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CMS has asked the Office of Management and Budget for expedited approval to revise requirements for its Medicare home health Review Choice Demonstration, a step toward adding California. The notice cites concerns about fraud but does not give a start date; it provides for a 14-day public comment period after Federal Register publication.
The Centers for Medicare & Medicaid Services has asked the Office of Management and Budget for expedited approval to revise requirements for its Medicare home health Review Choice Demonstration, a step toward expanding the program to California. CMS cites concerns about fraud in the state, but the notice does not specify when California home health agencies would begin participating.
CMS filed the notice on Friday, requesting expedited approval to revise the demonstration’s information collection requirements. The notice is scheduled to appear in the Federal Register on Nov. 2; its text was available on the Federal Register website before publication, according to Home Health Care News. The request is a procedural step toward expansion, not confirmation that California participation has begun.
The notice says CMS considers emergency action necessary to prevent public harm. It links that concern to alleged significant fraud in California’s traditional Medicare home health benefit and describes potential costs including taxpayer and Medicare Trust Fund losses, payment for care that was not delivered, and beneficiaries receiving care that was not medically necessary. These are CMS’s stated concerns; the notice does not provide a specific fraud estimate in the supplied report.
The demonstration is already operating in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. It uses more rigorous claims review procedures intended to address improper billing. The proposed California expansion would bring the state into a program that gives participating agencies review options tied to their claims and review outcomes.
How California Agencies Could Be Affected
For California home health providers, expansion could mean additional review of claims and a change in how agencies document care and seek payment under traditional Medicare. The review process can affect when claims are assessed and how providers address documentation gaps, although the notice does not lay out a California launch schedule or state-specific implementation details.
The program also has potential implications for beneficiaries and public spending. CMS argues that closer review could help limit payments for improper or undelivered care and preserve funds for medically needed services. That rationale is the agency’s position; the source material does not report a quantified estimate of the expected savings or describe evidence measuring the demonstration’s effects in the states already participating.
Supporters have also described a possible benefit for providers: a pre-claim review can let an agency address documentation concerns before it submits a final claim. That could offer greater payment predictability and reduce the risk of a later denial, but it does not guarantee approval or payment. The overall effect in California will depend on the final requirements, implementation schedule and how the review options work in practice.
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How the Review Demonstration Works
RCD is a Medicare home health claims review program that offers agencies several review choices. Under current CMS guidance, an agency that reaches a 90% target full provisional affirmation rate, based on at least 10 requests or claims during a six-month review period, becomes eligible for additional options. These include relief from most reviews, with spot checks remaining.
The program’s pre-claim review option allows agencies to request review before submitting a final claim. Supporters say that can give providers an opportunity to resolve documentation issues earlier rather than learning months later that a claim has been denied. The source report describes this as a claimed advantage, not a guarantee of payment or a finding that the process will produce the same results for all providers.
Some providers have previously supported extending the program to California and nationally. In 2025, Stacey Smith, AccentCare’s vice president of public affairs, told Home Health Care News that the company supported expansion to California and across the country. California has also been repeatedly identified as a hotspot for home health and Medicare fraud, according to the report, but the current notice’s cited concerns should be distinguished from any adjudicated finding against an individual provider.
“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 notice, as quoted by Home Health Care News
Launch Timing and Final Rules
The notice does not say when California agencies would start participating, which providers would be included first, or what operational steps CMS would use to begin the expansion. The request for expedited approval concerns revised information collection requirements; it does not itself establish a start date or confirm that the expansion is complete.
It is also not yet clear what changes, if any, OMB may require before approving the revised collection, or how CMS will respond to comments. The supplied report does not provide a specific dollar estimate for the fraud alleged in the notice, nor does it quantify potential savings or establish the effects the California rollout would have on providers and beneficiaries.
Federal Review and Public Comments
The notice is scheduled for Federal Register publication on Nov. 2, 2026, after which it provides for a 14-day public comment period. Providers, beneficiaries and other interested parties will have an opportunity to submit feedback on the proposed information collection changes. The source material does not state the deadline date separately; it depends on the notice’s publication and the applicable comment-period calculation.
OMB’s consideration of CMS’s expedited request is the next procedural step described in the report. CMS would still need to communicate how and when California agencies would enter the demonstration. Until those details are released, the expansion remains a proposed next step rather than an operational change for California providers.
Key Questions
Has CMS started the demonstration in California?
No. CMS has requested expedited approval for a change that is a step toward expansion. The notice does not give a California start date.
What is the Review Choice Demonstration?
RCD is a Medicare home health claims review program using more rigorous review procedures intended to address improper billing. Agencies can become eligible for additional review choices if they meet CMS’s stated performance target.
Which states currently participate?
The source report lists Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas as states where the demonstration is currently in place.
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 taxpayers, Medicare funds and beneficiaries. Those points are the agency’s stated rationale; the supplied report does not give a specific fraud estimate.
When can the public comment?
The notice is scheduled for publication on Nov. 2, 2026 and provides for a 14-day comment period after publication. The report does not provide a separate calendar deadline.
Source: homehealthcarenews.com
