Home health Review Choice Demonstration: how the choices work in Illinois and five other states

If your home health agency bills Medicare in Illinois, Ohio, Texas, North Carolina, Florida or Oklahoma, your claims fall under the Review Choice Demonstration (RCD). CMS's RCD page was last modified September 25, 2026. Its update log has no program changes after the May 2024 extension; the most recent entry, dated September 16, 2025, is a statistics release.

How the choices work

Agencies start by picking one of two initial options:

• Pre-claim review
• Postpayment review

After six months, agencies that show compliance get more choices, including relief from most reviews except for a small sample of claims. To qualify, an agency needs a 90% full provisional affirmation rate on at least 10 requests or claims.

CMS says it runs the demonstration under Section 402(a)(1)(J), which authorizes the Secretary to "develop or demonstrate improved methods for the investigation and prosecution of fraud in the provision of care or services under the health programs established by the Social Security Act." CMS adds that the program does not alter the Medicare home health benefit and "should not delay care to Medicare beneficiaries."

The five-year extension

CMS extended RCD for five years, effective June 1, 2024, in all six current states. Oklahoma had joined on December 1, 2023. CMS said then that claims analysis showed increased home health use in Oklahoma, and that the state had higher allowed spending and use than the other Jurisdiction M states not already in the demonstration.

As part of the extension, CMS dropped Choice 3, minimal review with a 25% payment reduction. Agencies that had been in Choice 3 had to pick pre-claim or postpayment review. Those that didn't choose were defaulted to postpayment review.

CMS says it can expand the demonstration to other states in the JM jurisdiction, which Palmetto GBA administers, if there is evidence of fraud, waste or abuse there. The page announces no expansion.

A wording gap on Medicare.gov

Medicare.gov's home health coverage page, written for patients, asks: "Do you get services from a home health agency in Florida, Illinois, Ohio, North Carolina, or Texas?" Oklahoma isn't named. CMS's RCD page lists all six states.

Palmetto's monthly webinar

Palmetto GBA holds a Monthly Review Choice Demonstration provider webinar for home health providers in Illinois, North Carolina, Ohio, Florida, Texas and Oklahoma. Palmetto's registration pages for the October 7 and December 2 sessions give the format: Wednesdays, 11 a.m. to noon ET (10 to 11 a.m. CT), with an NPI, PTAN and jurisdiction needed to register. Palmetto's October 12 schedule notice lists the next session for Wednesday, November 4, 2026. Check Palmetto's listing to register.

Where to look

CMS's downloads section includes the HH RCD Operational Guide, FAQs, process and review-decision flowcharts, and a physician/practitioner letter. The operational guide lists MAC contacts. Provider questions go to homehealthrcd@cms.hhs.gov.

Related: Home health and hospice deadlines through Jan. 1 · JM Palmetto GBA hub

Sources

• CMS, Review Choice Demonstration for Home Health Services
• Medicare.gov, Home health services
• Palmetto GBA, Monthly HH RCD webinar schedule (Oct. 12 notice)
• Palmetto GBA, HH RCD webinar registration, December 2, 2026

It is general information, not clinical, billing or legal advice.*

Drafted with AI assistance from primary sources and reviewed by Monsaur Othman before publication. Read how we use AI, our editorial policy and our corrections policy.

Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.