The Centers for Medicare and Medicaid Services has issued a proposed rule that would increase total payments to all end-stage renal disease facilities by about 1.9%, bringing the ESRD Prospective Payment System base rate to $281.06.
The proposed rule also includes a proposed payment adjustment for certain non-labor costs for ESRD facilities in Alaska, Hawaii and the United States Pacific Territories.
CMS also said it wants to shorten In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey to 39 questions, removing 23 questions, and eliminate three health equity reporting measures from the ESRD Quality Incentive Program (QIP).
WHAT'S THE IMPACT
Under the ESRD Prospective Payment System (PPS) for 2026, Medicare expects to pay $6.9 billion to about 7,600 ESRD facilities for furnishing renal dialysis services.
The proposed base rate of $281.06 would be an increase of $7.24 from the current base rate, which for 2025 sits at $273.82. CMS projects that the updates for 2026 would increase the total payments to all ESRD facilities by 1.9% from CY 2025.
For hospital-based ESRD facilities, CMS projects an increase in total payments of 1.5%, and for freestanding facilities, an increase in total payments of 1.9%.
The agency is also proposing to update the ESRD PPS wage index using the latest available Bureau of Labor Statistics (BLS) Occupational Employment and Wage Statistics (OEWS) data, and is proposing to continue to apply the wage-index floor of 0.6000 and a 5% cap on wage-index decreases from the prior year.
CMS is considering a new facility-level payment adjustment for ESRD facilities in Alaska, Hawaii, and the U.S. Pacific Territories. An internal analysis of costs for renal dialysis services found that ESRD facilities in certain remote noncontiguous regions have higher nonlabor costs when compared with the contiguous U.S., and the agency is proposing that they would receive an increase to the nonlabor portion of the ESRD PPS base rate accordingly, which would be capped at 25%.
ESRD facilities in Alaska and the U.S. Pacific Territories would receive the maximum increase of 25%, and ESRD facilities in Hawaii would receive an increase of 21% under the proposed rule.
Under this proposal, CMS would reduce the CY 2026 ESRD PPS base rate by approximately 0.1%, or $0.40, in a bid to maintain budget neutrality.
THE LARGER TREND
Beginning in 2027, CMS is proposing to remove the Facility Commitment to Health Equity reporting measure, Screening for Social Drivers of Health reporting measure, and Screen Positive Rate for Social Drivers of Health reporting measure, claiming the costs may outweigh the benefits to providers and patients.
If finalized, facilities that don't report their 2027 data for those three measures would not be penalized for scoring or payment purposes.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.