Tax Exempt Hospital Transparency Act

Full Title:
Tax Exempt Hospital Transparency Act

Summary#

This bill adds a new reporting section to the Internal Revenue Code that requires tax-exempt hospital organizations to include extra information on the annual return filed under section 6033(a). Required items include: a description of how the hospital is addressing community health needs from its most recent community health needs assessment and any needs not being addressed; audited financial statements; the Centers for Medicare & Medicaid Services certification number (or other ID the Secretary requires); the value (at cost) of financial assistance given under the hospital’s financial assistance policy; and counts of completed financial assistance applications received, granted, and denied.

Larger hospitals and higher-revenue hospitals must provide more detail. A “large” hospital (not a critical access or rural emergency hospital and with more than 100 staffed inpatient beds) must report its top three community health needs, spending on programs to address each need, actions taken, and impact on community health, plus spending on quality improvement, nonclinical programming, and other community benefits. A “high revenue” hospital (not critical access or rural emergency and with net patient revenue over $100,000,000, adjusted after 2028) must report advertising costs (allowable and unallowable), describe each health service line with gross receipts and costs, and, if the hospital participates in the Federal 340B drug discount program as a covered entity, report counts of individuals dispensed 340B drugs by insurance type, aggregate net 340B payment amount, and aggregate costs to participate in the 340B program.

The bill requires separate facility-level reporting for many items for large and high-revenue organizations, directs the Secretary of Health and Human Services (in consultation with the Treasury Secretary) to publish a standardized health service line taxonomy within 2 years, and allows the Secretary to issue regulations for cost-allocation methods. The effective date is tied to publication of the first standardized taxonomy: the reporting rules apply to taxable years beginning after 1 year from that publication. Two financial assistance items for smaller tax-exempt hospitals take effect 3 years after enactment. The bill also directs the Comptroller General to study and report on administrative and compliance costs and to estimate hypothetical tax amounts for the 25 hospitals with the highest gross revenue.

What it means for you#

  • If you are a tax-exempt hospital organization required to file under section 6033(a), your annual return must include the additional information listed in the bill.
  • Large and high-revenue hospital organizations will have more detailed reporting duties, including separate reporting for each hospital facility unless the Secretary allows otherwise.
  • Hospitals that participate in the 340B program and meet the covered-entity definition must report program-specific totals and costs.
  • A standardized service-line taxonomy will be published within 2 years; hospitals must map their internal service lines to that taxonomy for reporting.
  • The bill sets timelines for when the requirements begin: generally 1 year after the taxonomy is published, with a 3-year delay for some smaller-hospital financial assistance items.

Expenses#

No publicly available information on overall cost estimates is included in the bill text. The bill requires the Comptroller General to study and report, within a 1-year period beginning 3 years after enactment, on: (1) estimated additional labor and resource costs to the Department of the Treasury to administer the new reporting and estimated additional compliance costs to tax-exempt hospital organizations; and (2) estimated hypothetical income tax amounts for the 25 tax-exempt hospital organizations with the highest gross revenue if they were not tax-exempt.

Proponents' View#

No publicly available information.

Opponents' View#

No publicly available information.