Alabama law does not expressly require nonprofit hospitals to provide community benefits.

Alabama law does not expressly require nonprofit hospitals to provide community benefits.

Alabama does not require nonprofit hospitals to report community benefits.

Alabama does not require nonprofit hospitals to conduct community health needs assessments.

Alabama does not require nonprofit hospitals to develop community benefit plans or implementation strategies.

Alabama does not require nonprofit hospitals to adopt or implement financial assistance policies.

Alabama requires hospitals that have financial assistance policies to make written information about these policies available.

Each bill or summary of charges issued by a nonprofit or for-profit hospital must include a prescribed statement that a patient meeting income criteria may qualify “for the financial assistance policy of the hospital.” In addition, signs must be posted in admission and registration areas indicating the availability of financial assistance to qualified patients. A description of the financial assistance application process and a copy of the financial assistance application must be prominently posted on the hospital’s website “if financial assistance is available at the hospital.” Ala Code 22-21-300.

Alabama does not limit nonprofit hospital charges, billing, or collection practices.

Alabama exempts nonprofit hospitals from state income tax.

Alabama exempts from state income tax organizations that are exempt from federal income tax under Internal Revenue Code §501(a). Ala. Code 40-18-32(a).

Alabama exempts from ad valorem taxes nonprofit hospitals’ real and personal property used exclusively for charitable purposes unless the property is “let for rent or hire or for use for business purposes.” Ala. Code 40-9-1(1).

Alabama law provides for a general ad valorem tax exemption of the real and personal property owned and operated by a nonprofit hospital. For-profit hospitals that use a portion of their property for charitable purposes may qualify for a partial ad valorem tax exemption (limited to $75,000 of assessed value) if the hospital certifies that in the previous year it “has done 15 percent of its treatment of patients as charity work.” Ala. Code 40-9-1(1) and (2); Alabama Const., Amendment 373(k); Mingledorff v. Vaughan Regional Medical, 682 So. 2d 415, 422 (1996).

Alabama law does not generally exempt nonprofit hospitals from sales and use taxes.

Alabama law provides nonprofit organizations “no special exemption” from the state’s sales and use taxes; only organizations that are specifically identified in the statute are exempt. Ala. Admin. Code R. 810-6-3-.07.05.

California requires nonprofit hospitals to provide community benefits.

California law expressly recognizes that nonprofit hospitals receive "favorable tax treatment by the government... [i]n exchange [for assuming] a social obligation to provide community benefits …” Cal. Health & Safety Code 127340(a). California defines “community benefit” as hospital activity “intended to address community needs and priorities primarily through disease prevention and improvement of health status.” The statute lists, as non-exclusive examples of community benefit, the unreimbursed costs of providing health care services to vulnerable populations (including both Medicaid and Medicare shortfall); medical research; health professions education; adult day care; child care; sponsoring food, shelter, and clothing for the homeless; support of public health programs; contributions to a community priority; health care cost containment; enhancing access to care; and education, transportation, and other goods or services that help maintain a person’s health. Cal. Health & Safety Code §127345(c).

In addition, California’s certificate of need (CON) law exempts from certain specified CON requirements a health care project proposed by a hospital that agrees to provide free health care services to indigents, over a five year period, equivalent in dollar value to that of the proposed health care project. Cal. Health & Safety Code §127190.

California does not require nonprofit hospitals to provide a specified minimum level of community benefits.

California requires nonprofit hospitals to annually submit community benefit plans specifying the economic value of the community benefits to be provided.

Nonprofit hospitals must annually submit their community benefit plans which, “to the extent practicable,” report the economic value of the community benefits provided, mechanisms for evaluating the plan’s effectiveness, and measurable objectives to be achieved within specified timeframes. The plans must be submitted to the Office of Statewide Health Planning and Development (OSHPD), which makes them available to the public. Cal. Health & Safety Code §127350(d).

In addition, every two years—or when a significant change to the policy is made—a nonprofit hospital must provide copies to OSHPD of its discount payment policy, charity care policy, procedures for determining eligibility under those policies, review process, and the application for charity care or discounted payment programs. Cal. Health & Safety Code §127435.

California requires nonprofit hospitals to conduct assessments to evaluate the health needs of the communities they serve.

