An Empirical Examination of State and Local Revocations of Tax-Exempt Status for Nonprofit Hospitals

2005 ◽  
Vol 27 (2) ◽  
pp. 1-25 ◽  
Author(s):  
Ran Barniv ◽  
Kreag Danvers ◽  
Joanne P. Healy-Burress
Keyword(s):  
Public Health ◽  
Health Benefit ◽  
Nonprofit Hospitals ◽  
Survivorship Analysis ◽  
Tax Base ◽  
Empirical Examination ◽  
State Revenue ◽  
Tax Exemptions ◽  
Tax Exempt ◽  
State And Local

In recent years, many states and local authorities have revoked the tax exemptions for several nonprofit hospitals. In this study we examine whether hospital-specific and governmental revenue-need characteristics, organized by four underlying constructs, affect state and local tax authorities' decisions to revoke nonprofit hospitals' tax-exempt status. Based on analyses of state and local tax laws, we distinguish three types of taxes paid by hospitals: Medicaid taxes; state revenue-based taxes; and local taxes. We separately examine the effects of these characteristics on the revocation of the tax-exempt status for each type. We use survivorship analysis and fit logistic regressions that employ panel data to study the risk of revocation for each type of tax. Our results suggest that the likelihood that state authorities assess Medicaid taxes increases with the size of the tax base (i.e., patient revenue) and ability to pay, but decreases with lower revenue needs. We find that the likelihood of revocation for hospitals paying state revenue-based tax increases with the size of the tax base (i.e., total operating revenue), but decreases with public health benefits provided (e.g., charity care) and lower revenue needs. Finally, we show that the size of the tax base (public health benefit provided) increases (decreases) the likelihood of revoking the tax-exempt status for hospitals that pay local tax. Implications for local tax authorities and hospital managers are briefly discussed.

The Evolution of Charity Care within the Healthcare Industry

2006 ◽  
Vol 4 (1) ◽  
pp. 101-116 ◽  
Author(s):  
Pamela C. Smith ◽  
Aaron D. Crabtree
Keyword(s):  
Charity Care ◽  
Nonprofit Hospitals ◽  
Tax Exempt ◽  
Long Time ◽  
State And Local ◽  
To Come ◽  
Definition Of ◽  
State Examination ◽  
Concise Definition

Tax-exempt classification of nonprofit hospitals has been increasingly subject to federal and state examination. Considering the benefits tax-exempt entities receive, it should not be surprising that these organizations face heavy regulatory scrutiny. The problem for tax-exempt hospitals is the lack of a clear and concise definition of charity care in order to maintain exempt status. State and local regulations aside, the IRS has not presented a consistent position regarding standards for nonprofit hospitals. This paper examines the evolution of hospital tax-exempt status and its relationship to charity care. Given the IRS's evolving and conflicting definitions of charity care, we can expect this issue to be debated for a long time to come.

Charitable Hospital Accountability: A Review and Analysis of Legal and Policy Initiatives

1998 ◽  
Vol 26 (2) ◽  
pp. 116-137 ◽  
Author(s):  
Alice A. Noble ◽  
Andrew L. Hyams ◽  
Nancy M. Kane
Keyword(s):  
Local Authorities ◽  
Nonprofit Hospitals ◽  
Community Benefit ◽  
State Legislation ◽  
American Hospital ◽  
Early American ◽  
Community Benefits ◽  
Tax Exempt ◽  
Nonprofit Hospital ◽  
State And Local

Hospitals long ago shed their role as alms houses for the poor. What vestiges remain of the early American hospital are the tax-exempt, nonprofit hospital form and a general perception that hospitals, as charitable institutions, owe a duty to their communities. The appropriateness of the nonprofit hospital tax exemption has long been debated, and many theories have been advanced to justify the tax exemption of nonprofit hospitals. In a growing number of jurisdictions, however, state and local authorities have gone beyond the theoretical debate and are challenging the tax exemption of their nonprofit hospitals. For various reasons, efforts are afoot to capture greater community benefit from nonprofit hospitals.At the heart of such challenges is the debate over the nature and extent of the duty charitable institutions owe to their communities. A demand is growing for nonprofit hospitals to earn their tax exemptions by benefiting their communities in concrete ways. Some have been stripped of their tax-exempt status by local authorities or pressured to make payments in lieu of taxes. A number of states have recently implemented initiatives in an attempt to make hospitals more accountable for their community benefits. Many hospitals are responding to this heightened scrutiny in a proactive way, by voluntarily documenting community benefits. A number of nonprofit hospitals and hospital associations are cooperating with—or even sponsoring—state legislation in this area.

scholarly journals Baby Box Distributions: Public Health Benefit or Concern?

