On 2 November 2026 the Centers for Medicare and Medicaid Services (CMS) published a Federal Register notice asking for emergency clearance to revise the paperwork behind its home health Review Choice Demonstration, a step toward expanding the demonstration to California. The notice, document 2026-22297, asks the Office of Management and Budget to process the revision under the emergency clearance process in the Paperwork Reduction Act of 1995. CMS says approval is essential so the demonstration can be expanded to California within the timeframe the agency has set, and it invites comments by 16 November 2026, referencing document identifier CMS-10599 or Office of Management and Budget control number 0938-1311.
Why CMS Is Asking for Emergency Clearance
The case CMS makes in the notice rests on fraud. The agency says public harm is reasonably likely if normal, non-emergency clearance procedures are followed. A delay in the expansion, it says, means an extended period in which the public is harmed through the continuation of significant fraud found in the traditional Medicare home health benefit in California. It lists the consequences plainly: waste of taxpayer money, loss of funds from the Medicare Trust Funds that could have been used for care patients truly need, payment for care that is never delivered, and beneficiaries potentially receiving care that is not medically necessary. Emergency clearance is not routine, and CMS is tying that speed directly to the scale of the problem it says it has found in California.
How the Demonstration Works
Under the Review Choice Demonstration, a home health agency chooses between two review tracks for its Medicare claims. In pre-claim review, each billing period is reviewed before the final claim is submitted. In postpayment review, the claim is paid first and then pulled for a full record review. An agency stays on its chosen track until it reaches the target affirmation or claim approval rate, after which it can move to lighter spot-check review. Home Health Care News reports that the demonstration currently operates in Illinois, Ohio, Oklahoma, North Carolina, Florida and Texas, and that CMS filed the notice on 30 October 2026 requesting expedited approval from the Office of Management and Budget to revise the demonstration's information collection requirements. That filing is the step that would allow CMS to add California to the list.
Part of a Wider Crackdown in California
The move does not arrive on its own. It sits inside a broader CMS fraud crackdown that has hit California hardest. At the National Alliance for Care at Home annual conference, CMS Deputy Administrator and Chief Operating Officer Kimberly Brandt told providers that the agency has suspended payments to 899 hospice and home health providers, 812 of them in California, withholding a total of 1.4 billion dollars, according to Medical Daily's report of her remarks on 29 October 2026. During the same freeze, CMS denied 50 hospice applications and 250 home health applications. A separate nationwide freeze on new hospice and home health Medicare enrollments, in place since 13 May 2026, is set to expire on 13 November 2026, and as of 30 October CMS had not announced whether it would extend it. Brandt also acknowledged that legitimate operators can get caught up in the effort.
Why This Matters for Healthcare Organizations
For California home health agencies, the practical message is to prepare documentation now, before any start date is announced. Pre-claim review rewards agencies whose records already prove medical necessity visit by visit, with orders, visit notes and assessments that line up. Agencies that wait for the expansion to begin before tightening documentation will face review on their current habits, not their improved ones. Referral partners should take note too. Hospitals and clinics that discharge patients to home health in California may see slower first payments while agencies adjust to review, and discharge planners should ask agencies early which track they plan to choose and how they will handle additional documentation requests. For agencies in the six current demonstration states, the notice expands a programme they already live under.
Analysis: Speed Against Burden
The emergency route tells its own story. CMS is not presenting this as a routine paperwork update. It is arguing that the standard timetable itself causes harm, because every month of delay leaves the current system in place in the state where its own figures show the largest concentration of suspended providers. The counterweight is burden. Review programmes demand staff time, careful records and patience with payment timing, and smaller agencies feel that cost first. The comment window, short as it is, is the place where that trade-off gets tested: agencies can challenge the burden estimates, question the necessity of the collection, or suggest ways to make it clearer and less costly. What to watch next is whether the Office of Management and Budget grants emergency clearance, and whether CMS then publishes a selection period and start date for California. Until both happen, California agencies are in a preparation window, not yet under review.
Clinics and home health agencies reviewing how referrals, intake and patient communication work can explore MedClinicX's AI patient portal, see how after-hours calls are handled on our AI medical receptionist page, or explore the demos and request a quote for their own practice.
Sources and References
- Federal Register — Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB), document 2026-22297, Centers for Medicare and Medicaid Services, 2 November 2026: https://www.federalregister.gov/documents/2026/11/02/2026-22297/emergency-clearance-public-information-collection-requirements-submitted-to-the-office-of-management
- Home Health Care News — CMS Moves To Expand Home Health Review Choice Demonstration To California, 30 October 2026 (text as republished by RamaOnHealthcare): https://ramaonhealthcare.com/cms-moves-to-expand-home-health-review-choice-demonstration-to-california/#content
- Medical Daily — Medicare Freeze on New Hospice and Home Health Agencies Expires November 13 as CMS Stays Silent, 29 October 2026: https://www.medicaldaily.com/cms-medicare-hospice-home-health-freeze-extension-480578
Reporting based on the sources above, accessed 2 November 2026. The Federal Register notice was read directly in full, and the Home Health Care News and Medical Daily reports were read directly and cross-checked against it. MedClinicX did not conduct original reporting or interviews for this article. This article is for information only and is not medical advice. Corrections: contact us via https://medclinicx.com/contact