In the first two years of the model, the Kidney Care Choices (KCC) Model has improved quality across several important outcomes, including increased Optimal ESRD Starts, rates of homes dialysis, and preemptive and living donor transplants. Despite these gains, the model resulted in statistically significant net losses of approximately $304 million to Medicare in performance year (PY) 2023.
The Centers for Medicare & Medicaid Services (CMS) is announcing a coordinated set of changes to the KCC Model starting in PY 2026 that are expected to improve the model test by adjusting the financial methodology and participation options to improve model sustainability. In addition, the model is being extended by one year for continuation of quality care to beneficiaries through 2027.
| PY 2026 Update | Description |
| Expansion of the Core-Based Statistical Area (CBSA) rules to include other U.S. Territories. | Current Policy: For participants (kidney contracting entities (KCEs)) in the Comprehensive Kidney Care Contracting (CKCC) options, the market area definition is “the geographic area in which the main practice locations of the KCE Nephrology Professionals are physically located as determined by CMS in accordance with Section 4.01.C.” The service area is defined as the KCE market area and any CBSAs that are contiguous to the CBSAs in the KCE market area in which KCE Nephrology Professionals provide Nephrology Services to beneficiaries with CKD and ESRD and any rural counties located in the same state(s) as the KCE market area in which KCE Nephrology Professionals provide Nephrology Services to beneficiaries with CKD and ESRD. In PY 2025, all CBSAs in the following states and territories were deemed contiguous to one another:
New Policy: Starting from PY 2026, other U.S. Territories will be included in the CBSA rules.
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| Addition of discount for CKD benchmark. | Current Policy: Participants in the Global risk track include a discount for only the ESRD benchmarks. New Policy: Starting from PY 2026, participants in the Global risk track will include a 1% discount for the CKD benchmarks. |
| Addition of discount for CKD and ESRD benchmarks. | Current Policy: The CKD and ESRD benchmarks for participants in the Professional risk track do not have discounts. New Policy: The CKD & ESRD benchmarks, separately, will include a 1% discount starting from PY 2026. |
| Reduction of the Chronic Kidney Disease Quarterly Capitation Payment (CKD QCP). | Current Policy: 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 1/3 of the monthly capitation payment for ESRD beneficiaries, which is more than double the fee-for-service (FFS) amount for E&M claims. New Policy: 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). |
| Eliminate the Kidney Transplant Bonus (KTB). | Current Policy: 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. New Policy: Transplants performed starting from PY 2026 will no longer receive the Kidney Transplant Bonus. |
| Terminate the Kidney Care First option early. | Current Policy: The Kidney Care First option in the model is scheduled to end at the end of performance year 2026, or December 31, 2026. New Policy: The Kidney Care First option will terminate one year earlier at the end of performance year 2025, or December 31, 2025. |
| Extension of the CKCC options in the model by one year. | Current Policy: The CKCC options in the model are scheduled to end at the end of PY 2026, or December 31, 2026. New Policy: Extend 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. |