Big Changes Coming to Kidney Dialysis Care in 2026—Here's What You Need to Know

Starting January 1, 2026, Medicare is implementing sweeping changes to kidney dialysis care that will affect roughly 7,600 facilities nationwide and introduce new technology-supported treatment options for chronic kidney disease (CKD) patients. The Centers for Medicare & Medicaid Services (CMS) is increasing the base payment rate for dialysis treatments while launching a groundbreaking 10-year program designed to expand access to digital health tools for kidney patients.

What's Changing with Dialysis Payments in 2026?

The most immediate change affects how Medicare pays for dialysis treatments under the End-Stage Renal Disease (ESRD) Prospective Payment System. The base rate will increase to $281.71 per treatment, with Medicare expecting to pay approximately $6 billion total to dialysis facilities. This represents a significant shift in how kidney care is funded and delivered across the United States.

The updated payment system also introduces special cost adjustments for facilities in Hawaii, Alaska, and US Pacific Territories, recognizing the unique challenges of providing dialysis care in these regions. Additionally, the rule aligns payments for acute kidney injury dialysis with the standard ESRD rate, creating more consistency in how different types of kidney treatments are reimbursed.

How Will the New ACCESS Model Transform Kidney Care?

Perhaps even more transformative is CMS's launch of the Advancing Chronic Care with Effective, Scalable Solutions (ACCESS) Model, a voluntary 10-year program beginning July 1, 2026. This initiative specifically targets chronic conditions common among Medicare beneficiaries, including chronic kidney disease, hypertension, and diabetes—conditions that often occur together and significantly impact kidney health.

The ACCESS Model represents a fundamental shift from paying for the volume of services to rewarding actual health improvements. Participating organizations can offer integrated care using various approaches:

• In-Person Care: Traditional face-to-face appointments with healthcare providers for comprehensive kidney disease management
• Virtual Technologies: Remote monitoring and telehealth consultations to track kidney function and adjust treatments
• FDA-Authorized Devices: Digital tools and software specifically approved for managing chronic kidney disease and related conditions
• Lifestyle Modification Support: Technology-assisted programs to help patients make dietary and lifestyle changes that protect kidney function

The model organizes care into four clinical tracks, with the early cardio-kidney-metabolic and cardio-kidney-metabolic tracks directly addressing the interconnected nature of heart, kidney, and metabolic health. Performance will be measured using clinical guidelines, biomarkers, and patient-reported outcomes, with CMS publishing risk-adjusted results to help patients and providers make informed decisions.

What Does This Mean for Kidney Patients?

These changes signal a broader transformation in kidney care delivery, moving away from the traditional model of waiting until kidney disease progresses to ESRD requiring dialysis. The ACCESS Model's focus on early intervention and technology-supported care could help patients maintain kidney function longer and avoid or delay the need for dialysis altogether.

For patients already on dialysis, the payment system changes aim to ensure facilities have adequate resources to provide quality care. However, one notable change is the early termination of the ESRD Treatment Choices Model on December 31, 2025. This CMS Innovation Center program, which incentivized home dialysis and transplant waitlisting, is ending because it didn't meet projected improvements in patient outcomes or cost savings.

The quality incentive programs are also being streamlined. Starting with Payment Year 2027, three health equity and social driver measures will be removed from the ESRD Quality Incentive Program. In Payment Year 2028, 23 questions will be eliminated from the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems survey, potentially reducing administrative burden on facilities while maintaining focus on core quality measures.

These comprehensive changes reflect Medicare's evolving approach to kidney care, emphasizing prevention, early intervention, and outcome-based payments rather than simply paying for services rendered. For the millions of Americans living with chronic kidney disease, these reforms could mean more personalized, technology-enhanced care designed to preserve kidney function and improve quality of life.