Waiver provisions applicable to health care-related taxes.

(a) Bases for requesting waiver. (1) A State may submit to CMS a request for a waiver if a health care-related tax does not meet any or all of the following: (i) The tax does not meet the broad based criteria specified in § 433.68c); and/or (ii) The tax is not imposed uniformly but meets the criteria specified in § 433.68(d)(2) or (d)(3). (2) When a tax that meets the criteria specified in paragraph (a)(1) of this section is imposed on more than one class of health care items or services, a separate waiver must be obtained for each class of health care items and services subject to the tax. (b) Waiver conditions. In order for CMS to approve a waiver request that would permit a State to receive tax revenue (within specified limitations) without a reduction in FFP, the State must demonstrate, to CMS's satisfaction, that its tax program meets all of the following requirements: (1) The net impact of the tax and any payments made to the provider by the State under the Medicaid program is generally redistributive, as described in § 433.68(e); (2) The amount of the tax is not directly correlated to Medicaid payments; and (3) The tax program does not fall within the hold harmless provisions specified in § 433.68(f). (c) Effective date. A waiver will be effective: (1) The date of enactment of the tax for programs in existence prior to August 13, 1993 or; (2) For tax programs commencing on or after August 13, 1993, on the first day in the quarter in which the waiver is received by CMS. [57 FR 55138, Nov. 24, 1992, as amended at 58 FR 43182, Aug. 13, 1993]