A hospital may conduct—either alone, with other health care providers, or through other organizational arrangements—an assessment that evaluates the health needs of the community the hospital serves. At a minimum, the assessment must describe the process employed by the hospital to consult with community groups and local government officials in identifying and prioritizing community needs that can be addressed directly by the hospital, and those that the hospital can address in collaboration with other entities, or through other organizational arrangements. The assessment must be updated at least every three years. Cal. Health & Safety Code §127350(b).

California requires nonprofit hospitals to submit annual community benefit plans that include the activities undertaken by the hospital to address community needs that are within the hospital’s mission and financial capacity. Cal. Health & Safety Code 127350(d).

The plan must also include a statement as to the economic value of the community benefits provided, mechanisms for evaluating the plan’s effectiveness, and measurable objectives to be achieved within specific timeframes. Community benefits are to be categorized into the following framework: 1) medical care services, 2) other benefits for vulnerable populations, 3) other benefits for the broader community, 4) health research, education, and training programs, and 5) nonquantifiable benefits. Cal. Health & Safety Code §127355.

California requires all hospitals to adopt financial assistance policies.

California’s Hospital Fair Pricing Policies Act establishes, as a condition of licensure, minimum standards to be used in determining eligibility for free or discounted care under a hospital’s charity care and discounted care policies. Cal. Health & Safety Code §§127400 – 127466. Hospitals have discretion to extend eligibility for their discount payment and charity care policies to patients with incomes over 350 percent of the federal poverty level. Cal. Health & Safety Code §127400(a)-(g). Hospitals have discretion to extend eligibility for their discount payment and charity care policies to patients with incomes over 350 percent of the federal poverty level. Cal. Health & Safety Code §127405(a)(1)(A).

Among the additional elements that financial assistance policies must include is a requirement that emergency room physicians provide discounted emergency services to patients who are uninsured or have high medical costs and whose incomes do not exceed 350 percent of the federal poverty level. Cal. Health & Safety Code §§127400 – 127466.

California requires hospitals to provide patients written notice of their financial assistance plans and to post notices of the hospital’s financial assistance policies for financially qualified and self-pay patients in specified locations in the hospital.

Each hospital’s written notice must contain information about the availability of the hospital’s discount payment and charity care policies and contact information for an individual or office from which additional information may be accessed. The notice must also advise that emergency room physicians in the hospital must provide discounted emergency services to uninsured patients and patients with high medical costs. Cal. Health & Safety Code §127405(a)(1)(B). Notice of the hospital’s policy for financially qualified and self-pay patients must be conspicuously posted in locations that are visible to the public, including in the emergency department, billing office, admissions office, and other outpatient settings. Cal. Health & Safety Code §127410.

California law limits hospital billing and collection practices.

California limits the amounts hospitals may charge patients with income not exceeding 350 percent of the federal poverty level. Cal. Health & Safety Code §12705. Hospitals must have written policies specifying when and under whose authority patient debt is referred for collection. Cal. Health & Safety Code §127425(a). For uninsured patients and those with high medical costs, the hospital or assignees of hospital debt owed by a “financially qualified” patient may not, until 150 days after the initial billing, report adverse information concerning the patient to a consumer credit reporting agency and may not commence an action against the patient in civil court. Cal. Health & Safety Code §127425(d). Additional details concerning a patient’s property rights and limits on hospital payment practices are set forth in Cal. Health & Safety Code §§127425-127430.

California exempts federally tax-exempt nonprofit hospitals from state income tax.

exclusively for charitable purposes and recognized exempt from federal income tax under §501(c)(3) of the Income Tax Code. In addition, a charitable corporation may not attempt to influence legislation or campaign on behalf of any candidate for public office. Cal. Rev. & Tax. Code §23701d.

California exempts from taxation the property of qualifying nonprofit hospitals.

California law exempts property used exclusively for charitable hospital purposes where, during its immediately preceding fiscal year, the hospital’s operating revenues (exclusive of gifts, endowments, and grants-in-aid) did not exceed operating expenses by an amount equivalent to 10 percent of those operating expenses. Cal. Rev. & Tax Code §214(a)(1).

California law includes no express statutory exemption from sales tax for purchases by nonprofit hospitals. California State Board of Equalization, Sales and Use Taxes: Exemptions and Exclusions (2012).

Louisiana law does not expressly require private nonprofit hospitals to provide community benefits.

