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CMS has asked for expedited approval to revise the information collection requirements for Medicare’s Home Health Review Choice Demonstration, a procedural step toward expanding it to California. The agency cites fraud concerns, but has not set a start date; a 14-day public comment period is due after the notice is published.
The Centers for Medicare & Medicaid Services has requested expedited approval to revise the information collection requirements for its Medicare Home Health Review Choice Demonstration, a step toward extending the program to California. CMS cited concerns about fraud in the state’s traditional Medicare home health benefit; the notice does not say when California providers would begin participating.
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, though its text is already available there. The request concerns changes to information collection requirements and is not, by itself, a start date or confirmation that California agencies have begun reviews.
In the notice, CMS said it considers expedited action necessary to prevent public harm. The agency argued that delay would prolong what it described as significant fraud in California’s traditional Medicare home health benefit, including taxpayer spending on care that is not delivered or is not medically necessary. Those are CMS’s stated concerns; the notice excerpt does not provide figures quantifying suspected fraud or describe specific cases.
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. Under current CMS guidance, agencies that reach 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. These can include relief from most reviews, subject to spot checks.
How Reviews Could Affect California Agencies
Adding California would extend a federal claims-review program to a state that CMS identifies as a concern for home health and Medicare fraud. The agency’s stated rationale is to limit improper payments and protect Medicare funds. The notice also points to a possible cost of delay: money spent on undelivered or medically unnecessary care cannot be used for care that beneficiaries need.
The review process may also affect how providers manage claims. Supporters have said that pre-claim review can give agencies a chance to address documentation issues before sending final claims, potentially reducing the risk of denials later. That is a stated benefit of the option, not a guarantee that claims will be paid or that reviews will be faster. How the program would work in California, and which review choices would be available to local agencies, have not been specified in the reported notice.
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A Review Program Already in Six States
The Review Choice Demonstration is designed to apply greater scrutiny to home health claims and give agencies review choices tied to their performance. Under the described guidance, the 90% affirmation target is measured over a six-month review period and requires at least 10 requests or claims. Agencies meeting the target may become eligible for options that reduce the scope of routine review, while spot checks can remain.
California has repeatedly been identified in reporting and by officials as a location of concern for home health and Medicare fraud. Some providers have also previously backed expansion of 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 a provider position, not a CMS finding about the program’s effects in California.
“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 requesting expedited approval
California Start Date Still Unset
The notice does not specify when California agencies would enter the demonstration, how implementation would be phased, or which review options would apply to them. CMS’s request is for expedited approval of revised information collection requirements; the available account does not establish that OMB has approved it or that all remaining steps are complete.
The notice also does not provide detailed data supporting CMS’s fraud concerns, such as the amount of suspected improper billing, the number of providers or claims involved, or the period covered. Those details may be addressed in other materials, but they are not supplied in the source report. The program’s operational effects on California providers and beneficiaries are also not yet known.
Federal Review and Public Comments
The notice is scheduled for publication in the Federal Register on Nov. 2. After publication, the notice provides for a 14-day public comment period. Providers, beneficiaries and other interested parties will have an opportunity to submit feedback during that window.
After the comment period and review of the request, further action would be needed before California participation begins. CMS has not announced a launch date in the notice described by Home Health Care News. Updates to watch for include the agency’s response to public comments, any approval of the revised information collection requirements, and details about timing and review procedures for California home health agencies.
Key Questions
What has CMS done?
CMS requested expedited approval from the Office of Management and Budget to revise information collection requirements for its Home Health Review Choice Demonstration. The request is a step toward expanding the program to California, not confirmation that reviews there have started.
Why does CMS want to add California?
CMS cited concerns about fraud in California’s traditional Medicare home health benefit and said delay could prolong harm to the public and waste of Medicare funds. The reported notice does not give a specific fraud total or case-by-case evidence.
Which states are already in the demonstration?
The program is in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas, according to the source report.
When will California agencies start participating?
No start date is specified in the notice described in the report. The notice is scheduled for Federal Register publication Nov. 2, followed by a 14-day public comment period.
What does the demonstration require of providers?
It uses more rigorous claims review procedures. Under current guidance, agencies reaching a 90% target full provisional affirmation rate, based on at least 10 requests or claims during a six-month period, may qualify for additional review choices, including relief from most reviews subject to spot checks.
Source: homehealthcarenews.com
