On June 26, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule under the end-stage renal disease (ESRD) Prospective Payment System for dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. This includes facility-level adjustments for ESRD facilities that have a low patient volume, for facilities in rural areas, and for the wage index. In addition, CMS is issuing a Request for Information (RFI) soliciting comments regarding potential changes to the Low-Volume Payment Adjustment (LVPA) methodology and the possible creation of a new payment adjustment that accounts for isolation, rurality, and other geographic factors to inform future rulemaking. Comments are due by August 25, 2023.