The ten state-supported charity hospitals of the Louisiana State University (LSU) Health Care Services Division are responsible for providing nonemergency care to medically indigent and uninsured patients. La. Rev. Stat. Ann.§ §46:6; 17:1519.4(a), (B)(1).

Louisiana does not expressly require private nonprofit hospitals to provide community benefits.

Louisiana does not require nonprofit hospitals to report community benefits.

Louisiana does not require private nonprofit hospitals to conduct community needs assessments.

The Community Advisory Committees of the ten state-supported charity hospitals of the LSU Health Care Services Division are required to assess their communities’ unmet health needs through their Community Advisory Committees, which make recommendations on how the identified needs may be met. La. Rev. Stat. Ann. §17:1519.7(E).

Louisiana does not require nonprofit hospitals to develop community benefit plans or implementation strategies.

Louisiana does not require nonprofit hospitals to adopt or implement financial assistance policies.

The ten state-supported charity hospitals of the LSU Health Care Services Division are solely responsible for providing nonemergency care to medically indigent and uninsured patients. La. Rev. Stat. Ann.§ §46:6; 17:1519.4(a), (B)(1).

Louisiana does not require nonprofit hospitals to adopt, implement, or disseminate financial assistance policies.

Louisiana limits specified collection practices of both nonprofit and for-profit hospitals.

Louisiana prohibits the seizure and sale of a person’s homestead to satisfy debts arising from “catastrophic or terminal illness or injury.” La. Rev. Stat.§ Ann. 20:1(A)(2).

Louisiana law exempts nonprofit hospitals from state income tax.

Louisiana exempts from state income tax the income of any organization that is exempt from federal income tax under Internal Revenue Code §501. La. Rev. Stat. Ann. §47:287.501(A).

The Louisiana Constitution exempts from taxation the property of nonprofit corporations.

The Louisiana Constitution exempts from state taxation property owned by a nonprofit corporation organized and operated exclusively for charitable purposes. La. Const. art 7, §21(B)(1)(a)(i). Medical equipment leased for a term exceeding five years to a nonprofit corporation that operates a small rural hospital may also be exempt from property tax if additional statutory requirements are met. La. Const. art 7, §21(B)(1)(a)(ii).

Louisiana does not exempt nonprofit hospitals (except “free hospitals”) from state sales tax.

Louisiana exempts free hospitals from sales tax. (A “free hospital” is one that “does not charge any patients for health care provided by the hospital.”) The exclusion applies to sales of supplies, equipment, and services that are “reasonably necessary for the operation of free hospitals.” La. Rev. Stat. Ann. 47:301(7)(3), (10)(p), (18)(c), (21).

North Carolina law does not expressly require nonprofit hospitals to provide community benefits.

However, the state requires nonprofit hospitals to report community benefits as a condition of receiving authorization to issue tax-exempt financing. N.C. Gen. Stat.§§131A-21; 131A-7; North Carolina Medical Care Commission, Community Benefits Report (Hospitals).

North Carolina law does not expressly require nonprofit hospitals to provide community benefits.

North Carolina requires nonprofit hospitals to report community benefits.

Tax-exempt hospitals must submit annually to the state health department the information contained on IRS Form 990, which the department then posts on its website. The same information must be conspicuously displayed in the hospital’s original place of business. HB 97/SL 2015-241 (2015). North Carolina also requires nonprofit hospitals to report community benefits as a condition of receiving authorization from the state’s Medical Care Commission to issue tax-exempt financing. N.C. Gen. Stat.§§131A-21; 131A-7; North Carolina Medical Care Commission, Community Benefits Report (Hospitals).

North Carolina does not require nonprofit hospitals to conduct community health needs assessments.

North Carolina does not require nonprofit hospitals to submit community benefits plans or implementation strategies.

Although North Carolina does not require nonprofit hospitals to submit community benefit plans/implementation strategies, it requires an individual applying for a certificate of need (required prior to offering a new “institutional health service”) to include in the application a “commitment and plan for serving indigent and medically underserved populations.” N.C. Gen. Stat. §131E-178(a)(4). The application must indicate how the new service will meet the needs of the “medically underserved,” including low-income and medically indigent individuals. N.C. Gen. Stat. §131E-183(13).

North Carolina does not require nonprofit hospitals to adopt or implement financial assistance policies.

