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CMS has asked the Office of Management and Budget for expedited approval to revise the information-collection rules for Medicare’s home health Review Choice Demonstration, a step toward expanding the program to California. The agency cites fraud concerns, but its notice does not give a start date; it allows 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 information-collection requirements for its Medicare home health Review Choice Demonstration, a procedural step toward expanding the program to California, as CMS considers building palliative care into the home health system. CMS cited concerns about fraud in the state, but its notice does not say when California agencies would begin participating.
CMS filed the request on Friday, according to a report by Home Health Care News. The notice is scheduled for publication in the Federal Register on Nov. 2, although its text is already available on the Federal Register website. The request concerns revisions to the demonstration’s information collection; it is not itself a stated launch date for California.
The program is currently operating in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. It subjects participating home health claims to more rigorous review procedures intended to address improper billing. CMS’s notice says expedited processing is needed to prevent public harm, describing concerns about taxpayer spending, Medicare Trust Fund losses, payment for care that is not delivered and care it considers not medically necessary.
Under current CMS guidance, agencies that meet 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, with spot checks retained. The notice provides for a 14-day public comment period after Federal Register publication.
How California Agencies Could Be Affected
If CMS proceeds, California home health providers would face a claims-review framework that already applies in six other states. The demonstration could change how agencies document and submit Medicare claims, and how quickly they learn whether documentation meets review requirements. CMS frames the proposed expansion as a response to fraud concerns; the notice does not provide figures detailing the scale of the alleged California problem.
Providers may experience the review process differently depending on their documentation and performance. Supporters have argued that the program’s pre-claim review option can give agencies more payment certainty by allowing them to address documentation issues before submitting final claims, rather than facing a denial months later. That is a position attributed to supporters, not a finding established by the notice. The policy question is whether expanded review can limit improper payments while avoiding unnecessary administrative burdens or delays for legitimate care.
The implications extend beyond providers. CMS says that money lost to improper billing could otherwise support needed care through Medicare. At the same time, beneficiaries and agencies could be affected by how reviews distinguish unsupported claims from appropriate services. The notice establishes CMS’s rationale for seeking expedited action, but it does not report outcomes from the existing state demonstrations or quantify expected savings in California.
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Where the Demonstration Already Operates
The Review Choice Demonstration uses claims review options as a tool to address improper billing in traditional Medicare home health. CMS’s current guidance ties access to certain less intensive review choices to agencies meeting the 90% affirmation target over a defined six-month period, with at least 10 requests or claims. Agencies that qualify may receive relief from most reviews, although spot checks remain possible.
California has been repeatedly identified as a hotspot for home health and Medicare fraud, according to the source report. Some providers have also supported extending the demonstration to the state. In 2025, Stacey Smith, AccentCare’s vice president of public affairs, told Home Health Care News that her company supported expansion to California and nationwide. That comment reflects the company’s position; it does not establish that all providers favor the policy or that CMS has finalized the expansion.
“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
Launch Timing and Review Details
No California start date appears in the notice described by Home Health Care News. The filing requests expedited OMB approval for changes to information collection, but the available account does not establish whether approval has been granted or when CMS would begin implementation.
The notice also does not specify which California agencies would be included first, how CMS would phase any expansion, or what operational instructions providers would receive. CMS’s fraud rationale is stated in the notice, but the source material does not provide supporting case counts, dollar estimates, or a detailed breakdown of the alleged conduct. The 14-day comment period will allow public responses after publication, but the filing alone does not settle the final policy or schedule.
Public Comments and CMS Decisions
The notice is scheduled to appear in the Federal Register on Nov. 2, 2026. A 14-day public comment period is due to follow publication. Providers, beneficiaries and other interested parties can use that period to respond to the proposed information-collection changes.
After the comment period and OMB review, CMS would need to communicate whether it will proceed and provide implementation details, including any effective date and instructions for California agencies. Until CMS announces those steps, the expansion remains a proposal in process rather than an operating requirement for California providers.
Key Questions
What did CMS request?
CMS requested expedited OMB approval to revise the information-collection requirements for the home health Review Choice Demonstration. The filing is a step toward possible expansion to California, not a confirmed start notice.
When would California providers have to participate?
The notice does not specify a California start date. CMS would need to provide further implementation details before providers could know when or how the program would apply to them.
Which states currently have the demonstration?
The program currently operates in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas, according to the source report.
How does the review program work?
It uses more rigorous claims reviews to address improper billing. Under current guidance, agencies meeting a 90% affirmation target over a six-month review period, with at least 10 requests or claims, may qualify for additional review choices, including relief from most reviews with spot checks retained.
Why does CMS say it wants to expand the program?
CMS cited concerns about fraud in California’s traditional Medicare home health benefit and potential losses to taxpayers and the Medicare Trust Funds. The notice’s statements are CMS’s rationale; the source report does not give a quantified estimate of the alleged fraud.
Source: homehealthcarenews.com
