Review Choice Demonstration for Home Health Services (RCD)
Background
The Review Choice Demonstration for Home Health Services (RCD) provides flexibility and choice for Home Health Agencies (HHAs), as well as risk-based changes to reduce burden on providers demonstrating compliance with Medicare home health policies. HHAs will select from two initial choices:
- Pre-claim review
- Postpayment review
After a 6-month period, HHAs demonstrating compliance with Medicare rules through pre-claim review or postpayment review will have additional choices, including relief from most reviews except for a review of a small sample of claims. (To be eligible, HHAs must meet a 90% target full provisional affirmation rate based on a minimum 10 requests/claims submitted.)
CMS conducts this demonstration under Section 402 (a)(1)(j), which authorizes the Sectary 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 [the Act].” This program reduces the number of Medicare appeals, improves provider compliance with Medicare program requirements, should not delay care to Medicare beneficiaries, and does not alter the Medicare home health benefit.
Contact Us
RCD providers can email questions to homehealthrcd@cms.hhs.gov
For MAC contact information, please see page 7 of the ASC Operational Guide. This can be found in the downloads section.
Timeline & Updates
Updates are provided in reverse chronological order; scroll down for earlier updates.
Update 09/16/2025:
CMS is releasing updated stats on the Home Health RCD. Please click here to see the results (PDF).
Update 1/17/2025:
CMS is releasing updated stats on the Home Health RCD. Please click here to see the results (PDF).
Update 05/17/2024:
Effective June 1, 2024, CMS will be extending the Review Choice Demonstration for Home Health Services for an additional 5 years. The demonstration will be continuing in the current demonstration states of Illinois, Ohio, Texas, North Carolina, Florida, and Oklahoma.
As part of the extension, CMS is removing Choice 3: Minimal Review with 25% Payment Reduction from the initial choice selections. Palmetto GBA will proactively reach out to coordinate with the small number of affected providers to make a new review choice selection. Current Choice 3 providers must select between the other two initial review choice options: Pre-Claim Review or Postpayment Review according to the following dates:
- Choice selection period start date: June 17, 2024
- Choice selection period end date: July 1, 2024
- Cycle effective date: July 15, 2024
Providers who do not make an initial review choice selection will default to participate in Choice 2: Postpayment Review. Providers with less than 10 reviews at the conclusion of the current cycle, will have their results included in the next cycle’s results.
All other Home Health providers in the demonstration states will continue in their current review cycles and follow their regular cycle timelines. For Oklahoma providers, the choice selection period for cycle 2 is July 1, 2024, through July 15, 2024. Cycle 2 will begin on August 1, 2024.
Any providers who feel it is a hardship to continue participation in their current review choice selection and would like to modify their choice selection should notify Palmetto by June 14, 2024, to ensure their desired choice selection is updated.
For questions or to request additional information, please contact us via email at: homehealthrcd@cms.hhs.gov
Update 09/15/2023:
CMS is releasing updated stats on the Home Health RCD.
Please click here to see the results. (PDF)
Update 09/01/2023:
CMS will be implementing the Review Choice Demonstration for Home Health Services in Oklahoma, effective December 1, 2023. CMS has the ability to expand the demonstration to additional states in the JM MAC jurisdiction if there is evidence of fraud, waste, or abuse in those states. Claims analysis showed increased utilization of home health services in Oklahoma, and Oklahoma had higher allowed expenditures and utilization of home health services than the remaining states in the Home Health & Hospice Medicare Administrative Contractor (MAC) Jurisdiction M not already included in the demonstration. To ensure compliance with Medicare home health requirements and protection of the Medicare trust funds. CMS will implement the demonstration according to the following dates:
- Selection Period Start Date: October 16, 2023
- Selection Period End Date: November 15, 2023
- New Selection Effective Date: December 1, 2023
For questions or to request additional information, please contact us via email at: homehealthrcd@cms.hhs.gov
Related Links
HHAs may visit the Palmetto GBA Provider Portal for information and instructions on the selection process.