Holding Nonprofit Hospitals Accountable Act

To amend the Internal Revenue Code of 1986 to establish new community benefit standards for tax-exempt hospital organizations, and for other purposes. 1. Short title This Act may be cited as the Holding Nonprofit Hospitals Accountable Act 2. Additional requirements for certain hospitals (a) In general Section 501(r) (1) in paragraph (1), by striking and , and (E) meets the community benefit standard described in paragraph (7). , (2) by redesignating paragraph (7) as paragraph (8), and (3) by inserting after paragraph (6) the following new paragraph: (7) Community benefit standard (A) In general A hospital organization meets the requirements of this paragraph if such organization— (i) has a board of directors drawn from the community in which such organization is located, (ii) both— (I) treats patients who pay their bills through public programs, including under the Medicare program under title XVIII of the Social Security Act or under the Medicaid program under title XIX of such Act, and (II) does not limit the number of such patients served at any clinical site owned or controlled by such organization, and (iii) spends an amount which meets or exceeds the expenditure threshold for the taxable year on any combination of— (I) training, education, or research designed to improve patient care, (II) improvements to facilities and equipment except as provided in subparagraph (C), and (III) free or discounted care pursuant to a financial assistance policy. (B) Expenditure threshold For purposes of this paragraph, the term expenditure threshold (C) Special rules for improvements to facilities and equipment (i) In general For purposes of clause (iii)(II) of subparagraph (A)— (I) expenditures under such clause may not be used to account for more than 50 percent of the minimum spending requirement under such subparagraph, and (II) expenditures for the acquisition of a physician practice, hospital, ambulatory surgical center, or any other care delivery organization shall not be taken into account as an improvement to facilities or equipment under such clause. (ii) Care delivery organization For purposes of clause (i), the term care delivery organization . (b) Effective date The amendments made by this section shall apply to taxable years beginning after December 31, 2024. 3. Hospital organization financial assistance policy compliance requirements (a) In general Section 501(r) according to Medicare rates with respect billed (b) Effective date The amendment made by this section shall apply to taxable years beginning after December 31, 2024. 4. Financial assistance policy review and report (a) Review The Treasury Inspector General for Tax Administration shall conduct a review of financial assistance policies of hospital organizations under section 501(r)(4) (b) Report Not later than 365 days after the date of the enactment of this Act and annually thereafter, the Treasury Inspector General for Tax Administration shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the results of the review conducted under subsection (a), including— (1) the content of financial assistance policies of hospital organizations, (2) compliance of hospital organizations with the financial assistance policy requirements of section 501(r)(4) (3) such other topics as are determined by the Treasury Inspector General for Tax Administration to be relevant to financial assistance policies. 5. Internal Revenue Service enforcement review and report (a) Review The Comptroller General of the United States shall conduct a review of the effectiveness of the Internal Revenue Service in enforcing compliance with the community benefit standard for hospital organizations under section 501(r)(7) (b) Report Not later than 365 days after the date of the enactment of this Act and no later than every three years thereafter, the Comptroller General of the United States shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the results of the review conducted under subsection (a).

Summary: Holding Nonprofit Hospitals Accountable Act The bill imposes additional community benefit standards for tax-exempt hospital organizations. A hospital organization must have a board of directors drawn from the community in which it is located and must provide medical care for patients who pay their bills through public programs, including Medicare and Medicaid. The organization may not limit the number of patients served at any clinical site it owns or controls and must spend specified amounts on (1) training, education, or research designed to improve patient care; (2) improvements to facilities and equipment; and (3) free or discounted care. The Inspector General for Tax Administration of the Department of the Treasury must conduct a review of the financial assistance policies of tax-exempt hospital organizations. The Government Accountability Office must review and report on the effectiveness of the Internal Revenue Service in enforcing compliance of tax-exempt hospitals with the new community benefit standards.