[Code of Federal Regulations] [Title 42, Volume 3] [Revised as of October 1, 2004] From the U.S. Government Printing Office via GPO Access [CITE: 42CFR433.58] [Page 76-77] TITLE 42--PUBLIC HEALTH CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PART 433_STATE FISCAL ADMINISTRATION--Table of Contents Subpart B_General Administrative Requirements State Financial Participation Sec. 433.58 Provider-related donations and health care-related taxes during a State's transition period. (a) General rule. During the State's transition period specified in paragraph (b) of this section, a State may receive certain provider- related donations and health care-related taxes without a reduction in FFP. These provider-related donations and health care-related taxes must meet the conditions specified in this section and are subject to limitations specified in Sec. 433.60. (b) Transition periods for States. (1) Except as provided in paragraph (b)(2) of this section, the provisions of this section apply for the period beginning January 1, 1992 and ending-- (i) September 30, 1992, for States whose State fiscal year begins on or before July 1, 1992; or (ii) December 31, 1992, for States whose State fiscal year begins after July 1, 1992. (2) The provisions of this section apply for the period beginning January 1, 1992 and ending June 30, 1993 for States that-- (i) Are not scheduled to have a regular legislative session in calendar year 1992; (ii) Are not scheduled to have a regular legislative session in calendar year 1993; or (iii) Had enacted a health care-related tax program on November 4, 1991. (c) Provider-related donations during the transition period. Subject to the limitations specified in Sec. 433.60, a State may receive, without a reduction in FFP, provider-related donations described in paragraph (d)(3) of this section during the applicable transition period. (d) Permissible donations. To be permissible donations, the donations must be-- (1) Bona fide donations, as defined in Sec. 433.54; (2) Donations made by a hospital, clinic, or similar entity (such as a Federally-qualified health center) for the direct costs of State or local agency personnel who are stationed at that facility to determine the eligibility (including eligibility redeterminations) of individuals for Medicaid and/or to provide outreach services to eligible (or potentially eligible) Medicaid individuals. Direct costs of outstationed eligibility workers refers to the costs of training, salaries and fringe benefits associated with each outstationed worker and similar allocated costs of State or local agency support staff, and a prorated cost of outreach activities applicable to the outstationed workers at these sites. The prorated costs of outreach activities will be calculated taking the percent of State outstationed eligibility workers at a facility to total outstationed eligibility workers in the State, and multiplying the percent by the total cost of outreach activities in the State. Costs [[Page 77]] for such items as State agency overhead and provider office space are not allowable for this purpose; or (3) Provider-related donations, even if the donations do not qualify under the provisions of paragraph (d) (1) or (2) of this section, that meet the following conditions: (i) The donation program was in effect on September 30, 1991, described in State plan amendments or related documents submitted to CMS by that date, or substantiated by written documentary evidence (as described in paragraph (e) of this section) that was in existence as of that date; and (ii) The donation program is applicable to the State's fiscal year 1992, as demonstrated by written documentary evidence as described in paragraph (e) of this section. (e) Written documentary evidence. The State must have written documentation, which was in existence on September 30, 1991, of a donation program described in paragraph (d)(3) of this section that includes the dollar amounts it received in State fiscal year 1992 and the amounts it intended to receive, as evidenced by one or more of the following: (1) Reference to a donation program in a State plan amendment or related documents, including a satisfactory response, as determined by CMS, to a CMS request for additional information; (2) State budget documents identifying the amounts States expected to be received in donations; (3) Written agreements with the parties donating the funds; and/or (4) Other written documents that identify amounts that the States planned to receive in donations from specified organizations during that period. (f) Application of rules to State fiscal year 1993. For any portion of a State's fiscal year 1993 that occurs during the transition period, the State may receive, without a reduction in FFP, the amount of provider-related donations that it received in the corresponding period in State fiscal year 1992, including the 5 days after the end of that period, subject to the limitations specified in Sec. 433.60(a). (g) Health care-related taxes during the transition period. (1) Subject to the limitations specified in Sec. 433.60, States may receive, without a reduction in FFP, health care-related taxes during the State's transition period if: (i) The health care-related taxes are broad-based and uniformly imposed, and the taxpayer will not be held harmless, as specified in Sec. 433.68; or (ii) The health care-related taxes are imposed under-- (A) A tax program that was in effect as of November 22, 1991; or (B) Legislation or regulations that were enacted or adopted as of November 22, 1991. (2) A State may not modify health care-related taxes in existence as of November 22, 1991, without a reduction of FFP, unless the modification only-- (i) Extends a tax program that was scheduled to expire before the end of the State's transition period; (ii) Makes technical changes that do not alter the rate of the tax or the base of the tax (for example, the providers on which the tax is imposed) and do not otherwise increase the proceeds of the tax; (iii) Decreases the rate of the tax, without altering the base of the tax; or (iv) Modifies the tax program to bring it into compliance with Sec. 433.68(f). [57 FR 55138, Nov. 24, 1992; 58 FR 6095, Jan. 26, 1993, as amended at 58 FR 43180, Aug. 13, 1993]