119-hr3019

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3019 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 3019

 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 24, 2025

 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 Representatives 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 HOSPITALS.

    (a) In General.--

Section 501

    (r) of the Internal Revenue Code of 
1986 is amended--

    (1) in paragraph

    (1) , by striking ``and'' in subparagraph
            (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 standard 
 described in paragraph

    (7) .'',

    (2) by redesignating paragraph

    (7) as paragraph

    (8) , and

    (3) by inserting after paragraph

    (6) the following new 
 paragraph:
 ``

    (7) Community benefit standard.--
 ``
        (A) In general.--A hospital organization meets 
 the requirements of this paragraph if such 
 organization--
 ``
            (i) has a board of directors drawn from 
 the community in which such organization is 
 located,
 ``
            (ii) both--
 ``
            (I) treats patients who pay their 
 bills through public programs, 
 including under the Medicare program 
 under title XVIII of the Social 
 Security Act or under the Medicaid 
 program under title XIX of such Act, 
 and
 ``
            (II) does not limit the number of 
 such patients served at any clinical 
 site owned or controlled by such 
 organization, and
 ``
            (iii) spends an amount which meets or 
 exceeds the expenditure threshold for the 
 taxable year on any combination of--
 ``
            (I) training, education, or 
 research designed to improve patient 
 care,
 ``
            (II) improvements to facilities 
 and equipment except as provided in 
 subparagraph
            (C) , and
 ``
            (III) free or discounted care 
 pursuant to a financial assistance 
 policy.
 ``
        (B) Expenditure threshold.--For purposes of this 
 paragraph, the term `expenditure threshold' means 100 
 percent of the value of the Federal, State, and local 
 tax exemptions of the hospital organization for the 
 taxable year.
 ``
            (C) Special rules for improvements to facilities 
 and equipment.--
 ``
            (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 
 subparagraph, and
 ``
            (II) expenditures for the 
 acquisition of a physician practice, 
 hospital, ambulatory surgical center, 
 or any other care delivery organization 
 shall not be taken into account as an 
 improvement to facilities or equipment 
 under such clause.
 ``
            (ii) Care delivery organization.--For 
 purposes of clause
            (i) , the term `care delivery 
 organization' means an organization of people, 
 institutions, and resources 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, 2025.

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 provision 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, 2025.

SEC. 4. FINANCIAL ASSISTANCE POLICY REVIEW AND REPORT.

    (a) Review.--The Treasury Inspector General for Tax Administration 
shall conduct a review of financial assistance 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 conducted under 
subsection

    (a) , including--

    (1) the content of financial assistance policies of 
 hospital organizations,

    (2) compliance of hospital organizations with the financial 
 assistance policy requirements of 

section 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 REVIEW 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) .
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