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CMS has requested expedited federal approval to revise the information-collection rules for its Medicare home health Review Choice Demonstration, a step toward expanding it to California. The notice cites fraud concerns but does not set a California start date; it provides 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 extending the program to California. CMS says the proposed expansion is needed to address fraud concerns, but the notice does not specify when California agencies would have to participate.
CMS filed the request with the Office of Management and Budget on Friday, seeking emergency approval of the revisions. The notice is scheduled to appear in the Federal Register on Nov. 2; its text was available on the Federal Register website before publication. The request concerns the demonstration’s information collection and is not, by itself, a stated start date for California participation.
The notice says CMS considers expedited action necessary to prevent public harm. It links that concern to what it describes as significant fraud in California’s traditional Medicare home health benefit, including taxpayer spending on care it says may not be delivered or medically necessary. Those are CMS’s stated concerns; the supplied notice does not provide a California-specific fraud estimate or details of individual cases.
The demonstration is already operating in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. CMS uses more rigorous claims-review procedures under RCD to address improper billing. Agencies meeting 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, including relief from most reviews apart from spot checks.
How California Agencies Could Be Affected
If CMS proceeds, California home health agencies would face a claims-review framework intended to test documentation and billing before or during payment review. The operational effect could depend on which review choices apply, how agencies perform against the affirmation target and what implementation schedule CMS ultimately sets. The notice described in the report does not answer those questions for California.
For Medicare beneficiaries and taxpayers, the stated policy aim is to reduce improper payments and preserve program funds for eligible care. For providers, review requirements can affect administrative workload and payment timing. Supporters have also argued that pre-claim review may offer more certainty: agencies can address documentation issues before submitting final claims rather than risk denials later. That is a potential benefit cited by supporters, not a guaranteed outcome for every agency.
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Where RCD Already Operates
RCD is a Medicare home health claims-review demonstration. Under current CMS guidance described in the report, agencies that achieve the 90% affirmation threshold over a six-month review period, with at least 10 requests or claims, may access additional review options. One option is to be relieved of most reviews while remaining subject to spot checks. The demonstration therefore combines more intensive review with a possible route to reduced review for agencies that meet the target.
California has repeatedly been identified as an area of concern for home health and Medicare fraud, according to the report. Some providers have previously supported extending RCD 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; the available material does not establish consensus across the industry.
“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
Start Date and Review Rules Remain Open
The request does not say when California agencies would begin participating or spell out a California implementation schedule. It also does not establish which agencies would be included first or whether CMS would make California-specific changes to the existing review choices. Those details should not be treated as settled based on the request alone.
The notice cites significant fraud but, in the material provided, supplies no estimate of its scale, breakdown of affected claims or specific cases. The request also remains subject to the notice and public-comment process. CMS’s fraud rationale is therefore an attributed agency claim, while the timing and final terms of any expansion remain unknown.
Public Comment Before Any Rollout
The notice is scheduled for publication in the Federal Register on Nov. 2, followed by a 14-day public comment period. Providers, beneficiaries and other interested parties will have an opportunity to submit comments on the proposed information-collection changes. The request for expedited approval indicates CMS is seeking a faster process, but it does not confirm when OMB will act or when CMS would begin implementation.
The next developments to watch are publication of the notice, the comments submitted during the response window and any subsequent federal decision or CMS guidance. Until the agency provides those details, California providers cannot determine a start date or the precise review procedures they may face.
Key Questions
What did CMS ask the federal government to approve?
CMS asked the Office of Management and Budget for expedited approval to revise the information-collection requirements for the Medicare home health Review Choice Demonstration. The request is a step toward a possible California expansion, not a published start date.
What is the Review Choice Demonstration?
RCD uses more rigorous Medicare home health claims reviews to address improper billing. Under current guidance, agencies meeting a 90% full provisional affirmation target, with at least 10 requests or claims during a six-month review period, may qualify for additional review options, including relief from most reviews apart from spot checks.
When could California agencies begin participating?
The notice does not specify a California start date. CMS would need to provide further implementation details before agencies could know when or how participation would begin.
When can the public comment on the proposal?
The notice is scheduled for Federal Register publication on Nov. 2, 2026, and provides for a 14-day public comment period after publication.
Why does CMS say it wants to expand the program?
CMS cites concerns about fraud and improper payments in California’s traditional Medicare home health benefit. The supplied report does not include a specific fraud estimate, so the stated rationale should be understood as the agency’s position rather than a quantified finding in the notice material provided.
Source: homehealthcarenews.com
