,i #aai? ,,congress #b;d ,session ,h4 ,r4 #iejd ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,june #bi1 #bjbf,mr4 ,murphy 7= himself & ,mr4 ,smuck]7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,ways & ,means ,a ,,bill ,to am5d ! ,int]nal ,rev5ue ,code ( #aihf to e/abli% additional report+ requirem5ts = hospital organizations1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,tax ,exempt ,hospital ,transp>5cy ,act4 #b4 ,in=mation report+ by hospital organizations 7a7 ,9 g5]al ,subp>t ,a ( "p ,,iii ( sub*apt] ,a ( *apt] #fa ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by ins]t+ aft] section #fjcc ! foll[+ new section3 #fjcc;,a4 ,report+ by tax exempt hospital organizations 7a7 ,report+ by tax exempt hospital organizations 7#a7 ,9 g5]al ,e tax exempt hospital organization %all include on ! return fil$ "u section #fjcc7;a7 = ! taxable ye>-- 7,a7 a description ( h[ ! organization is address+ ! ne$s id5tifi$ 9 ! mo/ rec5t community heal? ne$s assessm5t conduct$ "u section #eja7r77#c7 & a description ( any su* ne$s t are n be+ address$ toge!r ) ! reasons :y su* ne$s are n be+ address$1 7,b7 ! audit$ f9ancial /atem5ts ( su* organization 7or1 9 ! case ( an organization ! f9ancial /atem5ts ( :i* are includ$ 9 a consolidat$ f9ancial /atem5t ) o!r organizations1 su* consolidat$ f9ancial /atem5t71 7,c7 ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices c]tification numb] ( ! organization 7or su* o!r id5tify+ in=mation z ! ,secret>y may require71 7,d7 ! value1 at co/1 ( ! f9ancial assi/ance provid$ dur+ su* taxable ye> pursuant to ! organization's f9ancial assi/ance policy 7z describ$ 9 section #eja7r77#d771 & 7,e7 ! numb]s ( complet$ f9ancial assi/ance applications receiv$1 grant$1 & d5i$ dur+ ! taxable ye> pursuant to ! organization's f9ancial assi/ance policy 7z describ$ 9 section #eja7r77#d774 7#b7 ,sep>ate report+ ) respect to ea* facility ,except z o!rwise provid$ by ! ,secret>y1 9 ! case ( any l>ge tax exempt hospital organization or any high rev5ue tax exempt hospital organization1 ! in=mation describ$ 9 subp>agraphs 7,a71 7,c71 7,d71 & 7,e7 ( p>agraph 7#a7 %all be provid$ ) respect to ! organization & sep>ately /at$ ) respect to ea* hospital facility op]at$ by su* organization4 7b7 ,additional report+ by l>ge tax exempt hospital organizations 7#a7 ,9 g5]al ,e l>ge tax exempt hospital organization %all include on ! return fil$ "u section #fjcc7;a7 = ! taxable ye>-- 7,a7 ! #c highe/ priority heal? ne$s id5tifi$ 9 ! mo/ rec5t community heal? ne$s assessm5t conduct$ "u section #eja7r77#c71 ! am\nt ( sp5d+ dur+ ! taxable ye> on programs design$ to address ea* su* ne$1 & a description ( actions tak5 dur+ ! taxable ye> to meet ea* su* ne$ & ! impact ( su* actions on community heal?1 & 7,b7 ! am\nt ( sp5d+ by ! organization dur+ ! taxable ye> on-- 7i7 quality improvem5t1 7ii7 noncl9ical programm+1 & 7iii7 su* o!r community b5efits z ! ,secret>y may prescribe4 7#b7 ,quality improvem5t ,= purposes ( ?is subsection1 ! t]m quality