CY 2027 ESRD Payment, AKI Dialysis and Quality Incentive Proposed Rule: What to Check

On June 26, 2026, the Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services, published a proposed rule in the Federal Register as document 2026-12925 ^[1]. The rule is framed around calendar year (CY) 2027 and addresses three areas: the End-Stage Renal Disease (ESRD) Prospective Payment System, payment for dialysis furnished to people with acute kidney injury (AKI), and the ESRD Quality Incentive Program ^[1]. This brief reports what the published summary states and marks what it leaves out, because that summary is the only account of the rule's content used here ^[1].

What the proposed rule would do

The summary describes three proposals ^[1].

• ESRD Prospective Payment System (PPS). CMS would both update and revise the ESRD PPS for CY 2027 ^[1].
• AKI dialysis payment. CMS proposes to update the payment rate that applies when an ESRD facility provides renal dialysis services to a person with AKI ^[1].
• ESRD Quality Incentive Program (QIP). CMS proposes updated requirements for the ESRD QIP ^[1].

The summary does not define ESRD or AKI, and it does not describe how the PPS or the QIP is structured, so this brief does not add those details ^[1]. It also gives no payment amounts, percentage updates or quality measure lists ^[1].

The Federal Register classifies the document as a proposed rule rather than a final rule ^[1].

Who it affects

• ESRD facilities that furnish renal dialysis to people with AKI. The summary names ESRD facilities in connection with the AKI payment rate ^[1].
• People with AKI. They receive the renal dialysis services whose payment rate CMS proposes to update ^[1].
• Those covered by the ESRD PPS and the ESRD QIP. The summary says both would be updated but does not state which providers or entities each provision applies to, so the full text is needed to confirm scope ^[1].
• The Medicare program. The rule is published under the heading "Medicare Program" ^[1].

Dates that matter

• Publication: June 26, 2026, in the Federal Register ^[1].
• Period covered: the rule's title applies CY 2027 to all three areas, and the summary ties CY 2027 explicitly to the PPS update ^[1].
• Comment deadline: not stated in the summary; the Federal Register document page is where the full notice can be checked ^[1].
• Final rule: the source used here is the proposed rule, and it does not show whether a final rule has since been issued ^[1].

What a practice should check

1. Whether a final rule has replaced the proposal. The source used here is the proposed rule published on June 26, 2026, and it does not indicate a final version ^[1].
2. The CY 2027 PPS provisions. The summary says the rule would both update and revise the PPS but does not list the changes, so the full text is where they are set out ^[1].
3. The AKI dialysis payment rate. For a facility that provides renal dialysis services to people with AKI, this is the provision the summary links to ESRD facilities ^[1].
4. The QIP requirements. The summary states that the requirements would be updated without listing them, so the full text is the reference for which requirements change ^[1].
5. The scope of each provision. Because the summary names ESRD facilities only for the AKI provision, the full text is needed to confirm who the PPS and QIP provisions apply to ^[1].

Limitations

This brief is based on the Federal Register summary of document 2026-12925, not on the full regulatory text ^[1]. The summary gives no payment amounts, percentage updates, QIP measure lists, impact estimates or comment deadline, so this brief reports none ^[1]. The summary also does not define its technical terms or describe the existing payment and quality programs, so background on those programs is outside this brief ^[1].