On April 6, 2011, CMS published an interim final rule with comment period eliminating a -3.1% “transition budget-neutrality adjustment” for Medicare end-stage renal disease (ESRD) facilities, effective April 1, 2011 through December 31, 2011. By way of background, on August 12, 2010, CMS published a final rule implementing a prospective payment system (PPS) for Medicare ESRD services effective January 1, 2011. CMS provided a four-year phase in-period, although CMS gave facilities the option to elect to be paid entirely under the new system beginning January 1, 2011. CMS adopted a -3.1% “transition budget neutrality adjustment factor” to all payments during the phase-in, since it expected facilities to base their election decision on which option was more financially advantageous. Based on a review of actual elections submitted by ESRD facilities, CMS determined that this is not the case. Instead of 43% of facilities electing to receive payment entirely under the ESRD PPS as it projected, 87% of ESRD facilities opted out of the transition and received full payment under the ESRD PPS. CMS therefore is eliminating the 3.1% payment cut to mitigate potential problems in patient access to renal dialysis services that could result from the reduced payment, applicable to renal dialysis services furnished April 1, 2011 through December 31, 2011. CMS will accept comments on the rule until June 6, 2011.