Hospital Community Benefits

Nonprofit hospital organizations are required by federal tax law to spend some of their surplus on “community benefits,” which are goods and services that address a community need. They must report this spending to the Internal Revenue Service (IRS) each year in order to stay exempt from paying federal income taxes. The allowable purposes of community benefits are to improve access to services, enhance the health of the community, advance medical knowledge, and reduce government burden. In order to meet the IRS requirement, many hospitals have traditionally provided free or low-cost clinical care and paid for other hospital-centered activities.

The overall business model for hospitals is changing with the implementation of the Affordable Care Act (ACA). As more patients have insurance, and as hospitals get penalized for readmissions and otherwise preventable hospitalizations, these medical institutions have an opportunity to increase their investments in population health and community-centered activities.

Hospital Community Benefits: Opportunities for Healthy Homes
This technical brief provides and overview of hospital community benefits and describes opportunities for healthy homes providers. [pdf; NCHH]

Housing and Community Benefit: What Counts?
Recognizing the link between homes and health, hospitals and health systems are increasingly seeking to improve community health through housing-related activities. Developed by Enterprise and the Catholic Health Association, Housing and Community Benefit: What Counts? offers guidance to tax-exempt hospitals on housing-related activities that they can report as community benefit to the Internal Revenue Service (IRS). The paper explores the latest instructions and executive order updates from the IRS relating to Part I of IRS Form 990 Schedule H, where hospitals report community benefit. [pdf; Enterprise, 2018]

Healing Communities and the Environment: Opportunities for Community Benefit Programs
The purpose of this document is to encourage and inform healthcare leaders to improve community and environmental health by engaging people within their organizations and communities. While environmental factors include the physical, social, and economic environment in which we live, work, and raise families, this document focuses on the physical environment, including the quality of our air, water, food, and facilities, as well as public energy and chemical policies. [pdf; Catholic Health Association of the United States]

Hospital Community Benefit Program
The Hospital Community Benefit Program is a central resource created specifically for state and local policy makers who seek to ensure that tax-exempt hospital community benefit activities are responsive to pressing community health needs. The program provides tools to state and local health departments, hospital regulators, legislators, hospitals, and revenue collection and budgeting agencies, as these stakeholders develop approaches that suit the unique needs of their communities and work toward a more accessible, coordinated, and effective community health system. [url; Hilltop Institute]

Understanding the Hospital Community Benefit Requirement and the Community Health Needs Assessment
The past few years have seen many changes in mandates, reporting, and oversight related to community benefits. One major area of change is the requirement that all not-for-profit hospitals conduct a community health needs assessment (CHNA) and adopt an implementation plan by the end of their 2013 fiscal year. In this webinar, Jessica Curtis, J.D., Director of the Hospital Accountability Project at Community Catalyst, and Julie Willems Van Dijk, Deputy Director, County Health Roadmaps, discuss the concept of community benefits, specific requirements related to community health needs assessment and implementation plans, and explore examples of how hospitals, public health and other community partners can work together to meet these requirements. [url; County Health Rankings]

ASTHO Community Health Needs Assessments Recommendations and Case Studies
This website includes resources created by the Association of State and Territorial Health Officials (ASTHO) and partners in response to the IRS request for comments regarding the IRS requirements for nonprofit hospital organizations to conduct a CHNA every three years and adopt an implementation strategy to meet the needs identified through the CHNA. The page also includes case studies that describe how state health agencies worked with nonprofit hospitals on CHNA to improve the coordination of hospital community benefits with other efforts to improve community health. [url; Association of State and Territorial Health Officials]

Environmental Health Community Benefit
Health Care without Harm and the Catholic Health Association collaborated to assist the Internal Revenue Service in clarifying and improving the instructions under which tax-exempt healthcare organizations report their social and environmental community benefit and community building activities. [url; Health Care Without Harm]

Community Benefit and the ACA: A Brief History and Update
This overview discusses the context of the community health needs assessment (CHNA) process and describes its elements, as implemented by the Internal Revenue Service and Department of the Treasury, the federal agencies charged with oversight and enforcement. [pdf; The George Washington University Department of Health Policy]

Bulletin: IRS Issues Final Rules for Charitable Hospitals under the Affordable Care Act
This bulletin from the Hilltop Institute summarizes the final rules published by the IRS on December 31, 2014, for implementing the “Additional Requirements for Charitable Hospitals” section of the Affordable Care Act (ACA). These rules relate to tax-exempt hospitals’ community health needs assessments (CHNAs); financial assistance policies (FAPs); and hospital charges, billing, and collection practices. [url; Hilltop Institute]