North Carolina requires nonprofit hospitals to provide the public access to their financial assistance policies.

Hospitals required to file IRC Form 990, Schedule H are also required to submit their financial assistance policies and financial assistance costs on an annual basis to the Department of Health and Human Services for display in one location on its website and in a manner that is searchable. Hospitals must also display this information “in a conspicuous place.” N.C. Gen. Stat. §131E-214.14 (2013).

North Carolina requires hospitals to provide to discharged patients an itemized list of charges upon request, as well as abide by reasonable collection practices.

Hospitals must provide an itemized list of charges to a patient upon request. A patient may request an itemized list at any time within three years after the date of discharge. N.C. Gen. Stat. §131E-91(a) (2013). Hospitals are also required to establish a method for patients to inquire about or dispute a bill. N.C. Gen. Stat. §131E-91(a) (2013). A hospital may not bill insured patients for charges that would have been covered by their insurance if the hospital had submitted the claim within the allotted time requirements. N.C. Gen. Stat. §131E-91(c) (2013).

Hospitals must also follow reasonable collection practices. Hospitals may not send a patient’s unpaid bill to collections while a decision on the patient’s charity care application is pending or attach a lien to a patient’s principal residence. N.C. Gen. Stat. §131E-91(d). Patients must be given written notice that their bill will be subject to collections activity at least 30 days prior to the referral for collection being made. N.C. Gen. Stat. §131E-91(d) (2013).

North Carolina law exempts nonprofit hospitals from state income tax.

North Carolina law exempts from state income tax corporations organized for charitable purposes and any other organizations that are exempt from federal income tax. N.C. Gen. Stat. § 105-130.11(a)(3).

North Carolina law exempts from taxation the real and personal property of nonprofit hospitals “actually and exclusively used for charitable hospital purposes.”

A “charitable hospital purpose” is defined as “a hospital purpose that has humane and philanthropic objectives [and] … benefits humanity or a significant rather than limited segment of the community without expectation of pecuniary profit or reward.” N.C. Gen. Stat. § 105.278.8.

North Carolina law does not exempt nonprofit hospitals from sales and use tax.

North Carolina law specifies that nonprofit hospitals are subject to state sales and use tax at the time tangible personal property is purchased. North Carolina Department of Revenue, State Taxation and Nonprofit Organizations, p. 4. However, subject to certain limitations, nonprofit hospitals are eligible to receive a semi-annual refund of sales and use taxes paid on purchases used to carry out their work. N.C. Gen. Stat.§105-164.14 (b)(1). All

Oklahoma law does not expressly require nonprofit hospitals to provide community benefits.

Oklahoma does not expressly require nonprofit hospitals to provide community benefits.

Oklahoma does not require nonprofit hospitals to report community benefits.

Oklahoma does not require nonprofit hospitals to conduct community health needs assessments.

Oklahoma does not require nonprofit hospitals to develop community benefit plans or implementation strategies.

Oklahoma law requires all hospitals to establish a discounted care program that provides medically necessary services at a reduced rate to qualified self-pay patients.

Discounted medically necessary care must be made available to individuals with household incomes below 300 percent of the federal poverty level who are ineligible for and not enrolled in a public or private insurance plan that provides hospital coverage. The minimum required hospital discount must be such that the hospital charge after discount is not more than the greater of the Medicare rate for the service or the hospital’s cost of providing the service. Okla. Stat. tit. 63 §1-723.2.

Oklahoma does not require hospitals to disseminate financial assistance policies.

Oklahoma limits nonprofit hospital charges.

Hospitals may charge patients who qualify for financial assistance no more than the greater of the amount Medicare would pay for the same services or the hospital’s cost of providing the services. A hospital’s disregard of this limitation may be raised as a defense to a collection action initiated by the hospital against a patient for medical debt. Okla. Stat. tit. 63 §1-723.2.

Oklahoma law exempts nonprofit hospitals from state income tax.

Oklahoma law exempts from state income tax organizations that are exempt from federal income tax. Okla. Stat. tit. 68 §2359.

Oklahoma law exempts nonprofit hospitals from state property tax.