improvem5t means any program1 initiative1 or dep>tm5t1 ) ! prim>y purpose ( improv+ heal? outcomes = pati5ts ( ! organization1 :i* may include-- 7,a7 education1 7,b7 tra9+1 7,c7 compliance ) quality improvem5t programs 7su* z quality improvem5t programs "u ! ,m$ic>e program "u title ,,xviii ( ! ,social ,security ,act71 & 7,d7 te*nical assi/ance4 7#c7 ,noncl9ical programm+ ,= purposes ( ?is subsection1 ! t]m noncl9ical programm+ means any program1 initiative1 or dep>tm5t1 ) a purpose o!r ?an ! purpose ( improv+ heal? outcomes = pati5ts ( ! organization & :i* is relat$ to-- 7,a7 adm9i/rative support & managem5t1 7,b7 in=mation te*nology1 hospital adm9i/ration1 human res\rces1 m$ical bill+ & cod+1 public affairs & communications1 gov]nm5t affairs & lobby+1 regulatory compliance1 or f9ancial plann+ & budget+1 7,c7 op]ations & facilities managem5t1 7,d7 programm+ relat$ to pati5t exp]i5ce1 pati5t education1 family support1 or f9ancial c\nsel+1 or 7,e7 dis*>ge plann+ & appo9tm5t s*$ul+4 7#d7 ,sep>ate report+ ) respect to ea* facility ,except z o!rwise provid$ by ! ,secret>y1 ! in=mation describ$ 9 p>agraph 7#a7 %all be provid$ ) respect to ! organization & sep>ately /at$ ) respect to ea* hospital facility op]at$ by su* organization4 7c7 ,additional report+ by high rev5ue tax exempt hospital organizations 7#a7 ,9 g5]al ,e high rev5ue tax exempt hospital organization %all include on ! return fil$ "u section #fjcc7;a7 = ! taxable ye>-- 7,a7 ! specifi$ adv]tis+ in=mation1 7,b7 ! specifi$ heal? s]vice l9e in=mation1 & 7,c7 9 ! case ( an organization :i* is a cov]$ entity describ$ 9 section #cdj;,b7a77#d7 ( ! ,public ,heal? ,s]vice ,act1 ! specifi$ ,f$]al #cdj;,b drug disc\nt program in=mation4 7#b7 ,specifi$ adv]tis+ in=mation ,= purposes ( ?is subsection1 ! t]m specifi$ adv]tis+ in=mation means-- 7,a7 ! all[able adv]tis+ co/s z report$ to ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices = purposes ( co/ reimbursem5t1 & 7,b7 ! unall[able adv]tis+ co/s 7z s report$74 7#c7 ,specifi$ heal? s]vice l9e in=mation 7,a7 ,9 g5]al ,= purposes ( ?is subsection1 ! t]m specifi$ heal? s]vice l9e in=mation means-- 7i7 a description ( ea* heal? s]vice l9e ( ! organization1 7ii7 ! am\nt ( gross receipts g5]at$ by ea* su* heal? s]vice l9e1 & 7iii7 ! co/s ( ea* su* heal? s]vice l9e 7& 9 ! case ( co/s t are %>$ by #a or m heal? s]vice l9es1 an explanation ( h[ su* co/s are allocat$74 7,b7 ,heal? s]vice l9e 7i7 ,9 g5]al ,= purposes ( ?is p>agraph1 ! t]m heal? s]vice l9e means a discrete cl9ical program1 dep>tm5t1 or c>e category op]at$ by ! organization t-- 7,i7 s]ves a def9$ pati5t population gr\p$ by disease category1 organ sy/em1 c>e sett+1 or cl9ical specialty1 7,,ii7 deliv]s a di/9ct set ( m$ical or heal? s]vices ?r\gh d$icat$ or allocat$ /aff1 facilities1 or equipm5t1 & 7,,iii7 is sep>ately track$ or id5tifiable 9 ! organization's int]nal co/ acc\nt+1 s]vice l9e managem5t1 or op]ational report+ sy/ems4 ,= purposes ( ?is p>agraph1 any co/ c5t] sep>ately id5tifi$ on ! organization's mo/ rec5tly fil$ co/ report "u section #ahae ( ! ,social ,security ,act %all be presumptively treat$ z a heal? s]vice l9e4 ,if ! organization ass]ts t su* a co/ c5t] does n con/itute a heal? s]vice l9e1 ! organization %all be> ! burd5 ( demon/rat+ t su* co/ c5t] does n satisfy ! requirem5ts ( subclauses 7,i7 & 7,,ii74 7ii7 ,/&>diz$ heal? s]vice l9e taxonomy ,= purposes ( ?is p>agraph-- 7,i7 ,9 g5]al ,n lat] ?an ! date t is #b ye>s aft] ! date ( ! enactm5t ( ?is section1 ! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,secret>y1 %all publi% & ma9ta9 a /&>diz$ heal? s]vice l9e taxonomy to :i* high rev5ue tax exempt hospital organizations %all map _! int]nally def9$ heal? s]vice l9es on _! returns "u section #fjcc4 7,,ii7 ,updates ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,secret>y1 %all update ! taxonomy describ$ 9 subclause 7,i7 no less frequ5tly ?an e #e ye>s to reflect *anges 9 cl9ical c>e deliv]y1 hospital organization1 & co/ acc\nt+ practices4 7,,iii7 ,compliance obligation ,a high rev5ue tax exempt hospital organization's compliance ) ! report+ requirem5ts ( ?is subsection ) respect to a heal? s]vice l9e enum]at$ 9 ! taxonomy publi%$1 ma9ta9$1 & updat$ "u ?is clause %all n be condition$ on :e!r ! organization sep>ately tracks su* s]vice l9e "u clause 7i77,,iii74 ,a high rev5ue tax exempt hospital organization t does n sep>ately track su* an enum]at$ heal? s]vice l9e %all disclose t fact & provide an explanation on _! return "u section #fjcc4 ,! ,secret>y ( ,heal? & ,human ,s]vices1 9 consultation ) ! ,secret>y1 may1 by regulation1 designate categories ( cl9ical activity t %all be treat$ z a s+le heal? s]vice l9e = report+ purposes not)/&+ any diff]5ce 9 h[ a high rev5ue tax exempt hospital organization tracks su* activity 9 its int]nal sy/ems4 7#d7 ,specifi$ ,f$]al #cdj;,b drug disc\nt program in=mation 7,a7 ,9 g5]al ,= purposes ( ?is subsection1 ! t]m specifi$ ,f$]al #cdj;,b drug disc\nt program in=mation means-- 7i7 ! total numb] ( individuals1 by _! type ( insurance cov]age1 :o 7 disp5s$ or adm9i/]$ cov]$ outpati5t drugs dur+ ! taxable ye> t 7 subject to an agreem5t "u section #cdj;,b ( ! ,public ,heal? ,s]vice ,act1 7ii7 ! aggregate net #cdj;,b paym5t am\nt ) respect to su* drugs subject to su* an agreem5t disp5s$ or adm9i/]$ by ! organization dur+ su* taxable ye>1 & 7iii7 ! aggregate co/s incurr$ by ! organization dur+ su* taxable ye> t 7 necess>y = su* organization to p>ticipate 9 ! program "u su* section & to comply ) su* program's requirem5ts 7includ+ program-relat$ compliance1 legal1 educational1 & adm9i/rative co/s1 & comp5sation paid to indep5d5t contractors to c>ry out program-relat$ functions74 7,b7 ,cov]$ outpati5t drug ,= purposes ( ?is p>agraph1 ! t]m cov]$ outpati5t drug has ! mean+ giv5 su* t]m 9 section #cdj;,b7b7 ( ! ,public ,heal? ,s]vice ,act4 7,c7 ,aggregate net #cdj;,b paym5t am\nt ,= purposes ( ?is p>agraph1 ! t]m aggregate net #cdj;,b paym5t am\nt means1 ) respect to a cov]$ outpati5t drug pur*as$ by an organization "u an agreem5t "u section #cdj;,b ( ! ,public ,heal? ,s]vice ,act & disp5s$ or adm9i/]$ to an individual by su* organization1 ! excess 7if any7 (-- 7i7 ! total am\nt ( paym5ts receiv$ f any payor by ! organization = su* drug1 ov] 7ii7 ! ceil+ price 7z describ$ 9 subsection 7a77#a7 ( su* section7 = su* drug 7or1 if less1 ! price at :i* su* organization acquir$ su* drug74 7#e7 ,sep>ate report+ ) respect to ea* facility ,except z o!rwise provid$ by ! ,secret>y1 ! in=mation describ$ 9 p>agraph 7#a7 %all be provid$ ) respect to ! organization & sep>ately /at$ ) respect to ea* hospital facility op]at$ by su* organization4 7#f7 ,ag5cy coord9ation ,! ,secret>y %all coord9ate )-- 7,a7 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices to c>ry out ! purposes ( p>agraphs 7#b7 & 7#c71 & 7,b7 ! ,adm9i/rator ( ! ,heal? ,res\rces & ,s]vices ,adm9i/ration to c>ry out ! purposes ( p>agraph 7#d74 7d7 ,def9itions ,= purposes ( ?is section-- 7#a7 ,tax exempt hospital organization ,! t]m tax exempt hospital organization means1 ) respect to any taxable ye>1 any organization-- 7,a7 to :i* ! requirem5ts ( section #eja7r7 apply = su* taxable ye>1 & 7,b7 :i* is requir$ to file a return "u section #fjcc7;a7 = su* taxable ye>4 7#b7 ,l>ge tax exempt hospital organization ,! t]m l>ge tax exempt hospital organization means1 ) respect to any taxable ye>1 any organization :i*-- 7,a7 is a tax exempt hospital organization = su* taxable ye>1 7,b7 is n a critical access hospital 7z def9$ 9 section #ahfa7mm77#a7 ( ! ,social ,security ,act7 = su* taxable ye>1 7,c7 is n a rural em]g5cy hospital 7z def9$ 9 section #ahfa7kkk77#b7 ( ! ,social ,security ,act7 = su* taxable ye>1 & 7,d7 has m ?an #ajj /aff$ inpati5t b$s 7z report$ 9 any co/ report "u section #ahae ( ! ,social ,security ,act ) respect to any portion ( su* taxable ye> or any portion ( any ( ! #c prec$+ taxable ye>s74 7#c7 ,high rev5ue tax exempt hospital organization 7,a7 ,9 g5]al ,! t]m high rev5ue tax exempt hospital organization means1 ) respect to any taxable ye>1 any organization :i*-- 7i7 is a tax exempt hospital organization = su* taxable ye>1 7ii7 is n a critical access hospital 7z def9$ 9 section #ahfa7mm77#a7 ( ! ,social ,security ,act7 = su* taxable ye>1 7iii7 is n a rural em]g5cy hospital 7z def9$ 9 section #ahfa7kkk77#b7 ( ! ,social ,security ,act7 = su* taxable ye>1 & 7iv7 has net pati5t rev5ue 7det]m9$ 9 su* mann] z ! ,secret>y may provide7 = su* taxable ye> ( m ?an #ajj1jjj1jjj4 7,b7 ,inflation adju/m5t 7i7 ,9 g5]al ,9 ! case ( any taxable ye> beg9n+ 9 a cal5d> ye> aft] #bjbh1 ! #ajj1jjj1jjj am\nt 9 subp>agraph 7,a77iv7 %all be increas$ by an am\nt equal to-- 7,i7 su* doll> am\nt1 multipli$ by 7,,ii7 ! co/-(-liv+ adju/m5t det]m9$ "u section #a7;f77#c7 = ! cal5d> ye> 9 :i* ! taxable ye> beg9s1 det]m9$ by sub/itut+ cal5d> ye> #bjbg = cal5d> ye> #bjaf 9 subp>agraph 7,a77ii7 !re(4 7ii7 ,r\nd+ ,any increase det]m9$ "u clause 7i7 %all be r\nd$ to ! ne>e/ multiple ( #ajj1jjj4 7e7 ,treatm5t z "p ( annual return ,= purposes ( ?is title1 ! in=mation requir$ to furni%$ "u ?is section %all be treat$ z in=mation requir$ to be furni%$ "u section #fjcc4 7f7 ,regulations ,! ,secret>y may issue su* regulations or o!r guidance z may be necess>y or appropriate to c>ry out ! purposes ( ?is section1 includ+ regulations or o!r guidance provid+ a me?odology = allocat+ co/s betwe5 ! categories describ$ 9 subsections 7a77#a77;,a71 7a77#a77;,d71 7b77#a77;,a71 7b77#a77;,b77i71 7b77#a77;,b77ii71 & 7b77#a77;,b77iii74 4 7b7 ,con=m+ am5dm5ts 7#a7 ,section #fjcc7;b7 ( su* ,code is am5d$-- 7,a7 by add+ & at ! end ( p>agraph 7#ad71 7,b7 by /rik+ p>agraph 7#ae71 & 7,c7 by r$esignat+ p>agraph 7#af7 z p>agraph 7#ae74 7#b7 ,! table ( sections = subp>t ,a ( "p ,,iii ( sub*apt] ,a ( *apt] #fa ( su* ,code is am5d$ by ins]t+ aft] ! item relat+ to section #fjcc ! foll[+ new item3 ,sec4 #fjcc;,a4 ,report+ by tax exempt hospital organizations4 4 7c7 ,effective date 7#a7 ,9 g5]al ,! am5dm5ts made by ?is subsection %all apply to taxable ye>s beg9n+ aft] ! date t is #a ye> aft] ! date ( ! publication ( ! fir/ /&>diz$ heal? s]vice l9e taxonomy "u section #fjcc;,a7c77#c77;,b77ii77,i7 ( ! ,int]nal ,rev5ue ,code ( #aihf 7z add$ by ?is section74 7#b7 ,exception ,9 ! case ( any tax exempt hospital organization :i* is nei!r a l>ge tax exempt hospital organization nor a high rev5ue tax exempt hospital organization1 subp>agraphs 7,d7 & 7,e7 ( section #fjcc;,a7a77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf 7z add$ by ?is section7 %all 7not)/&+ p>agraph 7#a77 apply to taxable ye>s beg9n+ aft] ! date t is #c ye>s aft] ! date ( ! enactm5t ( ?is ,act4 ,t]ms us$ 9 ?is p>agraph :i* are also us$ 9 section #fjcc;,a ( su* ,code 7z s add$7 %all h ! same mean+ z :5 us$ 9 su* section4 7d7 ,no inf]5ce ,no?+ 9 ?is ,act or ! am5dm5ts made by ?is ,act %all be con/ru$ to create any inf]5ce ) respect to ! prop] application ( section #cdj;,b ( ! ,public ,heal? ,s]vice ,act1 ( section #eja7;c77#c7 or #eja7r7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 or ( any op]ational te/ or ! private b5efit doctr9e4 #c4 ,,gao report ,dur+ ! #a-ye> p]iod beg9n+ #c ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,comptroll] ,g5]al ( ! ,unit$ ,/ates %all initiate a /udy & subsequ5tly report to ! ,committee on ,ways & ,means ( ! ,h\se ( ,repres5tatives & ! ,committee on ,f9ance ( ! ,s5ate on ! foll[+3 7#a7 ,an e/imate ( ! additional labor & res\rce co/s ( ! ,dep>tm5t ( ! ,treasury to adm9i/]1 & ( ! additional co/s ( tax exempt hospital organizations 7z def9$ 9 section #fjcc;,a7d77#a7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z add$ by ?is ,act7 to comply )1 ! report+ requirem5ts add$ by ! am5dm5ts made by ?is ,act4 7#b7 ,) respect to ! #be tax exempt hospital organizations 7z s def9$7 :i* h ! highe/ am\nt ( gross rev5ue1 ! e/imat$ am\nt ( tax :i* w\ld be impos$ "u *apt] #a ( su* ,code ) respect to ea* su* organization if su* organization 7 n exempt f su* tax4