TL;DR
Get workout gear delivered free with Prime
- Fast, free delivery on millions of items
- Prime Video, Amazon Music and more included
- Member-only deals all year
CMS has asked the Office of Management and Budget for expedited approval to revise information-collection requirements for the Medicare home health Review Choice Demonstration, paving the way for an expansion to California. The agency cites fraud concerns, but has not announced when California providers would begin participating.
The Centers for Medicare & Medicaid Services has asked for expedited approval to revise requirements for its Medicare home health Review Choice Demonstration, a step toward expanding the program to California. CMS says urgency is warranted because of fraud concerns, but the notice does not set a start date for California providers.
CMS filed the request with the Office of Management and Budget on Friday. The request seeks approval to revise the demonstration’s information-collection requirements. The notice is scheduled to appear in the Federal Register on Nov. 2; its unpublished text was available on the Federal Register website, according to Home Health Care News.
The notice asks for a 14-day public comment period after publication. CMS describes emergency processing as necessary to prevent public harm, citing alleged significant fraud in California’s traditional Medicare home health benefit. Its stated concerns include taxpayer spending on care that is never delivered, losses to Medicare trust funds, and beneficiaries receiving care CMS characterizes as not medically necessary. Those points are the agency’s rationale for the request, not findings detailed in the report.
The demonstration is already operating in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. It applies more rigorous claims review procedures intended to address improper billing. The California notice is a procedural move toward adding the state; it does not, by itself, establish when participation would begin or describe a complete implementation schedule.
How California Providers Could Be Affected
An expansion could change how California home health agencies document and submit Medicare claims, with implications for payment timing, administrative workload and scrutiny of billing. More review before payment may help CMS examine claims it considers at risk, while providers may need to prepare records and respond to additional review requirements.
There may also be a potential benefit for agencies that use the program’s pre-claim review option. Supporters have said that addressing documentation issues before a final claim is submitted can offer greater payment certainty and reduce the risk of denials issued months later. That is an argument made by supporters; the source material does not provide outcome data establishing how the program has affected denials, costs or fraud.
The practical effect will depend on the final requirements, the review options available in California and how CMS applies them. For agencies and people who rely on Medicare-funded home health care, the central issue is how the added review process balances program integrity with timely access to covered services.
Products Worth Considering
Fitbit Sense 2 Advanced Health and Fitness Smartwatch, Blue Mist/Pale Gold
Withings Body Smart Wi-Fi and Bluetooth Body Composition Scale
Hyperice Normatec Elite Wireless Compression Recovery Boots, Standard Size
As an affiliate, we earn on qualifying purchases.
How the Review Choice Program Works
The Review Choice Demonstration, or RCD, uses claims review procedures intended to identify improper billing in Medicare home health. Under current CMS guidance described in the report, agencies that reach a 90% target full provisional affirmation rate may qualify for additional review choices. The agency must have at least 10 requests or claims during a six-month review period for that threshold to apply.
Those choices can include relief from most reviews, subject to spot checks. The program’s review pathway also includes pre-claim review, which lets agencies seek review of documentation before submitting final claims. CMS’s latest filing concerns the information-collection requirements needed for the demonstration; the report presents it as a step toward expansion, rather than confirmation that California participation has begun.
Some providers have previously supported bringing RCD to California and beyond. In 2025, Stacey Smith, AccentCare’s vice president of public affairs, told Home Health Care News that the company supported expansion to the state and nationwide. The report also says California has repeatedly been identified as a focus of home health and Medicare fraud concerns, though the notice does not provide case counts or a comparison with other states.
“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 quoted by Home Health Care News
California Start Date Remains Unset
The notice does not say when California agencies would begin participating, what specific implementation dates CMS is considering, or whether the agency will revise the proposal after comments. The request is a step toward expansion, not an announcement that the review process is already active in California.
The source report does not give detailed evidence behind CMS’s fraud assertions, quantify the alleged losses, or explain how the agency selected the affected claims and providers. It also does not describe what operational changes California agencies would need to make or how any expansion might affect claim processing times. Those details may become clearer through the final notice or subsequent CMS guidance.
Comment Period and CMS Guidance
The notice is scheduled for Federal Register publication on Nov. 2, 2026, followed by a 14-day period for public comments. CMS will then need to address the request and the next steps for any California expansion. The source report does not identify a decision date or a timetable for providers.
Agencies, Medicare beneficiaries and other interested parties can look for the published notice and any later CMS materials for the proposed collection requirements, participation rules and implementation schedule. Until those details are issued, the status is a pending procedural move rather than a confirmed launch in California.
Key Questions
What has CMS done?
CMS requested expedited approval from the Office of Management and Budget to revise information-collection requirements for the Medicare home health Review Choice Demonstration. The filing is a step toward expanding the program to California.
Is the demonstration already operating in California?
The report does not say that it is. It lists Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas as current participating states and says the California notice gives no start date.
What does the Review Choice Demonstration do?
RCD uses more rigorous claims review procedures intended to combat improper billing. Options include pre-claim review, and some agencies may become eligible for less review after meeting CMS’s stated affirmation-rate threshold and claim-volume requirement.
Why does CMS say the expansion is urgent?
CMS cites concerns about alleged fraud in California’s traditional Medicare home health benefit, including spending on care it says may not have been delivered or medically necessary. Those are the agency’s claims and rationale in the notice; the report does not provide supporting case totals.
When will California agencies have to participate?
No participation date has been announced in the notice described by the report. The notice is scheduled for publication on Nov. 2, 2026, with a 14-day public comment period afterward; further CMS guidance would be needed to clarify timing.
Source: homehealthcarenews.com
