CMMI Extends Kidney Care Choices, But Lowers Some Payments
The Center for Medicare & Medicaid Innovation (CMM) is making some modifications to the Kidney Care Choices (KCC) alternative payment model and extending it by one year. Although the model has shown quality improvements in areas such as increased optimal end-stage renal disease (ESRD) starts, rates of homes dialysis, and preemptive and living donor transplants, the model has shown net losses of $304 million to Medicare.
KCC is a voluntary alternative payment model, and its core goal is to incentivize nephrologists, dialysis facilities and ESRD healthcare practices to focus on the total care of their patients. According to CMS, more than 430,000 Medicare fee-for-service ESRD beneficiaries spend an average of 12 hours a week receiving dialysis at a center, so the KCC model is structured to encourage participating practices to delay the onset of dialysis and instead focus on transplants.
The model builds upon the Comprehensive End Stage Renal Disease Care Model structure, in which dialysis facilities, nephrologists, and other healthcare providers form ESRD-focused accountable care organizations (ACOs) to manage care for beneficiaries with ESRD. The goal is to this by adding strong financial incentives for providers to manage the care for Medicare beneficiaries with chronic kidney disease (CKD) stages 4 and 5 and ESRD, to delay the onset of dialysis and to incentivize kidney transplantation, CMS has outlined.
Starting in performance year 2026 CMMI will adjust the financial methodology and participation options with the goal of improving model sustainability. In addition, the model is being extended by one year through 2027.
One of the changes lowers a quarterly capitation payment by 50%. Currently, participants receive a quarterly capitation payment (QCP) for chronic kidney disease (CKD) beneficiaries in lieu of evaluation & management (E&M) claims for these beneficiaries for care coordination purposes. This amount is around one-third of the monthly capitation payment for ESRD beneficiaries, which is more than double the fee-for-service (FFS) amount for E&M claims. Starting from PY 2026, participants will continue to receive the CKD QCP. However, the amount of the payment will be reduced by 50% relative to the status quo (FFS amount).
Another change involves transplants. Currently, both Kidney Care First (KCF) Practices and Kidney Care Entities (KCEs) in the model receive a total of $15,000 for each successful transplant per beneficiary in increasing installments over the course of three years. Transplants performed starting from PY 2026 will no longer receive the Kidney Transplant Bonus.
The Kidney Care First option in the model was scheduled to end at the end of performance year 2026, or December 31, 2026. CMMI has decided to terminate that option one year earlier at the end of performance year 2025, or December 31, 2025.
The CKCC [Comprehensive Kidney Care Contracting] options in the model were scheduled to end at the end of PY 2026, or December 31, 2026. CMMI is extending the CKCC options of the model, with the continuation of the updated policies from PY 2026, by one year to end at the end of PY 2027 or December 31, 2027.
In a statement, CMMI said that “these changes reflect the Innovation Center’s foundational principle of protecting the federal taxpayer, ensuring that models are on a clear path to certification and expansion, and a renewed commitment to our statutory mandate to reduce costs while testing strategies to deliver high-quality, coordinated care to patients.”
