Hospital Community Benefits after the ACA

The State Law Landscape

Exteriors of a hospital.

An issue brief from The Hilltop Institute’s Hospital Community Benefit Program explores the Affordable Care Act’s (ACA) updated standards that nonprofit hospitals must meet to qualify for federal tax exemption, and compares those standards to the regulations and policies defined by each state.

The new standards include: conducting a community health needs assessment and developing an implementation strategy every three years; adopting and publicizing a financial assistance policy; and limiting charges, billing, and collections with respect to individuals eligible for financial assistance under the hospital’s financial assistance policy.

Hospital Community Benefits after the ACA: The State Law Landscape is part of a series of briefs funded by the Robert Wood Johnson Foundation (RWJF) and the Kresge Foundation. In addition to federal community benefit requirements, nonprofit hospitals must also comply with community benefit standards of the state in which they are located, generally to protect state tax exemption. This brief is a companion to The Hilltop Institute’s Community Benefit State Law Profiles which present a comprehensive analysis of each state’s community benefit landscape viewed through the lens of the ACA.

The brief analyzes the new federal standards and how state policies and requirements currently compare to the updated standards and finds wide variation in state legislative and regulatory approaches. It concludes by offering policy-makers a range of options to think about as they consider aligning state requirements with new federal requirements, including deferring change, exploring non-legislative changes, and preserving existing state requirements.

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