Oklahoma law exempts from taxation property of nonprofit and charitable hospitals that are used “directly, solely, and exclusively” within Oklahoma for charitable purposes, with no part of its income inuring to private benefit. In addition, the hospital’s facilities must be open to the public without discrimination as to race, color, or creed and regardless of ability to pay. Okla. Stat. tit. 68 §2887(10).

Oklahoma does not exempt nonprofit hospitals from sales tax.

Rhode Island requires hospitals to provide charity care, uncompensated care, and other community benefits as a condition of licensure.

Rhode Island has established statewide standards for the provision of charity care, uncompensated care, and community benefits as conditions of initial and continued hospital licensure and for hospital conversions. R.I. Gen. Laws §23-17-43; 23-17 R.I. Code R. §8.7; 23-17.14 R.I. Code R. §§11.0 – 11.6.

Rhode Island’s hospital licensing regulations expressly require that hospital charity and uncompensated care and community benefit standards be consistent with the rules and regulations applicable to hospital conversions. 23-17 R.I. Code R. §8.7. These define “community benefit” broadly to include the provision of hospital services that meet the community’s needs, charity care, uncompensated care, programs to meet the needs of medically indigent individuals, non-revenue-producing programs available in the community (e.g., health screenings or transportation services), scientific or medical research, education activities, forming linkages with community partners focused on improving community health, and engaging in community health advocacy. 23-17.14 R.I. Code R. §1.9.

Rhode Island does not specify a minimum level of community benefits that hospitals must provide.

Rhode Island law requires hospitals to submit annual community benefit reports to the Director of the Department of Health (Director).

The reports must include detailed descriptions, with supporting documentation, of the costs of charity care, bad debt, and contracted Medicaid shortfalls. R.I. Gen. Laws Ann. § 23-17.14-15(d). If the Department of Health receives “sufficient information” indicating that a licensed hospital is not in compliance with state community benefit standards, then the Director is required to hold a hearing, issue written findings, and impose appropriate penalties. R.I. Gen. Laws Ann. § 23-17.14-15(e).

Rhode Island requires each hospital to develop a formal Board-approved community benefit plan that includes a comprehensive assessment of the health care needs of its community.

The assessment must include needs related to the goals articulated in A Healthier Rhode Island by 2010: A Plan for Action, and a statement of priorities consistent with the hospital’s resources. 23-17.14 R.I. Code R. §11.5 (b).

Rhode Island requires hospitals to develop a formal Board-approved community benefit plan that considers the health care needs of the community or communities served.

A hospital’s community benefit plan, to be updated every three years, must specify the communities (including racial or ethnic minority populations) that will be the focus of the plan. Representatives of the designated community or communities must be involved in the planning and implementation process. The plan must reflect a comprehensive assessment of the health care needs of these designated communities. It must also specify the actual or planned dates when the activities and proposals included in the plan will be implemented. 23-17.14 R.I. Code R. §11.5(b).

Rhode Island law establishes a statewide community standard for the provision of free and discounted care.

Rhode Island hospitals must make full or partial charity care available to uninsured low-income state residents who are ineligible for government or employer-sponsored health coverage. 23-17.14 R.I. Code R. §11.3(b). Hospitals may expand their financial assistance policies beyond what the state requires but may not reduce the amount of assistance or make their financial assistance eligibility standards more restrictive than the state prescribes.

Hospitals must provide free care for patients with annual income at or below 200 percent of the federal poverty level (FPL) and must provide discounted care for patients with annual income between 200 and 300 percent of the FPL. Each hospital’s discounted care policy must be based on a sliding fee scale that the hospital determines based on its evaluation of the needs of its service area and the hospital’s financial resources. 23-17.14 R.I. Code R. §11.3(f).

In determining a patient’s eligibility for free or discounted care, a hospital has discretion to consider, in addition to income, a patient’s assets pursuant to a criterion establishing an assets protection threshold. If assets are considered in determining whether a patient qualifies for free care, additional restrictions on permissible hospital billing and collections against the patient apply. 23-17.14 R.I. Code R. §11.3(d)-(f).

Rhode Island requires hospitals to develop a public “Notice of Hospital Financial-Aid” and post it prominently in emergency departments, admissions areas, outpatient care areas, and on the hospital’s website.

