Although there is sometimes a popular conception of U.S. hospitals as cogs in a for-profit healthcare machine, the majority of American hospitals are actually nonprofits. Like all nonprofits, these hospitals receive a number of financial benefits, including an exemption from the federal income tax. Many states and municipalities also provide nonprofit hospitals with exemptions from property, sales and other taxes. This favorable tax treatment comes with the responsibility that hospitals provide certain benefits to the communities they serve.
The Affordable Care Act (ACA) contains a provision that requires each nonprofit hospital to conduct an assessment every three years of the health needs of its community to maintain its nonprofit status. This assessment (called a Community Health Needs Assessment, or CHNA) is required to collect input from persons who “represent the broad interests of the community served” by the hospital facility, “including those with special knowledge of or expertise in public health.”
The hospital must also have an implementation strategy to:
Any hospital that violates the new requirements faces a penalty of $50,000 per year, per non-compliant facility. These requirements go into effect for tax years after March 23, 2012.
This new hospital requirement may present an opportunity for health departments, nonprofits and other community health actors to provide input on community health needs that hospitals can help address. The assessment may also provide an opportunity for more in-depth collaboration between nonprofit hospitals and public health departments where interaction already exists, and may provide an opportunity to develop partnerships where they are currently lacking.
State and local health departments are increasingly being subjected to enhanced reporting and action requirements as well. In fact, many health departments will be conducting community health needs assessments similar to those required of nonprofit hospitals either as part of a voluntary accreditation process or because of legal requirements. In many cases, the CHNA may be able to be completed as a joint venture between a nonprofit hospital and a health department.
Health departments and officials should explore the possibility of working with nonprofit hospitals in their area to determine if such collaboration would be feasible and beneficial to the hospital and health department, as well as the people both serve. Health departments should also reach out to community organizations and encourage them to provide feedback to hospitals during the CHNA process, and become involved in that process themselves. The CHNA requirement is a rare opportunity for everyone involved – hospitals, health departments and community members - to reap a meaningful and mutually beneficial return.
This information was developed by Corey Davis, staff attorney, for the Network for Public Health Law – Southeastern Region at National Health Law Program.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.