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CMS has asked the Office of Management and Budget for expedited approval to revise information collection requirements for its Medicare home health Review Choice Demonstration, a step toward adding California. The agency cites fraud concerns, but has not announced a start date; the notice allows for a 14-day public comment period after publication.
The Centers for Medicare & Medicaid Services has requested expedited approval to revise information collection requirements for its Medicare home health Review Choice Demonstration, a procedural step toward expanding the program to California. CMS says the move is needed to address fraud concerns, but the notice does not give a date for when California home health agencies would enter the demonstration.
CMS filed the request with the Office of Management and Budget on Friday. The notice is scheduled to appear in the Federal Register on Nov. 2, although its text was available on the register’s website before publication. It sets out a 14-day public comment period after publication. The request concerns revisions to information collection requirements; it is not, by itself, an announcement that California participation has begun.
The demonstration currently operates in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. It uses more rigorous claims review procedures intended to address improper billing in Medicare home health. CMS’s notice says expedited handling is necessary to prevent public harm, pointing to what the agency describes as significant fraud in California’s traditional Medicare home health benefit.
Under current CMS guidance, agencies that achieve a 90% target full provisional affirmation rate, based on at least 10 requests or claims during a six-month review period, can qualify for additional review choices. Those choices include relief from most reviews, subject to spot checks. The source report does not specify how the agency would apply participation timing or operational details to California providers.
How California Agencies Could Be Affected
Expansion would bring California home health claims under a review framework already used in six states. For providers, the demonstration can affect claims review and payment processes, including the amount of documentation submitted and when it is examined. The scale of the practical impact will depend on implementation details that CMS has not yet supplied.
Supporters have argued that pre-claim review can give agencies greater payment certainty by letting them address documentation problems before submitting final claims, rather than facing denials later. The approach also adds review requirements, so its effects may differ among providers depending on their claims and documentation performance. CMS’s stated rationale is to reduce improper payments and protect public funds; the notice does not quantify expected savings or describe a specific amount of suspected fraud.
For Medicare beneficiaries, the agency says its concerns include taxpayer money being spent on care that is not delivered and on care it considers not medically necessary. Those statements are CMS’s rationale for expedited action, not independently detailed findings in the source material. The notice does not identify cases, dollar totals, or the number of beneficiaries potentially affected.
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Review Choice Demonstration in Six States
The Review Choice Demonstration is a CMS program for Medicare home health claims. Its review options are designed to scrutinize claims while giving eligible agencies a choice among review pathways. Under the current guidance described in the report, a provider’s affirmation rate is assessed across a six-month period, and the threshold requires at least 10 requests or claims. Agencies that meet the 90% target may receive less frequent review, with spot checks retained.
California has been repeatedly identified in discussions of home health and Medicare fraud, according to the source report. Some providers have also previously supported extending the demonstration there. In 2025, Stacey Smith, AccentCare’s vice president of public affairs, told Home Health Care News that the company supported expansion to California and nationwide. That support reflects one provider’s position; it does not establish industry-wide agreement or indicate that CMS has finalized an implementation schedule.
“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 seeking expedited approval
Start Date and Provider Rules Remain Open
The notice does not specify when California agencies would begin participating, which providers would be included first, or how any rollout would be phased. It also does not provide a California-specific estimate of affected claims, projected savings, or the scale of the fraud CMS cites.
The request is a step toward expansion, not confirmation that the program is already operating in California. The comment period and review process remain ahead, and the source material does not say whether CMS will change the proposal in response to feedback or when OMB will make a decision.
Comments and Approval Will Set the Pace
After the notice is published in the Federal Register on Nov. 2, interested parties will have 14 days to submit comments, according to the report. OMB’s consideration of CMS’s request and any subsequent agency announcements should clarify whether the information collection revisions are approved and what steps remain before California is added.
Providers and beneficiaries will need further CMS guidance for practical details, including the participation timetable, review options, and instructions for affected agencies. Until those details are released, the expansion remains a proposed next step rather than an active California requirement.
Key Questions
Has CMS started the demonstration in California?
No. CMS has requested expedited approval for changes that would support expansion. The notice does not say that California agencies have begun participating.
Which states currently have the Review Choice Demonstration?
The report lists Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas as the states where the demonstration is in place.
What is the review program intended to do?
The demonstration uses more rigorous review of Medicare home health claims to address improper billing. Eligible agencies that meet CMS’s stated affirmation-rate threshold may qualify for additional review choices, including relief from most reviews with spot checks.
When could California agencies be included?
CMS has not provided a start date. The notice is scheduled for Federal Register publication on Nov. 2, 2026, followed by a 14-day public comment period; further timing depends on the approval and implementation process.
Source: homehealthcarenews.com