Each hospital is required to develop a “Notice of Hospital Financial-Aid” on a specified template for approval by the Director, as well as include the notice on each patient bill. Each hospital’s financial-aid criteria for financial assistance eligibility, including the sliding fee schedule for discounted care, are also subject to the Director’s approval. Hospitals must also make their financial aid criteria available to all persons upon request. 23-17.14 R.I. Code R. §11.3(h)-(j).

Rhode Island law limits nonprofit hospital billing and collection practices.

Regulations promulgated under Rhode Island’s Hospital Conversions Act, which applies to both hospital licensing and conversions, require each hospital to formally adopt a written collections policy and make it available to all persons upon request. 23-17.14 R.I. Code R. §11.3(n). Although a hospital may attach a patient or guarantor’s primary residence due to non-payment of medical debt, it may not force a foreclosure of the primary residence. 23-17.14 R.I. Code R. §11.4.

Rhode Island exempts non-profit hospitals from state Business Corporation tax. Rhode Island Department of Revenue, R.I. Gen. Laws §44-11-1(1)(c)(4)(iv).

Rhode Island law exempts from taxation the property of a hospital “for the sick or disabled.”

Real and personal property held by or for a hospital for the sick and disabled and used exclusively for that purpose is exempt. R.I. Gen. Laws §44-3-3(12); Lifespan Corporation v. City of Providence, 776 A.2d 1061 (R.I. 2001). State law also exempts intangible personal property owned by, or held in trust for, a charitable organization if the principal or income is used or appropriated for charitable purposes. R.I. Gen. Laws §44-3-3(7).

Rhode Island sales and use tax does not apply to sales of personal property to nonprofit hospitals. R.I. Gen. Laws §44-18-30(5); Rhode Island Sales Regulation SU 07-48.

Washington requires both nonprofit and for-profit hospitals to provide free and discounted care to indigent patients. Wash. Rev. Code §70.170.060(5).

Washington law does not specify a minimum level of community benefits that nonprofit hospitals must provide.

Washington requires nonprofit and for-profit hospitals to report charity care provided.

Washington law requires hospitals to compile and report to the Washington Department of Health the amount of free and discounted care provided. Wash. Admin. Code §246-453-080.

Washington requires nonprofit hospitals that have been federally recognized under §501(c)(3) of the Internal Revenue Code to make their federally required community health needs assessment widely available to the public within 15 days of its submission to the IRS. Wash. Rev. Code §70.41.470(1).

Washington requires nonprofit hospitals to make community benefit plans and implementation strategies publically available.

Washington requires each federally recognized 501(c)(3) tax-exempt hospital to make widely available to the public, within one year of completing its community health needs assessment, its federally required implementation strategy. Either as part of the implementation strategy or separately, the hospital must explain why any recommendations for community benefit proposals identified in the hospital’s community health needs assessment through stakeholder consultation were not accepted. If data are available, the implementation strategy must be evidence-based; innovative programs and practices should be supported by evaluation measures. Wash. Rev. Code §70.41.470 (2012).

Washington requires nonprofit and for-profit hospitals to adopt and implement financial assistance policies. Wash. Rev. Code §70.170.060(5).

Washington requires hospitals to provide free and discounted care to patients whose responsible parties are identified as indigent, based on specified criteria: responsible parties with family income not exceeding 100 percent of the federal poverty level are indigent and qualify for “charity sponsorship” for the full amount of hospital charges not otherwise covered by public or private sources. Wash. Admin. Code §246-453-040(1). Responsible parties with family income of 101 to 200 percent of the federal poverty level are indigent and qualify for discounted charges in accordance with the hospital’s sliding fee schedule and policies regarding individual financial circumstances. Wash. Admin. Code §246-453-040(2). Hospitals also have discretion to identify responsible parties with higher income as indigent and eligible for discounted charges based on individual financial circumstances. Wash. Admin. Code §246-453-040(3). Hospitals must implement a sliding fee schedule for patients identified as indigent for discounted charges following mandated guidelines. Wash. Admin. Code §246-453-050(1).

Washington requires hospitals to make publicly available notice that hospital charges incurred by indigent responsible parties may be waived or reduced. Wash. Admin. Code 246-453-020(2).

Washington limits nonprofit hospital billing and collection practices.

A nonprofit or for-profit hospital may not begin collection activities until it has made an initial determination of whether the patient has public or private insurance and whether the responsible party is indigent and eligible for free or discounted care. Wash. Admin. Code 246-453-020(1); Wash. Rev. Code §70.170.060(6). If a hospital’s initial determination finds that the patient may be an indigent person, collection efforts must cease until a final determination is made. Wash. Admin. Code 246-453-020(1)(c).

