Federal Register #2026-12925

CMS Proposes 2027 Medicare ESRD Payment System Updates Including Drug and Training Payment Adjustments

CMS, under the Department of Health and Human Services, is proposing significant updates to the Medicare End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2027. - Government Buyer: - Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - OEMs and Vendors Mentioned: - DefenCath (CorMedix Inc.) - Vafseo (Vifor Pharma/GlaxoSmithKline) - Korsuva (Cara Therapeutics) - Multiple phosphate binder manufacturers (e.g., Sanofi, Fresenius Medical Care, Keryx Biopharmaceuticals, Shire/Takeda, Akebia Therapeutics) - Products/Services Requested: - Renal dialysis services for ESRD and acute kidney injury (AKI) patients - Incorporation of oral phosphate binders (sevelamer carbonate, sevelamer hydrochloride, sucroferric oxyhydroxide, lanthanum carbonate, ferric citrate, calcium acetate) into the ESRD PPS base rate - Proposed per-treatment payment addition: $15.96 - Home and self-dialysis training services - Proposed payment: $138.22 per training treatment - Applies to both hemodialysis and peritoneal dialysis, including onset period (first 120 days) - Payment adjustments for new renal dialysis drugs and biologicals (TDAPA and post-TDAPA), specifically referencing DefenCath, Vafseo, and Korsuva - Unique or Notable Requirements: - Permanent pediatric ESRD payment adjustments replacing the transitional add-on - Expansion of low-volume payment adjustment (LVPA) - Updates to the ESRD Quality Incentive Program (QIP), including new and removed clinical measures - Request for public comment on home dialysis uptake, palliative dialysis care, and alternative dialysis schedules

Description

This proposed rule updates the End-Stage Renal Disease (ESRD) Prospective Payment System for calendar year 2027, including revisions to payment rates for renal dialysis services and updates to the ESRD Quality Incentive Program requirements. It also proposes changes to the payment rate for renal dialysis services provided to individuals with acute kidney injury (AKI). The rule includes modifications to case mix adjusters, payment adjustments, and quality measures, with comments due by August 24, 2026.

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