# Medicare updates for End-Stage Renal Disease to Take Effect Despite Congressional Review Concerns
A new rule updating Medicare payments for kidney dialysis and related services is set to go into effect on January 1, 2026, despite concerns raised regarding compliance with Congressional Review Act (CRA) procedures.
The Centers for Medicare & Medicaid Services (CMS) finalized changes to the End-Stage Renal Disease (ESRD) Prospective Payment System, impacting payments for dialysis services provided to individuals with acute kidney injury, the ESRD Quality Incentive Program, and the ESRD Treatment Choices Model. The rule, published in the Federal Register on November 24, 2025 (90 Fed. Reg. 53068), is estimated to involve approximately $140 million in federal transfers to ESRD providers, alongside $40 million in increased beneficiary coinsurance payments, for 2026.
According to CMS, the updates for calendar year 2026 revise the payment rates for renal dialysis and modify requirements for existing programs. Specifically, the agency anticipates $21.6 million in transfers to providers through the ESRD Quality Incentive Program (QIP) in payment year 2027, with an estimated $15.5 million in burden reductions.Further projections indicate $20.6 million in QIP transfers and $0.7 million in burden reductions for payment year 2028. The ESRD Treatment Choices Model is also expected to generate $1 million in annual transfers for 2026 and 2027.
Though, a report issued on December 9, 2025, raises questions about the rule’s adherence to the CRA. The CRA mandates a 60-day delay in the effective date of major rules, triggered by publication in the Federal Register or congressional receipt, whichever is later. While CMS argues for a waiver of this delay due to a prior government funding lapse, the report indicates the stated effective date of January 1, 2026, falls within 60 days of congressional receipt. The House of Representatives received the rule on November 21, 2025, and the Senate on December 2, 2025.
“CMS’s good cause finding relates to waiving the delay in effective date, not to waiving the notice and public procedure requirements,” the report states, suggesting the agency’s justification may not fully satisfy the CRA’s requirements. the report details CMS’s compliance with procedural steps outlined in section 801(a)(1)(B)(i) through (iv) of title 5,United States Code.
The rule also addresses other regulatory considerations. CMS steadfast the rule has significant economic impact on small entities, triggering a Regulatory Versatility Analysis. It also confirmed the rule does not impose mandates on state, local, or tribal governments. Furthermore, the agency acknowledged information collection requirements under the Paperwork Reduction Act and affirmed the rule’s authorization under sections 1302, 1395d, 1395f, and 1395g of title 42, United States Code. The office of Information and Regulatory Affairs reviewed the rule.
Why this matters: The updated Medicare payments aim to improve the quality and efficiency of kidney dialysis services. Who is affected: Approximately 750,000 Americans with ESRD and the dialysis providers who serve them.what changed: CMS finalized updates to payment rates and program requirements for ESRD treatment. How did it end?: Despite concerns about CRA compliance, the rule is scheduled to take effect on January 1,
