Hospital Community Benefit

Community Benefit State Law Profile Updates

Summary of Notable Changes

Hilltop methodically reviewed the community benefit frameworks of all 50 states to identify changes that occurred between the Profiles’ original publication in March 2013, the first update in January 2015, the second update in December 2015, and the third update in June 2016. Each individual state Profile has been updated to reflect, in detail, current laws, regulations, and policies.

Notable Changes between November 1, 2015, and May 31, 2016

During this time period, two (2) states made changes to their community benefit regulatory structures.

  1. Florida passed two bills—both relating to hospital billing and financial transparency—aimed at helping patients and their families know what to expect and how to plan their finances when they are admitted for non-emergent care. Both SB 1442 and HB 1175 require a hospital facility to disclose to a patient, in writing, the contact information of both non-participating and participating providers, as well as a statement that non-participating providers may bill patients with health insurance for services rendered within the facility. HB 1175 goes further by requiring a facility to provide information on average payments and payment ranges and quality of service measures. The facility is also required to disclose its financial assistance policy, payment plans, discounts, charity care policy, and collection procedures.
  2. Vermont passed one bill related to community needs assessments. S 255 requires hospitals to post on their websites a description of the health care needs identified through a strategic planning process, strategic initiatives developed to address those needs, and opportunities for public participation.

Notable Changes between January 1, 2015, and October 31, 2015

During this time period, two (2) states made changes to their community benefit regulatory structures.

  1. Connecticut modified its earlier statute to allow multi-hospital health systems to file one audited financial statement—reflecting, among other things, costs of free and discounted care—that includes the financial statements for each hospital within the system (HB 6987).
  2. North Carolina’s new provision, contained within an Appropriations Act, goes beyond requiring tax exempt hospitals to annually submit all information contained in the federal Form 990, Schedule H to the state health department; the new language also requires a hospital to display all of the submitted information in a conspicuous place and post it in one location on its website in a manner that is searchable. (HB 97/SL 2015-241).

Notable Changes between March 2013 and December 31, 2014

Hilltop methodically reviewed the community benefit frameworks of all 50 states to identify changes that occurred between the Profiles’ original publication in March 2013 and December 31, 2014. Each individual state Profile has been updated to reflect, in detail, current laws, regulations, and policies.

  • Forty-three (43) states made no changes to their community benefit regulatory structures.
  • Colorado established, among other things, compliance monitoring of hospitals and procedures for notifying patients of hospital billing errors.
  • Connecticut adopted a requirement that tax-exempt hospitals must annually file a copy of their most recently completed Form 990, including all schedules to the state Office of the Healthcare Advocate. They must also submit the data they compiled to prepare their hospital’s community health needs assessment.
  • Illinois adopted rules requiring that certain uniform provisions be included in all hospital financial assistance applications. Additional rules delineate categories of patients to be deemed “presumptively eligible” for hospital financial assistance “without further scrutiny.”
  • Maine now requires that hospitals provide information regarding charity care policies to any uninsured person who requests an estimate of the cost of medical care.
  • New York now requires that each hospital community service plan (community benefit plan) include two state-identified priorities selected jointly with the local health department.
  • North Carolina adopted a statute that requires each nonprofit hospital to provide public access to its federally required financial assistance policies.
  • Virginia enacted a statutory amendment that permits the State Board of Health to amend existing Certificates of Public Need related to, among other things, the provision of reduced rate care to indigents.