025.

CMS calculated this amount using the average sales prices of six binders that were paid separately during the two-year Transitional Drug Add-On Payment Adjustment (TDAPA) period. Facilities would receive the added amount for every patient they treat, whether or not the patient takes a phosphate binder.

Important note: Ardelyx, the manufacturer of Xphozah, a newer phosphate blocker, chose not to include the drug in the TDAPA program. As a result, CMS did not consider its cost when calculating the proposed payment. Medicare patients may have access to Xphozah if their doctor prescribes it, their Medicare drug plan covers it, and they can afford it.

Low-volume facility payment adjustment

CMS proposes adjusting payments for facilities that provided a median of fewer than 8,000 treatments during the past three cost-reporting years.

Facilities providing a median of fewer than 3,000 treatments would receive the largest adjustment. Those providing a median of 7,000 to 7,900 treatments would receive the smallest adjustment.

Higher home and self-dialysis training payments

CMS has not paid separately for home dialysis training provided during a patient’s first 120 days of dialysis because facilities already received a higher payment through the new-onset patient adjustment.

Beginning in 2027, CMS proposes:

• Paying for home or self-dialysis training during the first 120 days for Medicare-eligible patients

• Increasing the payment per training session from $95.60 to $138.22 to better align the payment with training costs

Important note: Medicare coverage can be backdated to the first month of dialysis when a Medicare-eligible patient begins home or self-care dialysis training before the fourth month of dialysis.

Payments for people with acute kidney injury

CMS proposes paying the same per-treatment rate and home or self-dialysis rate for patients with acute kidney injury (AKI) as it pays for patients with ESRD.

Proposed changes to the ESRD Quality Incentive Program

If finalized, the following changes would take effect in Payment Year 2029, using Calendar Year 2027 as the performance period.

CMS proposes to:

• Replace the Hypercalcemia reporting measure with a Hyperphosphatemia reporting measure

• Remove the Medication Reconciliation reporting measure

• Remove the COVID-19 Vaccination Coverage Among Healthcare Personnel reporting measure

• Update the National Healthcare Safety Network Bloodstream Infection clinical measure using 2023 national baseline data and risk-adjust the bloodstream infection measure using facility characteristics shown to predict infections, including patient access type, hospital affiliation, and number of stations

• Remove the Reporting Measure Domain because CMS proposes eliminating all reporting measures and adjust the weights assigned to individual measures and domain measures under the Clinical Care and Care Coordination domains

CMS is also seeking comments on possibly adding the Dialysis Facility Discussion of Patient Life Goals Patient-Reported Outcome Performance Measure, known as D-PaLS PRO-PM, to the QIP.

This measure would assess how satisfied patients are with discussions about their life goals and how well their dialysis teams incorporate those goals into care planning. CMS would need to undertake future rulemaking before formally adding the measure to the QIP.

Other proposed changes

The Fact Sheet and the Federal Register also describe proposals related to:

• Wage Index Update

• Updates to the Outlier Policy

• Payment Adjustments for Pediatric Patients

• Technical changes for the TDAPA and Post-TDAPA Add-on Payment Adjustment

How to submit a comment

CMS must receive comments by 11:59 p.m. ET on August 24, 2026. Refer to file code CMS-1846-P in your comment.

More than 100 comments have already been submitted and can be viewed through the “electronically” link below. CMS allows comments to be submitted in one of three ways:

1. Electronically

Visit the CMS-2026-2245 docket on Regulations.gov. Click the “Docket Documents” tab, then click the blue “Comment” box and follow the instructions to submit your thoughts.

2. By regular mail

This is the ONLY address where you can mail comments:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1846-P
P.O. Box 8010
Baltimore, MD 21244-8010

Please allow enough time for CMS to receive your comment before the August 24, 2026, deadline.

3. By express or overnight mail

Send comments to:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-1846-P
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850

NOTE: Please choose only one submission method.

Questions about the proposed rule?

The proposed rule includes who to contact for questions:

• For questions about the ESRD Prospective Payment System (PPS) or coverage and payment for dialysis services provided to people with acute kidney injury (AKI), email ESRDPayment@cms.hhs.gov or call Abigail Ryan at 410-786-4343.

• For questions about the Transitional Drug Add-on Payment Adjustment (TDAPA) or the Transitional Add-On Payment Adjustment for New and Innovative Equipment and Supplies (TPNIES), email ESRDApplications@cms.hhs.gov.

• For questions about the ESRD Quality Incentive Program (QIP), email QNETSUPPORT-ESRD@cms.hhs.gov.

CMS describes the current and proposed QIP measures in greater detail in its ESRD QIP Calendar Year 2027 Measure Technical Specifications.

Make your voice heard

Time is short to submit a comment, and you may wonder whether anyone at CMS will read or care about what you have to say. CMS must read and catalog every comment it receives.

I know comments can make a difference. When CMS published the final ESRD Conditions for Coverage in 2008, I was surprised to see that it had addressed a comment I submitted on the proposed regulations in 2005. So make your voice heard and submit your comments today!