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CMS has asked the Office of Management and Budget to expedite approval of changes that would allow the Medicare home health Review Choice Demonstration to expand to California. The request is a procedural step, not a confirmed start date; CMS’s notice provides for a 14-day public comment period after publication.
The Centers for Medicare & Medicaid Services has asked for expedited approval to revise requirements for its Medicare home health Review Choice Demonstration, taking a step toward expanding the program to California. CMS says the move is needed to address fraud concerns, but the notice does not set a date for California agencies to begin participating.
CMS filed the request with the Office of Management and Budget on Friday. The proposed revision to the demonstration’s information collection requirements is part of the process for adding California; it does not, by itself, confirm that the expansion has been approved or implemented. The notice is scheduled for publication in the Federal Register on Nov. 2, and it provides for a 14-day public comment period after publication.
The demonstration is already operating in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas. It applies more rigorous claims review procedures to Medicare home health services, with the stated aim of addressing improper billing. Under current CMS guidance, agencies that reach a 90% target full provisional affirmation rate, based on at least 10 requests or claims over a six-month review period, can qualify for additional review choices. Those can include relief from most reviews, subject to spot checks.
CMS’s notice argues that urgent action is needed. It says delays would prolong harm associated with fraud in California’s traditional Medicare home health benefit, including taxpayer spending on care that is not delivered and payment for care that is not medically necessary. These are CMS’s stated concerns; the notice does not provide a California-specific estimate of losses or detail particular cases in the supplied report.
How California Agencies Could Be Affected
If the expansion proceeds, California home health agencies would face a claims review framework already used in six other states. The review choices may affect how agencies submit claims and how quickly they receive payment decisions. For providers, the rules could bring additional documentation work, while the program’s review options may offer a way to address documentation issues before final claims are submitted.
Supporters have argued that pre-claim review can give agencies greater payment certainty by identifying documentation problems earlier and reducing the chance of denials months later. That is a claimed benefit, not a guarantee that claims will be affirmed or paid. For Medicare beneficiaries and taxpayers, CMS frames the expansion as a way to reduce improper payments and preserve funds for needed care. The actual effect would depend on implementation and review outcomes, which are not yet available for California.
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The Demonstration’s Review Options
The Review Choice Demonstration uses different claims review procedures intended to help CMS address what it identifies as improper billing in Medicare home health. Agencies can be subject to review before or after submitting claims, depending on applicable options and performance under CMS’s guidance. The 90% affirmation threshold and minimum of 10 requests or claims over six months determine eligibility for additional choices; they are not a general guarantee of payment.
California has repeatedly been identified in reporting and by authorities as a focus of home health and Medicare fraud concerns. Some providers have also supported expanding 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. Her comments reflect a provider’s position, rather than a finding about the effects of an 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
Approval and Start Date Remain Open
The filing does not establish whether OMB will grant expedited approval, when CMS would make a final decision, or when California agencies might have to participate. The notice lays out a 14-day comment period after Federal Register publication, but the supplied report does not identify a start date for reviews or describe the final implementation schedule.
The notice’s fraud assertions also do not include a quantified estimate of the alleged losses or details of specific cases in the source material. It remains unclear how many California agencies would be affected, what operational requirements they would face, and whether CMS will change any program details after considering public comments.
Public Comments and Federal Review
The notice is scheduled to appear in the Federal Register on Nov. 2, after which the stated 14-day public comment period would begin. OMB’s response to CMS’s expedited request and comments submitted during that window are the next procedural developments to watch.
Any later CMS action would clarify whether California is added, the conditions for participation and the timing of reviews. Until CMS announces those details, the expansion remains a proposed next step rather than an active California requirement.
Key Questions
What has CMS done?
CMS requested expedited approval from the Office of Management and Budget to revise the Review Choice Demonstration’s information collection requirements. The request is a step toward expanding the Medicare home health program to California, not confirmation that the expansion has begun.
When would California agencies start participating?
The notice does not specify a start date. CMS would need to take further action, and the supplied report does not provide a timetable for implementation.
Which states currently have the demonstration?
The program is in place in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas, according to the report.
What does the 90% affirmation threshold mean?
Under current CMS guidance, an agency reaching a 90% target full provisional affirmation rate, based on at least 10 requests or claims during a six-month review period, becomes eligible for additional review choices. Eligibility does not guarantee payment for every claim.
Why does CMS want to add California?
CMS cites concerns about fraud and improper payments in California’s traditional Medicare home health benefit. The notice presents the agency’s rationale; the supplied report does not provide a quantified estimate of losses.
Source: homehealthcarenews.com