Washington does not have a state income tax.

Washington law exempts nonprofit hospitals from state property tax.

Washington law exempts from taxation the real and personal property used by nonprofit hospitals. Wash. Rev. Code §84.36.040(1)(e).

Washington law exempts nonprofit hospitals from state property tax.

In general, Washington nonprofit organizations must pay sales tax on goods and services they purchase. Wash. Rev. Code §82.08.020(1); Washington State Department of Revenue. However, Washington law exempts sales to hospitals that do not charge patients for health care. Wash. Rev. Code §82.08.02795.

West Virginia nonprofit hospitals must demonstrate that their property is used for charitable purposes in order to qualify for property tax exemption.

West Virginia exempts from taxation “property used for charitable purposes and not held or leased out for profit” and “property belonging to … any hospital not held or leased out for profit.” W. Va. Code §11-3-9(a)(12) and (a)(17). Regulations establish that the primary factor in determining the charitable purpose of a hospital is the provision of charity care. W. Va. Code R. §110-3-24. Additional factors include “[t]he provision of activities which promote the health of the community served by the hospital and/or decrease the burdens of state, county and municipal governments …” W. Va. Code R. §§ 110-3-24.2. Charity care is uncompensated care provided to “indigent and medically indigent people” as part of a written mission or charity care policy. West Virginia Health Care Authority, 2013 Annual Report.

West Virginia law does not specify a minimum level of community benefits that nonprofit hospitals must provide.

As a condition of property tax exemption, nonprofit hospital property must be used for a charitable purpose. A hospital may demonstrate charitable use of its property by providing charity care “in a volume and frequency determined by the hospital board of trustees, as articulated in the charity care plan …” W. Va. Code R. §§ 110-3-24.2.1.

West Virginia nonprofit hospitals must report charity care discharge data to the state Health Care Authority.

West Virginia requires hospitals to report data extracted from billing systems with respect to all hospital inpatient stays, regardless of the expected source of payment, expressly including “charity discharges.” West Virginia HealthCare Authority, Data Collection Policies and Procedures, p.1.

West Virginia does not require nonprofit hospitals to conduct community health needs assessments.

West Virginia does not require nonprofit hospitals to develop community benefit plans or implementation strategies.

West Virginia nonprofit hospitals that rely on the provision of charity care to establish their property’s “charitable use” and qualification for property tax exemption must develop a charity care plan.

A hospital’s charity care plan must be reviewed by its Boards of Trustees at least every two years. W. Va. Code R. §§110-3-24.9.3 - 110-3-24.9 .8.5.

West Virginia nonprofit hospitals that rely on the provision of charity care to establish their property’s “charitable use” and qualification for property tax exemption must disseminate their financial assistance policies.

West Virginia requires that such hospitals post in the emergency and admitting areas a notice containing a statement of the existence of their obligation to provide free and below-cost care and of the criteria and mechanism for receiving such care. Written notices must also be provided to each person admitted or treated who does not demonstrate payment coverage under governmental programs or private insurance. W. Va. Code R. §110-3-24.9.4.5.

West Virginia does not limit nonprofit hospital charges, billing, or collection practices.

West Virginia law exempts nonprofit hospitals from state income tax.

West Virginia law exempts from state income tax corporations that are exempt from federal income tax. W. Va. Code §11-24-5(a).

West Virginia law exempts from state property tax real and personal property that is used for a “charitable purpose.”

West Virginia exempts from taxation “property used for charitable purposes and not held or leased out for profit” and “property belonging to … any hospital not held or leased out for profit.” W. Va. Code §11-3-9(a)(12) and (a)(17). Regulations establish that the requisite charitable uses include charity care and “[t]he provision of activities which promote the health of the community served by the hospital and/or decrease the burdens of state, county and municipal governments ….” W. Va. Code R. §§ 110-3-24.2. Charity care is uncompensated care provided to “indigent and medically indigent people” as part of a written mission or charity care policy. West Virginia Health Care Authority, 2013 Annual Report.

West Virginia law does not generally exempt nonprofit organizations from sales tax. W. Va. Code §11-15-9(a)(6).