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CMS has asked the Office of Management and Budget for expedited approval to revise the information collection requirements for its Medicare home health Review Choice Demonstration, a step toward adding California. The notice cites fraud concerns but does not set a start date; a 14-day public comment period is planned after Federal Register publication.
The Centers for Medicare & Medicaid Services has requested expedited approval for changes that would move its Medicare home health Review Choice Demonstration toward expansion into California, citing concerns about fraud and improper billing. The request is an administrative step, not a launch announcement: CMS has not specified when California agencies would begin participating.
CMS filed a notice seeking approval from the Office of Management and Budget to revise the demonstration’s information collection requirements. The notice is scheduled to appear in the Federal Register on Nov. 2, although its text was available on the Federal Register website before publication. It provides for a 14-day public comment period after publication.
In the notice, CMS said it considers expedited action necessary to prevent public harm. The agency cited alleged significant fraud in California’s traditional Medicare home health benefit, along with taxpayer spending on care that is not delivered and care it considers not medically necessary. Those statements are CMS’s rationale for the request; the notice does not provide figures quantifying the alleged fraud in the supplied report.
The demonstration uses more rigorous review of home health claims 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 California Agencies Could Be Affected
If CMS proceeds, California home health agencies would face the demonstration’s review framework, which changes how certain claims are examined. For agencies, the choice of review pathway and performance against CMS’s affirmation target could affect the amount of review they face. For Medicare beneficiaries and taxpayers, CMS says the program is intended to reduce payments for unsupported or improperly billed care.
The process also has potential operational consequences for providers. Supporters have argued that pre-claim review can give agencies an opportunity to address documentation issues before sending final claims, potentially reducing the risk of denials later. That is a supporter’s view of the option, not a reported guarantee of payment or a measured outcome for California.
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Where the Review Program Operates
Before the proposed California expansion, the Review Choice Demonstration was operating in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas, according to the report. The request concerns a revision to information collection requirements, an administrative step CMS says is needed before the demonstration can be expanded to another state.
California has repeatedly been identified as a hotspot for home health and Medicare fraud, the report said. 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 position reflects one provider’s support, not a consensus among California agencies.
“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
Start Date and Scope Still Undetermined
The notice does not say when California agencies would enter the demonstration, or provide a confirmed implementation schedule. CMS’s request for expedited approval is not itself confirmation that the expansion has received all necessary approvals or will begin on a particular date.
The supplied report also does not detail which California providers or claims would be included, how participation would be phased, or how many agencies could be affected. The notice’s fraud allegations are not accompanied in the report by a dollar estimate, case count or other measurement that would allow readers to assess their scale. Public comments and further CMS materials may clarify these points.
Comments Before Any California Launch
The next stated milestone is publication of the notice in the Federal Register on Nov. 2, followed by the planned 14-day public comment period. Interested providers and other members of the public will have an opportunity to submit comments during that window.
After the comment period, further agency action would be needed to clarify whether and how the demonstration expands to California. CMS has not announced a participation start date in the notice described by the report, so providers and beneficiaries should look for additional official guidance before treating the proposal as an active California program.
Key Questions
What did CMS do?
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 request is a step toward a possible California expansion, not a launch date.
Why does CMS want to add California?
CMS cited concerns about fraud and improper billing in California’s traditional Medicare home health benefit. Those concerns are the agency’s stated rationale; the report does not include figures that quantify the alleged fraud.
When could California agencies start participating?
No start date has been specified. The notice is scheduled for Federal Register publication on Nov. 2, 2026, with a 14-day comment period afterward, but the reported notice does not set an implementation timetable.
How does the Review Choice Demonstration work?
The program applies more rigorous claims review. Under current CMS guidance, agencies meeting a 90% target full provisional affirmation rate, based on at least 10 requests or claims during a six-month review period, can become eligible for additional review choices, including relief from most reviews with spot checks.
Is California already part of the demonstration?
No. The report lists Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas as current participating states. California is the proposed expansion, and the notice does not establish that California agencies have begun participating.
Source: homehealthcarenews.com
