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Home health review choice — official procedure references

Home health review choice offers pre-claim or postpayment review, not universal prior authorization. The May 2024 update removes the old 25% reduction initial choice still printed in guide page 5. The demonstration covers eligible home health agencies in Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma, with Palmetto GBA billing scope checked separately. The June 1, 2024 extension runs for five years. Initial review choices are pre-claim review or postpayment review; the older initial minimal-review option with a 25% payment reduction was removed. This change concerns review-choice administration and must not be generalized to every payment adjustment. Face-to-face evidence on subsequent periods: When care continues without discharge, a new encounter is not required solely for another billing period, but submit the original supporting encounter documentation again. Home health location and billing scope: The six-state demonstration is limited to rendering HHAs in Illinois, Ohio, North Carolina, Florida, Texas and Oklahoma that bill Palmetto GBA. These administrative timing and program-scope references do not establish that a patient satisfies home health or rehabilitation coverage criteria, and are not a professionally reviewed preparation checklist. Source checked 2026-10-15. Documentary verification only; no clinical review or individual coverage determination.

Prior authorization: unknown. Member-specific applicability must be checked with the payer.
PayerCMS / Medicare
Plan contextOriginal Medicare — reference context only
ServiceHome health review choice
State scopeNot verified
Effective dateNot verified
RevisionSource bc39a0b2440c
Retrieved10/15/2026
EvidenceOpen original source ↗

Source evidence

Documentary checks establish what the official source says, not clinical eligibility.

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This public reference is available in full above. Paid research tools are not currently available; no clinical checklist or cross-payer authorization determination is included.

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Evidence fingerprint: bc39a0b2440c1449bd9568c2c231ac811592ebd00dd7c0330fae15da2d415528