42 CFR §433.72

1. (a)Bases for requesting waiver.
   1. (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:
      1. (i)The tax does not meet the broad based criteria specified in § 433.68c); and/or
      2. (ii)The tax is not imposed uniformly but meets the criteria specified in § 433.68(d)(2) or (d)(3).
   2. (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.
2. (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. (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. (2)The amount of the tax is not directly correlated to Medicaid payments; and
   3. (3)The tax program does not fall within the hold harmless provisions specified in § 433.68(f).
3. (c)Effective date. A waiver will be effective:
   1. (1)The date of enactment of the tax for programs in existence prior to August 13, 1993 or;
   2. (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.