Nonprofit hospitals are exempt from federal income taxation if they pass organizational and operational tests. Foremost among these requirements is the community benefit standard. Under IRS regulations not-for-profit healthcare providers must satisfy this standard to maintain their exemption. To do so, hospitals must meet a multi-factor test intended to ensure that appropriate benefits flow to the community in exchange for the federal income tax exemptions hospitals enjoy. Despite its importance, the community benefit standard as it currently exists is problematic. It was established with limited public discussion and policy deliberation and in a time when the healthcare industry was very differently constituted than it is today. Due to the drastic changes which have accrued in the decades since the community benefit standard was established, as well as the more recent dramatic changes brought about by the affordable care act, a reexamination of the community benefit standard for nonprofit hospital tax exemption is timely. This dissertation reexamines the community benefit standard in the stages. First, it presents and overview of the community benefit.This overview first examines the historical and legal development of the community benefit standard, then it present the key controversies that have emerged in recent years and the policy responses attempted thus far, and, finally, it evaluates possible future policy directions which efforts at reform could follow. Second, it posts that expanding the current input-based reporting requirement to include not only monetary inputs but also population health outcomes would achieve greater benefit for society. Third, it examines the regulatory and legal ramifications of a move to a more outcome-oriented approach.
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Reforming the Community Benefit Standard for Nonprofit Hospital Tax Exemption.
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