In a one-paragraph statement released after 5 pm EST today, the Centers for Medicare and Medicaid Services said it would extend the deadlines for both letters of intent and the completed application for participation in the Comprehensive ESRD Care Initiative to August 30. The deadline for the letter of intent was Friday, July 19, and the application was due Thursday, Aug. 1.

This is the third time CMS has extended the deadline, but this time it is combining the letters of intent deadline with the application. CMS said in their statement that the extension is being granted "due to continued stakeholder input and feedback, including requests for changes to the Request for Applications (RFA)."

CMS has already agreed to make some changes to the requirements for providers to participate in the demonstration since first announcing the project on February 5, including reducing the minimum number of patients needed per application from 500 to 350. That change was requested by smaller provider organizations.

Each applicant must form an ESRD Seamless Care Organization that includes a dialysis provider, a physician practice group, and a third party, such as a hospital or supplier.

For questions, email the Comprehensive ESRD Care initiative resource box at For more information about the demonstration, visit the CMS Innovation Center website at

The Extended Tour: A timeline for the Renal ACO Demonstration application process

February 5: CMS releases the details of the Comprehensive ESRD Care initiative to the renal community. Deadline for non-binding letters of intent is set for March 15; the completed, 45-page application is due May 1.

February 26: CMS organizes an open door forum for questions dealing with the application process

March 13: The agency decides to extend the March 15 deadline for letters of intent to May 15, and the application deadline from May 1 to July 1.

May 3: CMS relents to requests from small- and medium-sized dialysis organizations and drops the minimum number of patients required in the demonstration from 500 to 350.

June 20:  CMS agrees to a second extension, this time setting a deadline for letters of intent to July 19, and full applications by August 1.

July 18: CMS announces a third extension, combining the letters of intent deadline with the application deadline, to August 30