CMS/HCBS Heightened Scrutiny and Tax Plan take Center Stage

PAR Mail 2017-229

CMS and Tax Plan take Center Stage

CMS to issue Heightened Scrutiny Clarification

Yesterday, PAR's national association ANCOR shared that: "ANCOR was invited to meet with Centers for Medicaid and Medicare Services (CMS) Administrator Seema Verma, Center for Medicaid and CHIP Services (CMCS) Director Brian Neale, and other top CMS officials to discuss the HCBS Settings Rule. Administrator Verma reported there is no official plan to reopen the rule at this time, but that CMS has decided to issue further subregulatory guidance with an immediate focus on the heightened scrutiny process.

In addition to Administrator Verma’s comments about the HCBS Settings Rule, she shared that CMS is planning to release Medicaid scorecards for states in the near future."

Last week Verma announced that the federal government would be granting states an “ unprecedented level of flexibility” with regard to the administration of state Medicaid programs, including flexibility on the concept of heightened scrutiny.

Increasing flexibility on the heightened scrutiny process, as suggested by Administrator Verma, could signal more discretion to states on the implementation of federal requirements for Home and Community Based Service (HCBS) settings.

Currently, states are obligated to report any settings that are presumed to be "institutional" or have the effect of isolating individuals receiving Home and Community Based Services (HCBS) from the broader community. States can use the process of heightened scrutiny to rebut or overcome this presumption by showing that the setting does not have the qualities of an institution and that it has the qualities of a community setting as required in the HCBS regulations. For more information on the heightened scrutiny process see this FAQ issued by CMS in 2015.

Tax Plan May Be Amended to Gut ACA Mandate

Despite three fairly significant failures on repealing the Affordable Care Act (see PAR Mail 2017-201), the Trump Administration and Speaker of the House Paul Ryan signaled yesterday that the GOP is readying an amendment to repeal the Individual Health Insurance Mandate provision of the ACA, which requires all Americans to have health insurance or pay a fine. If repealed, it is anticipated that the health insurance market, expanded by the ACA, would likely implode.

Not mentioned in Ryan's comments on the Sunday, November 5th talk shows was any mention of reducing Medicaid or converting it into a Block Grant program, earlier key elements of the Trump back American Health Care Act or the Graham/Cassidy bill, both failing to be enacted by the GOP majorities in the House and Senate.

PAR and ANCOR are continuing to monitor both health care and tax bill developments.

How Might the Tax Bill Impact the Disability Community?

CNN reports the Tax Bill does the following:

Reduces income tax brackets from seven to four
Nearly doubling the standard deduction
Eliminating personal exemptions
Expanding the child tax credit:
Eliminating the tax exclusion for dependent care assistance accounts:
Repealing state and local tax deductions, but preserves property tax break:
Limiting deductible mortgage interest
Repealing many other deductions: These include those for medical expenses, tax preparation fees, alimony payments, student loan interest and moving expenses.
Repealing the Alternative Minimum Tax
Repealing the estate tax

According to the Coalition on Human Needs and U.S. Senator Patty Murray (D-Washington), the tax cut plan to be taken up in the House Committee on Ways and Means will blow a hole in the deficit, leading to enormous pressure to cut domestic programs of all kinds – SNAP, Medicaid and other health care, low-income tax credits, child care, Head Start, housing, education, job training, SSI, environmental and consumer protection – all threatened with cuts now or in the years to come.

The plan will be a massive shift of resources from meeting the needs of low/moderate-income people and to tax breaks for high income people and corporations.