,i  #aagth ,,congress  #b;d ,session    
,h4 ,r4 #ijhj  ,,in ,,the ,,house ,,of  
,,representatives  ,september #bi1      
#bjbb,mrs4 ,spartz introduced the       
following bill2 which was referred to   
the ,committee on ,ways and ,means  ,a  
,,bill  ,to amend the ,internal ,revenue
 ,code of #aihf to establish new        
community benefit standards for         
tax-exempt hospital organizations1 and  
for other purposes4  #a4 ,short title   
,this ,act may be cited as the          
,non-,profit ,hospital ,tax ,exemption  
,transparency ,act4  #b4 ,additional    
requirements for certain hospitals  7a7 
,in general ,section #eja7r7 of the     
,internal ,revenue ,code of #aihf is    
amended-- 7#a7 in paragraph 7#a71 by    
striking and in subparagraph 7,c71 by   
striking the period at the end of       
subparagraph 7,d7 and inserting 1 and1  
and by adding at the end the following  
new subparagraph3  7,e7 meets the       
community benefit standard described in 
paragraph 7#g74  1  7#b7 by             

redesignating paragraph 7#g7 as         
paragraph 7#h71 and  7#c7 by inserting  
after paragraph 7#f7 the following new  
paragraph3  7#g7 ,community benefit     
standard  7,a7 ,in general ,a hospital  
organization meets the requirements of  
this paragraph if such organization--   
7i7 has a board of directors drawn from 
the community in which such organization
 is located1  7ii7 both-- 7,i7 treats   
patients who pay their bills through    
public programs1 including under the    
,medicare program under title ,,xviii of
 the ,social ,security ,act or under the
 ,medicaid program under title ,,xix of 
such ,act1 and  7,,ii7 does not limit   
the number of such patients served at   
any clinical site owned or controlled by
 such organization1 and  7iii7 spends an
 amount which meets or exceeds the      
expenditure threshold for the taxable   
year on any combination of-- 7,i7       
training1 education1 or research        
designed to improve patient care1       
7,,ii7 improvements to facilities and   

equipment except as provided in         
subparagraph 7,c71 and  7,,iii7 free or 
discounted care pursuant to a financial 
assistance policy4  7,b7 ,expenditure   
threshold ,for purposes of this         
paragraph1 the term expenditure         
threshold means #ajj percent of the     
value of the ,federal1 ,state1 and local
 tax exemptions of the hospital         
organization for the taxable year4  7,c7
 ,special rules for improvements to     
facilities and equipment  7i7 ,in       
general ,for purposes of clause         
7iii77,,ii7 of subparagraph 7,a7-- 7,i7 
expenditures under such clause may not  
be used to account for more than #ej    
percent of the minimum spending         
requirement under such subparagraph1 and
  7,,ii7 expenditures for the           
acquisition of a physician practice1    
hospital1 ambulatory surgical center1 or
 any other care delivery organization   
shall not be taken into account as an   
improvement to facilities or equipment  
under such clause4  7ii7 ,care delivery 

organization ,for purposes of clause    
7i71 the term care delivery organization
 means an organization of people1       
institutions1 and resources whose       
primary mission is to deliver health    
care services to meet the health needs  
of a target population4  4  7b7         
,effective date ,the amendments made by 
this section shall apply to taxable     
years beginning after ,december #ca1    
#bjbc4  #c4 ,hospital organization      
financial assistance policy compliance  
requirements  7a7 ,in general ,section  
#eja7r7 of the ,internal ,revenue ,code 
of #aihf1 as amended by the preceding   
provision of this ,act1 is further      
amended in paragraph 7#e77;,a7 by       
inserting according to ,medicare rates  
with respect after billed4  7b7         
,effective date ,the amendment made by  
this section shall apply to taxable     
years beginning after ,december #ca1    
#bjbc4  #d4 ,financial assistance policy
 review and report  7a7 ,review ,the    
,treasury ,inspector ,general for ,tax  

,administration shall conduct a review  
of financial assistance policies of     
hospital organizations under section    
#eja7r77#d7 of the ,internal ,revenue   
,code of #aihf4  7b7 ,report ,not later 
than #cfe days after the date of the    
enactment of this ,act and annually     
thereafter1 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 7a71  
including-- 7#a7 the content of         
financial assistance policies of        
hospital organizations1  7#b7 compliance
 of hospital organizations with the     
financial assistance policy requirements
 of section #eja7r77#d7 of the ,internal
 ,revenue ,code of #aihf1 and  7#c7 such
 other topics as are determined by the  
,treasury ,inspector ,general for ,tax  
,administration to be relevant to       
financial assistance policies4  #e4     

,internal ,revenue ,service enforcement 
review and report  7a7 ,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    
#eja7r77#g7 of the ,internal ,revenue   
,code of #aihf4  7b7 ,report ,not later 
than #cfe days after the date of the    
enactment of this ,act and no later than
 every three years thereafter1 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 7a74