990 frus­tra­tions

Providers protest pa­per­work, call for clar­i­fi­ca­tion

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jes­sica Zig­mond

Health­care providers last week crit­i­cized the re­form law’s ad­di­tional re­port­ing re­quire­ments for tax-ex­empt hos­pi­tals and sought clar­ity from the In­ter­nal Rev­enue Ser­vice, which has yet to re­lease a reg­u­la­tion on those changes.

This month the IRS of­fered a five-day pe­riod for the in­dus­try to com­ment on the Pa­tient Pro­tec­tion and Af­ford­able Care Act’s changes to hospi­tal in­for­ma­tion col­lec­tion through the Form 990 (May 14, p. 4). The Amer­i­can Hospi­tal As­so­ci­a­tion and the Health­care Fi­nan­cial Man­age­ment As­so­ci­a­tion on May 16 sent a joint let­ter to the IRS and the U.S. Trea­sury Depart­ment that fo­cused pri­mar­ily on the re­vised

“No­body yet knows what will be suf­fi­cient to sat­isfy the com­mu­nity needs as­sess­ment be­cause there are no reg­u­la­tions.”

—Health­care lawyer Dou­glas Man­cino

Sched­ule H, which re­quires not-for-profit hos­pi­tals to doc­u­ment com­mu­nity ben­e­fits.

The AHA and Hfma—which rep­re­sent about 5,000 hos­pi­tals and more than 39,000 health­care fi­nan­cial man­age­ment ex­ec­u­tives, re­spec­tively—com­plained that Sched­ule H’s cur­rent struc­ture will re­quire mul­ti­hos­pi­tal sys­tems to fill out the same an­swers mul­ti­ple times. They say that could lead to as many as 200 pages for Sched­ule H alone.

The groups also fo­cused on the com­mu­nity needs as­sess­ment that the ACA re­quires hos­pi­tals to con­duct once ev­ery three years. They con­tend that Sched­ule H’s cur­rent re­quire­ment that each par­tic­i­pat­ing hospi­tal de­velop a sep­a­rate and in­de­pen­dent com­mu­nity needs as­sess­ment “un­der­mines the ben­e­fit to the com­mu­nity of hos­pi­tals work­ing to­gether and cre­ates un­nec­es­sary pa­per­work.” In­stead,

they sug­gest a method that would al­low a shared com­mu­nity needs as­sess­ment among hos­pi­tals.

In his writ­ten tes­ti­mony for the House Ways and Means over­sight sub­com­mit­tee, Michael Regier, se­nior vice pres­i­dent of le­gal and cor­po­rate af­fairs at hospi­tal provider net­work VHA, said the or­ga­ni­za­tion needs more di­rec­tion from the IRS on ar­eas such as the ap­pli­ca­bil­ity of the law’s re­quire­ments to hospi­tal joint ven­tures and what con­sti­tutes “rea­son­able ef­forts” to de­ter­mine whether a pa­tient is el­i­gi­ble for fi­nan­cial as­sis­tance.

Regier also laid out a host of con­cerns the Irv­ing, Texas-based or­ga­ni­za­tion has re­gard­ing IRS guid­ance about the com­mu­nity needs as­sess­ment re­quire­ment. These in­clude re­quir­ing each hospi­tal fa­cil­ity in a mul­ti­hos­pi­tal sys­tem to is­sue a sep­a­rate writ­ten re­port, im­pos­ing de­tailed man­dates about con­sul­ta­tion with public health agen­cies and rep­re­sen­ta­tives of spe­cific pop­u­la­tions in a com­mu­nity, and man­dat­ing that each hospi­tal at­tach its most re­cently adopted com­mu­nity health needs as­sess­ment im­ple­men­ta­tion strat­egy to its Form 990.

But there’s a big­ger is­sue re­lated to the com­mu­nity needs as­sess­ment than pre­scrip­tive or du­plica­tive re­port­ing re­quire­ments, said Dou­glas Man­cino, a lawyer at Hun­ton & Wil­liams in Los An­ge­les spe­cial­iz­ing in health­care and tax-ex­empt or­ga­ni­za­tions. “I think, frankly, that’s a prob­lem that’s grossly over­stated,” Man­cino said. “Here’s the prob­lem: No­body yet knows what will be suf­fi­cient to sat­isfy the com­mu­nity needs as­sess­ment be­cause there are no reg­u­la­tions.”

He added that he thinks the IRS will make it less bur­den­some for mul­ti­hos­pi­tal sys­tems so they “don’t have to do ev­ery­thing from scratch.”

Rep. Charles Bous­tany (R-LA.), chair­man of the over­sight sub­com­mit­tee, said the panel needs to host more hear­ings on tax-ex­empt or­ga­ni­za­tions, which he said rep­re­sent a com­plex and grow­ing area that has not been sub­jected to much fed­eral scru­tiny.

And while he also heard from wit­nesses rep­re­sent­ing the na­tion’s col­leges, uni­ver­si­ties and char­i­ta­ble or­ga­ni­za­tions, Bous­tany made a point to men­tion the cur­rent tax-re­lated chal­lenges fac­ing hos­pi­tals.

“The bur­den­some re­quire­ments and the am­bi­gu­ity in what they’re be­ing asked to pro­vide is a prob­lem,” Bous­tany told Mod­ern Health­care. “The fact that the final rules have not been is­sued—it’s been a cou­ple of years now—we need to get some clar­ity from the IRS on all of that.”

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