2019 ◽  
Vol 134 (4) ◽  
pp. 328-331
Author(s):  
Wendy Middlemiss ◽  
Naomi C. Brownstein ◽  
Miranda Leddy ◽  
Scott Nelson ◽  
Srikant Manchiraju ◽  
...  
Keyword(s):  
Public Health ◽  
Health Benefit ◽  
Public Health Benefit

The Conversion Conundrum: The State and Federal Response to Hospitals’ Changes in Charitable Status

1997 ◽  
Vol 23 (2-3) ◽  
pp. 221-250
Author(s):  
Lawrence E. Singer
Keyword(s):  
Joint Venture ◽  
Low Cost ◽  
State Level ◽  
The State ◽  
Nonprofit Hospitals ◽  
For Profit ◽  
Tax Exempt ◽  
Federal Response ◽  
Profit Status ◽  
Hospital Conversions

The pressures encountered by hospitals in the current era of reimbursement declines and stiffened competition are well known. As the “ultimate” payors—primarily employers and government—aggressively continue to seek low cost care, the response of the hospital industry has been to move toward consolidation and efficiency-enhancing mechanisms.Increasingly, nonprofit, tax-exempt hospitals have come to believe that they are at a significant disadvantage vis-á-vis their for-profit brethren in their ability to attract the capital needed to compete in the market. A growing trend among nonprofit hospitals, therefore, is to sell to or enter into a joint venture with a proprietary organization, or alternatively to convert to for-profit status. In 1995, fifty-eight nonprofit hospitals became for-profit; hospital conversions to for-profit status in 1996 are projected to outstrip the pace established the prior year.The conversion trend has not gone unnoticed at the state level. Recently, several states have proposed or enacted laws regulating sales and conversions of nonprofit hospitals, and many more states are contemplating such legislation.

scholarly journals The Evolution of the Healthy Brain Initiative

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 720-720
Author(s):  
Lisa McGuire
Keyword(s):  
Public Health ◽  
Population Based ◽  
Public Health Issue ◽  
Dementia Caregivers ◽  
Local Public Health ◽  
Success Stories ◽  
Road Map ◽  
Indian Country ◽  
State And Local ◽  
Map Series

Abstract The Healthy Brain Initiative (HBI) seeks to advance public health awareness of and action on ADRD as a public health issue. The HBI Road Map Series, State and Local Public Health Partnerships to Address Dementia: The 2018–2023 Road Map (S&L RM) and Road Map for Indian Country (RMIC), provide the public health with concrete steps to respond to the growing burden of ADRD in communities, consistent with the aim of the Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115-406). This series of RMs for state, local, and tribal public health provide flexible menus of actions to address cognitive health, including ADRD, and support for dementia caregivers with population-based approaches. This session will describe how the initiative evolved over the past 15 years including policy and implementation success stories.

Opioid Crisis Response and Resilience: Results and Perspectives from a Multi-Agency Tabletop Exercise at the Pennsylvania Emergency Management Agency

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alexander Siedschlag ◽  
Tiangeng Lu ◽  
Andrea Jerković ◽  
Weston Kensinger
Keyword(s):  
Public Health ◽  
Emergency Management ◽  
Health Care Professionals ◽  
Resource Sharing ◽  
Crisis Response ◽  
Community Response ◽  
First Responder ◽  
Management Agency ◽  
Opioid Crisis ◽  
State And Local

