Assignment: The Treasury Department

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Assignment: The Treasury Department

Assignment: The Treasury Department

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Financial Assistance and Certain Other Community Benefits at Cost Part 2: Community Building Activities Part 3: Bad Debt, Medicare, and Collection Practices Part 4: Management Companies and Joint Ventures Part 5: Facility Information Part 6: Supplemental Information

In 2009, Senator Grassley convinced the Democratic majority to include many of the reforms in the Affordable Care Act (ACA) of 2010 (Grassley 2010):

or determining the amount charged to patients, permissible debt collection actions for patients on financial assistance, and the availability of emergency care regardless of the patient’s ability to qualify for assistance.

3. Limit charges to patients eligible for assistance to no more than the lowest amount billed to insured patients.

4. Avoid extraordinary billing and collection activities until eligibility for financial assistance is determined.

Regarding these requirements, the Treasury Department and the IRS issued final regulations referred to as IRS Section 501(r) Regulations that went into effect for taxable years after December 29, 2015. Generally speaking, the IRS can fine noncompliant hos- pitals $50,000, tax all of the organization’s revenue for one or more years, or rescind the hospital’s tax-exempt status (AHA 2015).

Projecting the effects of the ACA on hospital charity care is difficult. Both the individual mandate and the expansion of Medicaid eligibility in many states will replace charity care patients with insured patients. However, undocumented workers who are not covered under the ACA and individuals and small businesses who opt for the federal fines in lieu of purchasing coverage were expected to continue to seek charity care at hospitals (Chazin et al. 2010). Between 2013 and 2014, hospital admissions for uninsured patients in states that expanded Medicaid dropped 44 percent, while hospital admissions for unin- sured patients in states that refused to expand Medicaid increased 6 percent (Rudowitz and Garfield 2015). Uncompensated care costs were estimated to be $5.7 billion lower in 2014 due to the provisions of the ACA (DeLeire, Joynt, and McDonald 2014).

Former Representative Charles W. Boustany (R-LA), who at the time chaired the Subcommittee on Oversight of the Committee on Ways and Means, held hearings in 2012 to review the IRS oversight of tax-exempt organizations including hospital compliance with the ACA (House Committee on Ways and Means 2012).

The state level has also shown significant activity related to the tax privileges of tax-exempt organizations, and 39 states have passed legisla- tion that challenges—or at least defines more narrowly—tax-exempt status and requires either voluntary or mandated reporting of community benefit (Nelson, Tan, and Mueller 2015). For example, the 1993 Texas Charity Care Law requires tax-exempt healthcare organizations to provide a certain amount for community benefit and develop a mission statement and community benefit plan for serving the community’s healthcare needs.

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