What is an ESRD Network?
An ESRD Network is defined in the Code of Federal Regulations (CFR), at 42 CFR Part 405, Subpart U as all Medicare-approved ESRD facilities within a designated geographic area specified by CMS. These regulations require ESRD treatment facilities to be organized into Networks to promote effective coordination of care. Through this organized structure, dialysis and transplant providers can coordinate patient referrals and resource allocation more efficiently.
What is the ESRD Network Program?
On June 13, 1978, Congress enacted modifications to the Medicare ESRD Program (PL 95-292) to improve cost-effectiveness, ensure quality of care, encourage kidney transplantation and home dialysis, and assist patients in returning to work. This legislation amended Title XVIII of the Social Security Act by adding Section 1881, which designated ESRD Network areas and established statutory requirements for the Network Organization Program, consistent with criteria determined by the Secretary of the Department of Health and Human Services.
ESRD Network Organizations serve as the administrative governing body for each Network and act as liaisons to the Federal government. To achieve coordinated delivery of ESRD services, representatives from hospitals and health facilities serving dialysis and transplant patients are connected with patients, physicians, nurses, social workers, dietitians, and technicians through Network Councils. Currently, 18 Network Organizations operate across the United States and its territories.
Why does CMS have an ESRD Network Program?
CMS relies on Network Organizations to develop relationships with dialysis professionals, providers, and patients while creating a collaborative environment to improve patient care. A primary function of Network Organizations is to assist CMS in understanding the needs of ESRD patients by including them in quality improvement activities and meetings with CMS. CMS directs Network Organizations through contractual agreements and conducts annual evaluations of quality improvement activities and organizational goals.
Title XVIII Section 1881 of the Social Security Act requires each Network Organization to be responsible for:
- Encouraging, consistent with sound medical practice, the use of treatment settings most compatible with successful patient rehabilitation and promoting patient, provider, and facility participation in vocational rehabilitation programs
- Developing criteria and standards relating to quality and appropriateness of patient care, and establishing Network goals regarding patient placement in self-care settings and transplantation preparation
- Evaluating procedures by which facilities and providers assess the appropriateness of patients for proposed treatment modalities
- Implementing procedures for evaluating and resolving patient grievances
- Conducting on-site reviews of facilities and providers as necessary, utilizing established standards of care to ensure proper medical care
- Collecting, validating, and analyzing data necessary for reporting and maintaining the patient registry
- Identifying facilities and providers not cooperating toward meeting Network goals and assisting them in developing appropriate corrective action plans
2026-2031 Activities for ESRD Network Organizations
Our Empowering Patient and Family Choice focus expands access to patient-centered kidney care by promoting home-based dialysis options and transplantation pathways. The strategy emphasizes empowering patients through comprehensive education about treatment modalities and settings, enabling them to make informed decisions about their care. Key efforts include streamlining the transplant referral process and improving pre-transplant preparation to enhance waitlist efficiency. Additionally, the program aims to increase acceptance of kidney offers across a broader range of quality indicators, ensuring more patients receive life-saving transplants while optimizing organ utilization.
We support our patients by Promoting Decision Making and Care Coordination, improving their access to care, and helping them avoid unnecessary emergency room visits and hospital stays. The network focuses on better care coordination and decision-making support to keep patients healthier and out of the hospital. By working closely with patients and their care teams, the program aims to reduce the need for emergency care through better planning and management of their kidney disease. The goal is to help patients get the right care at the right time in the right place, preventing health crises before they happen.
Our Whole Health focus takes a comprehensive approach to caring for kidney disease patients by addressing their physical health, mental health, nutrition, and ability to work. The initiative ensures that patients are screened for depression and receive proper follow-up care when needed, recognizing that mental wellness is just as important as physical health. The program also focuses on protecting patients from preventable illnesses through vaccination efforts for pneumonia and flu. By supporting patients across all these areas —from their emotional well-being to their nutritional needs and work goals —the program helps them live fuller, healthier lives beyond just managing their kidney disease.
And finally, we focus on Enhancing Interoperability by improving patient access to their data, increasing the efficiency of clinical workflows using Electronic Health Records (EHR), and enabling the use of real-time data. Modernizing kidney care through better technology and data-sharing systems will give patients easier access to their own health information while helping dialysis facilities use electronic health records more effectively in their daily work. By promoting advanced digital tools and real-time data capabilities, the program aims to streamline communication between healthcare providers and improve care coordination. These efforts support our system of record, End Stage Renal Disease Quality Reporting System (EQRS), and the Quality Incentive Program (QIP), ensuring accurate quality reporting and data-driven improvements in patient care. The goal is to create a more connected healthcare system where patient information flows seamlessly between dialysis centers, doctors, and patients themselves, making care safer and more efficient.
ESRD Network Organization Reports to the Health and Human Services Secretary
The Network Organizations are required to submit an annual report to the Secretary on July 1st of each year which will include a full statement of the Network’s goals, data on the Network’s performance in meeting its goals, identification of those facilities that have consistently failed to cooperate with Network goals, and recommendations with respect to the need for additional or alternative services or facilities in the Network in order to meet the Network goals, including self-dialysis training, transplantation, and organ procurement facilities.