On June 20, the Centers for Medicare & Medicaid Services sent a proposed rule entitled, “Changes to the End-Stage Renal Disease Prospective Payment System for CY 2014 ” to the Office of Management and Budget (OMB) for final approval, according to the executive order that governs the review process for regulations, the National Renal Administrators Association reported in its June 21 "Renal Watch." This is the final stage of the approval process before CMS publishes the regulation to the public for comment.  It's not clear how long it will take OMB to analyze the rule, but many in the renal community are anticipating the rule in the next month.