{"abstract":"This proposed rule is intended to address a loophole in a regulatory statistical test applied to State proposals for Medicaid tax waivers. The test is designed to ensure, as required by statute, that non-uniform or non-broad -based health care-related taxes, authorized under a waiver, are generally redistributive. The inadvertent loophole currently allows some health care-related taxes, especially taxes on managed care organizations, to be imposed at higher tax rates on Medicaid taxable units than non-Medicaid taxable units, contrary to statutory and regulatory intent for health care-related taxes to be generally redistributive. The proposed provisions would better implement the statutory requirements by adding additional safeguards to ensure that tax waivers that exploit the loophole because they pass the current statistical test, but are not generally redistributive, are not approvable.","action":"Proposed rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2025/05/15/2025-08566.html","cfr_references":[{"chapter":null,"citation_url":null,"part":"433","title":42}],"citation":"90 FR 20578","comment_url":null,"comments_close_on":"2025-07-14","correction_of":null,"corrections":[],"dates":"To be assured consideration, comments must be received at one of the addresses provided below, by July 14, 2025.","disposition_notes":null,"docket_ids":["CMS-2448-P"],"dockets":[{"supporting_documents":[],"agency_name":"CMS","documents":[{"comment_count":1266,"comment_start_date":"2025-05-14","updated_at":"2026-07-29T01:56:38.937-04:00","comment_url":"https://www.regulations.gov/commenton/CMS-2025-0052-0001","allow_late_comments":false,"id":"CMS-2025-0052-0001","comment_end_date":"2025-07-15","regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"CMS-2025-0052","title":"Medicaid Program; Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole Proposed Rule (CMS-2448-P)"}],"document_number":"2025-08566","effective_on":null,"end_page":20600,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2025/05/15/2025-08566.xml","html_url":"https://www.federalregister.gov/documents/2025/05/15/2025-08566/medicaid-program-preserving-medicaid-funding-for-vulnerable-populations-closing-a-health","images":{"EP15MY25.000":{"large":"https://img.federalregister.gov/EP15MY25.000/EP15MY25.000_large.png","medium":"https://img.federalregister.gov/EP15MY25.000/EP15MY25.000_medium.png","original_size":"https://img.federalregister.gov/EP15MY25.000/EP15MY25.000_original_size.png"}},"images_metadata":{"EP15MY25.000":{"large":{"identifier":"EP15MY25.000","content_type":"image/png","size":39618,"width":821,"sha":"6a1ad8d18e7dfe47e399c7c0d97d5259","url":"https://img.federalregister.gov/EP15MY25.000/EP15MY25.000_large.png","height":551},"medium":{"identifier":"EP15MY25.000","content_type":"image/png","size":12493,"width":402,"sha":"2c9c3c7f2086df4e46ab58bcaefe843e","url":"https://img.federalregister.gov/EP15MY25.000/EP15MY25.000_medium.png","height":270},"original_size":{"identifier":"EP15MY25.000","content_type":"image/png","size":30109,"width":1523,"sha":"6ae6b28b4e8d0773c89793049d1c1453","url":"https://img.federalregister.gov/EP15MY25.000/EP15MY25.000_original_size.png","height":1022}}},"json_url":"https://www.federalregister.gov/api/v1/documents/2025-08566?publication_date=2025-05-15","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2025-05-15/2025-08566/mods.xml","not_received_for_publication":null,"page_length":23,"page_views":{"count":10334,"last_updated":"2026-08-25 14:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-05-15/pdf/2025-08566.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-08566.pdf?1747080968","publication_date":"2025-05-15","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2025/05/15/2025-08566.txt","regulation_id_number_info":{"0938-AV58":{"issue":"202504","html_url":"https://www.federalregister.gov/regulations/0938-AV58/preserving-medicaid-funding-for-vulnerable-populations-closing-a-health-care-related-tax-loophole-cm","title":"Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole (CMS-2448) ","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202504&RIN=0938-AV58&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AV58"],"regulations_dot_gov_info":{"supporting_documents":[],"regulatory_plan":{"html_url":"https://www.federalregister.gov/regulations/0938-AV58/preserving-medicaid-funding-for-vulnerable-populations-closing-a-health-care-related-tax-loophole-cm","title":"Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole (CMS-2448) "},"comments_count":1266,"agency_id":"CMS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=CMS-2025-0052","supporting_documents_count":0,"docket_id":"CMS-2025-0052","document_id":"CMS-2025-0052-0001","regulation_id_number":"0938-AV58","title":"Medicaid Program; Preserving Medicaid Funding for Vulnerable Populations – Closing a Health Care-Related Tax Loophole Proposed Rule (CMS-2448-P)","checked_regulationsdotgov_at":"2026-07-30T08:55:03Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":20578,"subtype":null,"title":"Medicaid Program; Preserving Medicaid Funding for Vulnerable Populations-Closing a Health Care-Related Tax Loophole Proposed Rule","toc_doc":"Preserving Medicaid Funding for Vulnerable PopulationsClosing a Health Care-Related Tax Loophole","toc_subject":"Medicaid Program","topics":["Administrative practice and procedure","Child support","Claims","Grant programs-health","Medicaid"],"type":"Proposed Rule","volume":90}