Community benefits and Schedule H: Holding nonprofit hospitals accountable for their financial policies and practices

“Community benefits” are health-related investments and activities, other than fully reimbursed medical care, that a hospital provides to its community. Community benefit obligations can arise in several legal contexts (e.g. condition of licensure, conversions or health planning processes) but are most commonly associated with tax-exempt hospitals. Section 9007 of the Affordable Care Act (ACA) established new requirements and reporting standards nonprofit hospitals must satisfy for federal tax exemption. These provisions clarify and promote transparency of tax-exempt hospitals' efforts to meet federal community benefit responsibilities in four areas: community health needs assessment, financial assistance policies, limitations on hospital charges, and billing and debt collection requirements. The latter requirements respond partly to persistent reports by national media involving hospital mistreatment and overreaching with respect to indigent, uninsured, and underinsured patients. This presentation will focus on the ACA's requirements relating to nonprofit hospital financial assistance, charges, billing, and collections practices, and how the ACA requirements have been translated into enforceable standards through IRS reporting requirements (Schedule H). It will discuss how hospital billing and collections practices can impact patient behavior and economic stability, as well as which populations are likely to continue to rely on hospital financial assistance despite expanded coverage through the ACA. Finally, it will highlight promising approaches some hospitals and regulators are using to improve hospital practices and patient experiences. The audience for this session includes public health lawyers and practitioners involved in community-based population health improvement initiatives; public health professionals without legal expertise; and state and local policymakers.