The Arc Calls on Advocates to Support Lifeline Programs

Medicaid, Social Security Disability Insurance (SSDI), and other lifeline programs for people with I/DD are under attack. The House and Senate passed a concurrent budget resolution that calls for significant cuts, setting in motion a process to restructure the Medicaid program. It’s time to act! We are calling on our advocates to engage their members of Congress in support of these critical programs.  Please register your concerns by responding to the action alert posted above.  To assist you with engaging in other activities, The Arc has created a toolkit with tips and key messages to convey.   The Memorial Day recess and the July 4th recess are excellent times to step up our activities by writing, calling or visiting your Member of Congress.

New Report Released by the Centers for Medicare and Medicaid Services

Last week, the Centers for Medicare and Medicaid Services (CMS) released a report titled “The Right Supports at the Right Time: How Money Follows the Person (MFP) Programs Are Supporting Diverse Populations in the Community.” This report examines how six MFP grantees are serving populations with diverse needs in the community and the factors that have contributed to their performance on key outcome measures. The report is available here.

U.S. Supreme Court Rules That Providers Cannot Sue to Enforce Payment Levels

On March 31, in Armstrong v. Exceptional Child Center, Inc., the U.S. Supreme Court decided that the Constitution’s Supremacy Clause cannot be used by private providers of Medicaid-funded community services for people with developmental disabilities to sue the state of Idaho for setting payment rates too low. The providers of habilitation services had sued Idaho for violating a provision of the Medicaid program that requires states to set rates that ensure adequate access to services.  The United States Court of Appeals for the Ninth Circuit upheld the providers’ right to sue Idaho under the Supremacy Clause.

The issue of provision of adequate rate-setting is a major one for Medicaid beneficiaries, including people with I/DD. Unfortunately, the Supreme Court decided that the Supremacy Clause does not confer a private right of action, and that Medicaid providers cannot sue to enforce the Medicaid provisions requiring states to “assure that payments are consistent with efficiency, economy, and quality of care” while “safeguard[ing] against unnecessary utilization of … care and services”. Some court observers believe that this decision could further narrow the rights of beneficiaries to use other means to protect individual rights. It remains to be seen how this decision will be interpreted in the lower courts and in future Supreme Court decisions.

HCBS Settings Rule

Last week, the deadline for states to submit their transition plans to CMS outlining how they will come into compliance with the HCBS Settings Rule passed. Several states have yet to submit their final plans; in fact some states are still collecting public comment in response to their proposals. CMS has not yet approved any of the transition plans which have been submitted for consideration. Federal resources and state by state details, including draft and final plans, can be found at www.hcbsadvocacy.org. The Arc will continue to monitor this issue.

HCBS Settings Rule

Last week, the Centers for Medicare & Medicaid Services (CMS) provided updated portions of the CMCS Home and Community-Based Services (HCBS) Toolkit: the HCBS Basic Element Review Tool for Statewide Transition Plans and the HCBS Content Review Tool for Statewide Transition Plans. The full HCBS toolkit, including the updated portions, is available online at http://www.medicaid.gov/hcbs/

New HCBS Resource: Questions and Answers About the Home and Community Based Services (HCBS) Settings Rules

The Arc is pleased to share a new Q&A document designed to be a resource to assist advocates understand the impact of the HCBS Settings Rule as the March 17, 2015 deadline for states to submit a transition plan to the Centers for Medicare and Medicaid Services (CMS) approaches. The document provides answers to frequently asked questions about the Rule as well as links to primary source documents and additional information members of The Arc may find helpful as they advocate for the full inclusion and community participation of people with I/DD.

Tax Exempted Waiver Payments

Last week, The Arc reported on IRS Bulletin (2014-4) and an accompanying Q&A clarification document which, as of January 3, 2014, under IRS Code §131, allow payments to qualified Medicaid waiver providers to be excluded from gross income tax for reporting purposes. The clarification document states, in part, “… the IRS will treat ‘qualified Medicaid waiver payments’ as difficulty of care payments excludable from gross income under §131 of the Internal Revenue Code.  For purposes of the notice, qualified Medicaid waiver payments are payments by a state, a political subdivision of a state, or a certified Medicaid provider under a Medicaid waiver program to an individual care provider for nonmedical support services provided under a plan of care to an individual (whether related or unrelated) living in the individual care provider’s home.” The Arc sought clarification from the Internal Revenue Service and learned that individual providers can amend previous tax returns according to standard amendment practice. The IRS will release additional FAQs next month.

Tax Exempted Waiver Payments

Recently, The Arc became aware of an IRS Bulletin (2014-4) as well as an accompanying Q&A clarification document which, as of January 3, 2014 under IRS Code §131, allow payments to qualified Medicaid waiver providers to be excluded from gross income tax for reporting purposes. The clarification document states, in part, “… the IRS will treat ‘qualified Medicaid waiver payments’ as difficulty of care payments excludable from gross income under § 131 of the Internal Revenue Code.  For purposes of the notice, qualified Medicaid waiver payments are payments by a state, a political subdivision of a state, or a certified Medicaid provider under a Medicaid waiver program to an individual care provider for nonmedical support services provided under a plan of care to an individual (whether related or unrelated) living in the individual care provider’s home.” The Arc is seeking further clarification from the Internal Revenue Service and will share additional information accordingly.

Centers for Medicare & Medicaid Services (CMS) Leader Resigning

Marilyn Tavenner, the chief administrator for the federal agency that oversees Medicaid, Medicare and most of the Affordable Care Act is resigning at the end of the month. She was confirmed overwhelmingly by the Senate in May, 2013 and oversaw the roll out of the Affordable Care Act. Prior to her announcement, several other key leaders at CMS had resigned including Cindy Mann, who was the Deputy Administrator and Director of the Center for Medicaid and CHIP Services. Under the leadership of Ms. Tavenner and Ms. Mann, several important initiatives were advanced and there was increased openness to working with advocates and stakeholders.

Supreme Court to Hear Medicaid Case

Today, the Supreme Court will hear arguments in an important case involving Medicaid. At issue in the case (Armstrong v. Exceptional Child Center, Inc.) is whether there is a judicial process to ensure that Medicaid beneficiaries have equal access to care as required by the law.   Specifically, this case involves Medicaid providers suing the state over inadequate reimbursement rates. The Arc will be following the case closely as judicial action by private parties has been an important advocacy tool in enforcing aspects of the Medicaid law. The Arc is also very concerned that inadequate provider reimbursement rates create barriers to accessing health care and living in the community.