Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB)

Issuing agencies

Abstract

The Centers for Medicare & Medicaid Services (CMS) is requesting that an information collection request revision for the Review Choice Demonstration or Home Health Services (CMS-10599/0938- 1311) processed under the emergency clearance process associated with the implementing regulations of the Paperwork Reduction Act of 1995 (PRA). Public harm is reasonably likely to occur if normal, non- emergency clearance procedures are followed. The approval of this data collection process is essential to ensure that the Review Choice Demonstration (RCD) for Home Health (HH) Services is expanded to California within the specified timeframe. 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 through the waste of taxpayer money, a loss of funds from the Medicare Trust Funds that could have been used for truly needed care, paying for care that is never delivered, and beneficiaries potentially receiving non-medically necessary care. Under the PRA, federal agencies are required to publish notice in the Federal Register concerning each proposed ICR. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this ICR including the necessity and utility of the proposed ICR for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.

Full Text

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<title>Federal Register, Volume 91 Issue 210 (Monday, November 2, 2026)</title>
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[Federal Register Volume 91, Number 210 (Monday, November 2, 2026)]
[Notices]
[Pages 68960-68961]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-22297]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10599]


Emergency Clearance: Public Information Collection Requirements 
Submitted to the Office of Management and Budget (OMB)

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
requesting that an information collection request revision for the 
Review Choice Demonstration or Home Health Services (CMS-10599/0938-
1311) processed under the emergency clearance process associated with 
the implementing regulations of the Paperwork Reduction Act of 1995 
(PRA). Public harm is reasonably likely to occur if normal, non-
emergency clearance procedures are followed. The approval of this data 
collection process is essential to ensure that the Review Choice 
Demonstration (RCD) for Home Health (HH) Services is expanded to 
California within the specified timeframe. 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 through the waste of taxpayer money, 
a loss of funds from the Medicare Trust Funds that could have been used 
for truly needed care, paying for care that is never delivered, and 
beneficiaries potentially receiving non-medically necessary care.
    Under the PRA, federal agencies are required to publish notice in 
the Federal Register concerning each proposed ICR. Interested persons 
are invited to send comments regarding our burden estimates or any 
other aspect of this ICR including the necessity and utility of the 
proposed ICR for the proper performance of the agency's functions, the 
accuracy of the estimated burden, ways to enhance the quality, utility, 
and clarity of the information to be collected and the use of automated 
collection techniques or other forms of information technology to 
minimize the information collection burden.

DATES: Comments must be received by November 16, 2026.

ADDRESSES: When commenting, please reference the document identifier 
(CMS-10599) or OMB control number (0938-1311). To be assured 
consideration, comments and recommendations must be submitted in any 
one of the following ways:
    1. Electronically. You may send your comments electronically to 
<a href="http://www.regulations.gov">http://www.regulations.gov</a>. Follow the instructions for ``Comment or 
Submission'' or ``More Search Options'' to find the information 
collection document(s) that are accepting comments.
    2. By regular mail. You may mail written comments to the following 
address: CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: CMS-10599/OMB Control 
Number 0938-1311, Room C4-26-05, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' website address at <a href="http://www.cms.hhs.gov/PaperworkReductionActof1995">http://www.cms.hhs.gov/PaperworkReductionActof1995</a>.

FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.

SUPPLEMENTARY INFORMATION:

Contents

    This notice sets out a summary of the use and burden associated 
with the following ICR. More detailed information can be found in the 
collection's supporting statement and associated materials (see 
ADDRESSES).
    Under the PRA (44 U.S.C. 3501-3520), federal agencies must obtain 
approval from the Office of Management and Budget (OMB) for each 
collection of information they conduct or sponsor. The term 
``collection of information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 
1320.3(c) and includes agency requests or requirements that members of 
the public: submit reports, keep records, or provide information to a 
third party. To comply with this requirement, CMS is publishing this 
notice that summarizes the following proposed collection(s) of 
information for public comment:

Information Collection

    1. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Pre-Claim Review 
Demonstration For Home Health Services; Use: Section 402(a)(1)(J) of 
the Social Security Amendments of 1967 (42 U.S.C. 1395b-1(a)(1)(J)) 
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 (the Act).'' Pursuant to this authority, the CMS seeks to 
develop and implement a Medicare demonstration project, which CMS 
believes will help assist in developing improved procedures for the 
identification, investigation, and prosecution of Medicare fraud 
occurring among Home Health Agencies (HHA) providing services to 
Medicare beneficiaries.
    This revised demonstration helps assist in developing improved 
procedures for the identification, investigation, and prosecution of 
potential Medicare fraud. The demonstration helps make sure that 
payments for home health services are appropriate through either pre-
claim or post payment review, thereby working towards the prevention 
and identification of potential fraud, waste, and abuse; the protection 
of Medicare Trust Funds from improper payments; and the reduction of 
Medicare appeals. CMS has implemented the demonstration in Illinois, 
Ohio, North Carolina, Florida, and Texas with the option to expand to 
other states in the Palmetto/JM jurisdiction. Under this demonstration, 
CMS offers choices for providers to demonstrate their compliance with 
CMS' home health policies. Providers in the demonstration states may 
participate in either 100 percent pre-claim review or 100 percent post 
payment review. These providers will continue to be subject to a review 
method until the HHA reaches the target affirmation or claim approval 
rate. Once an HHA reaches the target pre-claim review affirmation or 
post-payment review claim approval rate, it may choose to be relieved 
from claim reviews, except for a spot check of their claims to ensure 
continued compliance. Providers who do not wish to participate in 
either 100 percent pre-claim or post payment reviews have the option to 
furnish home health services and submit the associated claim for 
payment without undergoing such reviews; however, they will receive a 
25 percent payment reduction on all claims submitted for home health 
services and may be eligible for review by the Recovery Audit 
Contractors.
    The information required under this collection is required by 
Medicare contractors to determine proper payment or if there is a 
suspicion of fraud. Under the pre-claim review option, the HHA sends 
the pre-claim review request along with all required documentation to 
the Medicare contractor for review prior to submitting the final claim 
for payment. If a claim is submitted without a pre-claim review

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decision on one file, the Medicare contractor will request the 
information from the HHA to determine if payment is appropriate. For 
the post payment review option, the Medicare contractor will also 
request the information from the HHA provider who submitted the claim 
for payment from the Medicare program to determine if payment was 
appropriate. Form Number: CMS-10599 (OMB control number: 0938-1311); 
Frequency: Frequently, until the HHA reaches the target affirmation or 
claim approval threshold and then occasionally; Affected Public: 
Private Sector (Business or other for-profits and Not-for-profits); 
Number of Respondents: 4,700; Number of Responses: 3,173,016; Total 
Annual Hours: 1,600,608. (For questions regarding this collection 
contact Jennifer McMullen (410) 786-7635.)

William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2026-22297 Filed 10-30-26; 8:45 am]
BILLING CODE 4169-69-P


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