[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR433.52]



[Page 80]

 

                         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.  433.52  General definitions.



    As used in this subpart--

    Entity related to a health care provider means--

    (1) An organization, association, corporation, or partnership formed 

by or on behalf of a health care provider;

    (2) An individual with an ownership or control interest in the 

provider, as defined in section 1124(a)(3) of the Act;

    (3) An employee, spouse, parent, child, or sibling of the provider, 

or of a person with an ownership or control interest in the provider, as 

defined in section 1124(a)(3) of the Act; or

    (4) A supplier of health care items or services or a supplier to 

providers of health care items or services.

    Health care provider means the individual or entity that receives 

any payment or payments for health care items or services provided.

    Provider-related donation means a donation or other voluntary 

payment (in cash or in kind) made directly or indirectly to a State or 

unit of local government by or on behalf of a health care provider, an 

entity related to such a health care provider, or an entity providing 

goods or services to the State for administration of the State's 

Medicaid plan.

    (1) Donations made by a health care provider to an organization, 

which in turn donates money to the State, may be considered to be a 

donation made indirectly to the State by a health care provider.

    (2) When an organization receives less than 25 percent of its 

revenues from providers and/or provider-related entities, its donations 

will not generally be presumed to be provider-related donations. Under 

these circumstances, a provider-related donation to an organization will 

not be considered a donation made indirectly to the State. However, if 

the donations from providers to an organization are subsequently 

determined to be indirect donations to the State or unit of local 

government for administration of the State's Medicaid program, then such 

donations will be considered to be health care related.

    (3) When the organization receives more than 25 percent of its 

revenue from donations from providers or provider-related entities, the 

organization always will be considered as acting on behalf of health 

care providers if it makes a donation to the State. The amount of the 

organization's donation to the State, in a State fiscal year, that will 

be considered health care related, will be based on the percentage of 

donations the organization received from the providers during that 

period.