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CMS has asked the Office of Management and Budget for expedited approval to revise information collection rules for Medicare’s home health Review Choice Demonstration, a procedural step toward expanding it to California. The notice cites concerns about fraud but does not set a start date; it provides for a 14-day public comment period after Federal Register publication.
The Centers for Medicare & Medicaid Services has asked for expedited approval to revise information collection requirements for its Medicare home health Review Choice Demonstration, a step toward expanding the program to California. The notice cites fraud concerns in the state, but it does not give a date for when California home health agencies might begin participating.
CMS filed the request with the Office of Management and Budget on Friday. The notice is scheduled to appear in the Federal Register on November 2, though its text is already available on the Federal Register website. The request concerns revisions to the demonstration’s information collection requirements; it is not itself a notice that California participation has begun.
CMS says expedited handling is needed to prevent public harm. In the notice, the agency links delay to continued fraud in California’s traditional Medicare home health benefit and to possible losses for taxpayers and the Medicare Trust Funds. It also says improper payments can cover care that is not delivered or care it considers not medically necessary. These are CMS’s stated concerns; the notice does not provide a new estimate of the amount of fraud or losses.
The program currently operates in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. It uses more rigorous claims review procedures intended to address improper billing. CMS has not specified when California agencies would be required or able to participate. The notice provides for a 14-day public comment period after publication in the Federal Register.
What California Agencies May Face
An expansion would bring California home health providers into a process that subjects claims to additional review, with implications for documentation, billing workflows and payment timing. Providers may need to plan for review requirements even though CMS has not announced an implementation schedule or detailed state-specific operating arrangements.
The demonstration may also affect how agencies manage claim risk. Supporters have said that pre-claim review can give agencies an opportunity to resolve documentation issues before submitting final claims, potentially reducing the prospect of denials later. That is a supporters’ rationale, not a guarantee of payment or a measured outcome established by this notice.
For Medicare beneficiaries and the public, the policy question is whether added review can limit improper payments while allowing appropriate care to be paid for without unnecessary delay. The notice frames expansion as a response to fraud concerns, while the practical effects on agencies, beneficiaries and claim processing remain to be seen.
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How the Review Demonstration Works
The Review Choice Demonstration is a CMS initiative that applies more intensive review procedures to Medicare home health claims. Under current CMS guidance, agencies that reach a 90% target full provisional affirmation rate, based on at least 10 requests or claims during a six-month review period, become eligible for additional review choices. These can include relief from most reviews, aside from spot checks.
One available option is pre-claim review, which allows a provider to submit documentation for review before filing a final claim. AccentCare’s vice president of public affairs, Stacey Smith, told Home Health Care News in 2025 that the company supported expanding the demonstration to California and nationwide. Her comments reflect one provider’s position, not a decision by CMS or a consensus among agencies.
California has repeatedly been identified as a location of concern for home health and Medicare fraud. CMS’s latest notice applies that concern to its case for expedited action. The immediate development, however, is an OMB approval request and upcoming comment period, rather than a confirmed launch or a final rule setting participation requirements.
“A delay in the expansion means an extended time the public will be harmed through the continuation of significant fraud found in the traditional Medicare home health benefit in California.”
— CMS, in the notice requesting expedited approval
California Start Date Remains Open
The notice does not say when participation would start, which agencies would be covered first, or what transition arrangements CMS might use. It also does not establish that OMB has approved the requested changes or that CMS has finalized the expansion.
The public comment period is scheduled to last 14 days after Federal Register publication. The notice’s claims about fraud and potential harm are CMS’s stated assessment; the supplied material does not provide detailed supporting figures, a breakdown of affected claims, or an independent evaluation of the program’s effect in the six existing states. Those details may shape how providers and other commenters respond.
Comments Before Any Launch
The next scheduled milestone is publication of the notice in the Federal Register on November 2, followed by the stated 14-day window for public comments. Providers, beneficiaries and other interested parties can use that period to address the proposed information collection revisions and the contemplated California expansion.
After the comment period, CMS and OMB would need to address the request through the applicable review process. CMS has not announced a final decision, an implementation timetable or further operational details for California. Until it does, agencies should treat the expansion as under consideration, rather than as an active California requirement.
Key Questions
Has CMS officially started the demonstration in California?
No. CMS has requested expedited OMB approval for revisions that would be a step toward expansion. The notice does not announce that California participation has started.
When could California agencies begin participating?
The notice does not specify a start date. CMS has also not provided an implementation timetable in the source material.
What does the Review Choice Demonstration do?
It applies more rigorous review procedures to Medicare home health claims. Under current guidance, agencies meeting a 90% target full provisional affirmation rate, with at least 10 requests or claims during a six-month review period, can become eligible for additional review choices.
Can the public comment on the proposal?
The notice provides for a 14-day public comment period after its scheduled Federal Register publication on November 2, 2026.
Why does CMS say it wants to expand the program?
CMS cites concerns about fraud in California’s traditional Medicare home health benefit and potential harm to public funds and beneficiaries. Those points are the agency’s stated rationale; the notice, as described in the source material, does not provide a new quantified estimate.
Source: homehealthcarenews.com