Abstract This article presents and discusses, in the new context of COVID-19, findings from a tabletop exercise on response and resilience in the ongoing opioid crisis in Pennsylvania. The exercise was organized by [identifying information removed] and held at the Pennsylvania Emergency Management Agency (PEMA), in further collaboration with the Governor’s Office of Homeland Security, the Pennsylvania Department of Health, and with the participation of several additional agencies and institutions. It addressed first-responder and whole-community response and resilience to the ongoing opioid crisis. More than 50 experts participated in the one-day program that involved state and local agencies, first-responder organizations, as well as academia in a discussion about effectuating comprehensive response to overdose incidents. Participant experts represented a wide array of backgrounds, including state and local law enforcement agencies; emergency medical technicians; public health and health care professionals; and scholars from the fields of law, security studies, public policy, and public health, among other relevant areas. Participants addressed specific challenges, including resource sharing among responders; capacity-building for long-term recovery; effective integration of non-traditional partners, such as spontaneous volunteers and donors; and public education and outreach to improve prevention. The exercise aimed to strengthen the whole-community approach to emergency response.

Risk-Based Approach To Evaluate the Public Health Benefit of Additional Wastewater Treatment

2003 ◽  
Vol 37 (9) ◽  
pp. 1882-1891 ◽  
Author(s):  
Jeffrey A. Soller ◽  
Adam W. Olivieri ◽  
James Crook ◽  
Robert C. Cooper ◽  
George Tchobanoglous ◽  
...  
Keyword(s):  
Public Health ◽  
Wastewater Treatment ◽  
Health Benefit ◽  
Public Health Benefit ◽  
The Public

Toolkit for Epidemiologic Response to an Acute Chemical Release

2016 ◽  
Vol 10 (4) ◽  
pp. 631-632 ◽  
Author(s):  
Mary Anne Duncan ◽  
Maureen F. Orr
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Technical Assistance ◽  
Local Health ◽  
Toxic Substances ◽  
Public Health Action ◽  
Public Health Agencies ◽  
Chemical Release ◽  
State And Local ◽  
The Many

AbstractWhen a large chemical incident occurs and people are injured, public health agencies need to be able to provide guidance and respond to questions from the public, the media, and public officials. Because of this urgent need for information to support appropriate public health action, the Agency for Toxic Substances and Disease Registry (ATSDR) of the US Department of Health and Human Services has developed the Assessment of Chemical Exposures (ACE) Toolkit. The ACE Toolkit, available on the ATSDR website, offers materials including surveys, consent forms, databases, and training materials that state and local health personnel can use to rapidly conduct an epidemiologic investigation after a large-scale acute chemical release. All materials are readily adaptable to the many different chemical incident scenarios that may occur and the data needs of the responding agency. An expert ACE team is available to provide technical assistance on site or remotely. (Disaster Med Public Health Preparedness. 2016;10:631–632)

ActionHealthNYC: Effectiveness of a Health Care Access Program for the Uninsured, 2016‒2017

2021 ◽  
pp. e1-e10
Author(s):  
Rishi K. Sood ◽  
Jin Yung Bae ◽  
Adrienne Sabety ◽  
Pui Ying Chan ◽  
Caroline Heindrichs
Keyword(s):  
Public Health ◽  
Health Care ◽  
New York ◽  
Health Care Access ◽  
Access To Health Care ◽  
Controlled Trial ◽  
The Past ◽  
Care Access ◽  
State And Local ◽  
Access Program

Objectives. To evaluate the effectiveness of a novel health care access program (ActionHealthNYC) for uninsured immigrants. Methods. The evaluation was conducted as a randomized controlled trial in New York City from May 2016 through June 2017. Using baseline and follow-up survey data, we assessed health care access, patient experience, and health status. Results.At baseline, 25% of participants had a regular source of care; two thirds had visited a doctor in the past year and reported 2.5 visits in the past 12 months, on average. Nine to 12 months later, intervention participants were 1.2 times more likely to report having a primary care provider (58% vs 46%), were 1.2 times more likely to have seen a doctor in the past 9 months (91% vs 77%), and had 1.5 times more health care visits (4.1 vs 2.9) compared with control participants. Conclusions. ActionHealthNYC increased health care access among program participants. Public Health Implications. State and local policymakers should build on the progress that has been made over the last decade to expand and improve access to health care for uninsured immigrants. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e10. https://doi.org/10.2105/AJPH.2021.306271 )

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