42 C.F.R. § 433.54 Bona fide donations.
Title 42 - Public Health
(a) A bona fide donation means a provider-related donation, as defined in §433.52, made to the State or unit of local government, that has no direct or indirect relationship, as described in paragraph (b) of this section, to Medicaid payments made to— (1) The health care provider; (2) Any related entity providing health care items and services; or (3) Other providers furnishing the same class of items or services as the provider or entity. (b) Provider-related donations will be determined to have no direct or indirect relationship to Medicaid payments if those donations are not returned to the individual provider, the provider class, or related entity under a hold harmless provision or practice, as described in paragraph (c) of this section. (c) A hold harmless practice exists if any of the following applies: (1) The amount of the payment received (other than under title XIX of the Act) is positively correlated either to the amount of the donation or to the difference between the amount of the donation and the amount of the payment received under the State plan; (2) All or any portion of the payment made under Medicaid to the donor, the provider class, or any related entity, varies based only on the amount of the total donation received; or (3) The State or other unit of local government receiving the donation provides for any payment, offset, or waiver that guarantees to return any portion of the donation to the provider. (d) CMS will presume provider-related donations to be bona fide if the voluntary payments, including, but not limited to, gifts, contributions, presentations or awards, made by or on behalf of individual health care providers to the State, county, or any other unit of local government does not exceed— (1) $5,000 per year in the case of an individual provider donation; or (2) $50,000 per year in the case of a donation from any health care organizational entity. (e) To the extent that a donation presumed to be bona fide contains a hold harmless provision, as described in paragraph (c) of this section, it will not be considered a bona fide donation. When provider-related donations are not bona fide, CMS will deduct this amount from the State's medical assistance expenditures before calculating FFP. This offset will apply to all years the State received such donations and any subsequent fiscal year in which a similar donation is received.
Title 42: Public Health
PART 433—STATE FISCAL ADMINISTRATION
Subpart B—General Administrative Requirements State Financial Participation
§ 433.54 Bona fide donations.
