I 
118TH CONGRESS 
1ST SESSION H. R. 2859 
To amend the Internal Revenue Code of 1986 to establish new community 
benefit standards for tax-exempt hospital organizations, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 25, 2023 
Mrs. SPARTZ introduced the following bill; which was referred to the 
Committee on Ways and Means 
A BILL 
To amend the Internal Revenue Code of 1986 to establish 
new community benefit standards for tax-exempt hospital 
organizations, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Holding Nonprofit 
Hospitals Accountable Act’’. 
SEC. 2. ADDITIONAL REQUIREMENTS FOR CERTAIN HOS-
PITALS. 
(a) IN GENERAL.—Section 501(r) of the Internal 
Revenue Code of 1986 is amended— 
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(1) in paragraph (1), by striking ‘‘and’’ in sub-
paragraph (C), by striking the period at the end of 
subparagraph (D) and inserting ‘‘, and’’, and by 
adding at the end the following new subparagraph: 
‘‘(E) meets the community benefit stand-
ard described in paragraph (7).’’, 
(2) by redesignating paragraph (7) as para-
graph (8), and 
(3) by inserting after paragraph (6) the fol-
lowing new paragraph: 
‘‘(7) COMMUNITY BENEFIT STANDARD.— 
‘‘(A) IN GENERAL.—A hospital organiza-
tion meets the requirements of this paragraph 
if such organization— 
‘‘(i) has a board of directors drawn 
from the community in which such organi-
zation is located, 
‘‘(ii) both— 
‘‘(I) treats patients who pay their 
bills through public programs, includ-
ing under the Medicare program 
under title XVIII of the Social Secu-
rity Act or under the Medicaid pro-
gram under title XIX of such Act, 
and 
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‘‘(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 sub-
paragraph, and 
‘‘(II) expenditures for the acqui-
sition of a physician practice, hospital, 
ambulatory surgical center, or any 
other care delivery organization shall 
not be taken into account as an im-
provement to facilities or equipment 
under such clause. 
‘‘(ii) 
CARE
DELIVERY
ORGANIZA-
TION.—For purposes of clause (i), the 
term ‘care delivery organization’ means an 
organization of people, institutions, and re-
sources whose primary mission is to deliver 
health care services to meet the health 
needs of a target population.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years beginning after 
December 31, 2024. 
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SEC. 3. HOSPITAL ORGANIZATION FINANCIAL ASSISTANCE 
POLICY COMPLIANCE REQUIREMENTS. 
(a) IN GENERAL.—Section 501(r) of the Internal 
Revenue Code of 1986, as amended by the preceding pro-
vision of this Act, is further amended in paragraph (5)(A) 
by inserting ‘‘according to Medicare rates with respect’’ 
after ‘‘billed’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years beginning after 
December 31, 2024. 
SEC. 4. FINANCIAL ASSISTANCE POLICY REVIEW AND RE-
PORT. 
(a) REVIEW.—The Treasury Inspector General for 
Tax Administration shall conduct a review of financial as-
sistance policies of hospital organizations under section 
501(r)(4) of the Internal Revenue Code of 1986. 
(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 con-
ducted under subsection (a), including— 
(1) the content of financial assistance policies 
of hospital organizations, 
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(2) compliance of hospital organizations with 
the financial assistance policy requirements of sec-
tion 501(r)(4) of the Internal Revenue Code of 
1986, and 
(3) such other topics as are determined by the 
Treasury Inspector General for Tax Administration 
to be relevant to financial assistance policies. 
SEC. 5. INTERNAL REVENUE SERVICE ENFORCEMENT RE-
VIEW 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) of the Internal Revenue Code of 
1986. 
(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). 
Æ 
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