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.

Traversing the Regulatory Maze of Charity Care: The Institutional Method and IRC §501(r)

2013 ◽  
Vol 11 (2) ◽  
pp. 68-85
Author(s):  
Linda J. Campbell ◽  
Pamela C. Smith ◽  
J. Michael Hostetler
Keyword(s):  
Normal Level ◽  
Charity Care ◽  
Legal Realism ◽  
Tax Exempt ◽  
History Of ◽  
Healthcare Administrators ◽  
Definition Of ◽  
Concise Definition ◽  
The U.S ◽  
Regulatory Challenges

ABSTRACT The search for a concise definition of charity care continues to elude both practitioners and healthcare administrators. U.S. legislators recently took action by creating the new Internal Revenue Code (IRC) §501(r), mandating hospitals document and justify their tax-exempt status. The new provisions still do not provide a succinct definition of charity care, but may provide an opportunity to establish a quantifiable baseline of the normal level of charity care for hospitals. This paper looks to the history of charity care in the U.S., recent regulatory challenges, the theory of legal realism, and the institutional method to develop an approach to provide clear guidance on acceptable levels of charity care.

Comparison of Trends in Nonprofit Hospitals’ Charity Care Eligibility Policies Between Medicaid Expansion States and Medicaid Nonexpansion States

2021 ◽  
pp. 107755872110396
Author(s):  
Ge Bai ◽  
Hossein Zare ◽  
Matthew D. Eisenberg ◽  
Daniel Polsky ◽  
Gerard F. Anderson
Keyword(s):  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Care Provision ◽  
Policy Changes ◽  
Charity Care ◽  
Nonprofit Hospitals ◽  
Medicaid Coverage ◽  
Longitudinal Trend ◽  
Tax Exempt ◽  
The Affordable Care Act

Nonprofit hospitals provide charity care to financially disadvantaged patients according to their self-designed eligibility policies. The Affordable Care Act may have prompted nonprofit hospitals to adopt more generous eligibility policies, but no prior research has examined the longitudinal trend. The expansion of Medicaid coverage in many states has been found to reduce charity care provision, but it is unclear whether the change in charity care eligibility policies differed between Medicaid expansion and nonexpansion states. Using mandatory tax filings, we found that both hospitals in Medicaid expansion states and hospital in nonexpansion states adopted more generous eligibility policies in 2018 than in 2010, but the change was greater in the former for discounted charity care; while the former provided less charity care regardless of their policy changes, the latter provided more when their policies became more generous. This study has implications for policy discussions on the justification of nonprofit hospitals’ tax-exempt status.

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 The good(ish), the bad, and the ugly: a tripartite classification of ecosystem trends

2010 ◽  
Vol 67 (4) ◽  
pp. 745-768 ◽  
Author(s):  
Alida Bundy ◽  
Lynne J. Shannon ◽  
Marie-Joëlle Rochet ◽  
Sergio Neira ◽  
Yunne-Jai Shin ◽  
...  
Keyword(s):  
Size Structure ◽  
Ecosystem Structure ◽  
Initial State ◽  
Resource Managers ◽  
Ecosystem Indicators ◽  
The Status ◽  
Commercial Species ◽  
Long Time ◽  
Definition Of

Abstract Bundy, A., Shannon, L. J., Rochet, M-J., Neira, S., Shin, Y-J., Hill, L., and Aydin, K. 2010. The good(ish), the bad, and the ugly: a tripartite classification of ecosystem trends. – ICES Journal of Marine Science, 67: 745–768. Marine ecosystems have been exploited for a long time, growing increasingly vulnerable to collapse and irreversible change. How do we know when an ecosystem may be in danger? A measure of the status of individual stocks is only a partial gauge of its status, and does not include changes at the broader ecosystem level, to non-commercial species or to its structure or functioning. Six ecosystem indicators measuring trends over time were collated for 19 ecosystems, corresponding to four ecological attributes: resource potential, ecosystem structure and functioning, conservation of functional biodiversity, and ecosystem stability and resistance to perturbations. We explored the use of a decision-tree approach, a definition of initial ecosystem state (impacted or non-impacted), and the trends in the ecosystem indicators to classify the ecosystems into improving, stationary, and deteriorating. Ecosystem experts classified all ecosystems as impacted at the time of their initial state. Of these, 15 were diagnosed as “ugly”, because they had deteriorated from an already impacted state. Several also exhibited specific combinations of trends indicating “fishing down the foodweb”, reduction in size structure, reduction in diversity and stability, and changed productivity. The classification provides an initial evaluation for scientists, resource managers, stakeholders, and the general public of the concerning status of ecosystems globally.

Poecilimon bosphoricus group (Orthoptera, Phaneropterinae): iteration of morpho-taxonomy by song characteristics

Zootaxa ◽  
2012 ◽  
Vol 3225 (1) ◽  
pp. 1 ◽  
Author(s):  
SARP KAYA ◽  
BATTAL ÇIPLAK ◽  
DRAGAN CHOBANOV ◽  
KLAUS-GERHARD HELLER
Keyword(s):  
New Species ◽  
Species Level ◽  
Subgenital Plate ◽  
Long Time ◽  
Male Calling ◽  
Productive Structure ◽  
Definition Of ◽  
Caudal Margin

More than 20 species were reported under the circum Black Sea lineage Poecilimon bosphoricus group (Orthoptera, Tet-tigonioidea, Phaneropterinae). The taxonomy of the group has for a long time been controversial; once these species weretransferred to Eupoecilimon and many new species have been described since the revision by Ramme (1933) or synonymshave been suggested/re-established. This study aims to test the classification of the group presently based on morpholog-ical characters by bioacoustic data. The following results were obtained or conclusions arrived. First, several qualitativemorphological characters previously used in descriptions/diagnoses of the species are variable and overlap between spe-cies. Those are the elevation and widening of pronotum in metazona, the emargination of caudal margin of pronotal discand the structure of male subgenital plate at caudal margin. Thus, still the male cercus, especially the orientation of den-ticles, is the most productive structure may allow more objective delimitation of species. As in qualitative morphology thegeneral morphometry seems uninformative for the taxonomy of the group. Second, male calling song and partly the num-ber of stridulatory pegs are more useful characters both for delimitation of species and describing their relationships. Es-pecially, the pattern of the syllable, the number of impulses per syllable and the duration of early part of syllable in speciesgroup allow us a more objective delimitation of the species and definition of relationships. Third, from the distributionand relationships of species, we suggested three radiation centres for the lineage: (1) Northwest Anatolia + Eastern Bal-kans, (2) Northeast Anatolia + Caucasus and (3) Crimea. Fourth, after evaluating morphological and song phenotypes we considered 21 species in P. bosphoricus group constituting three subgroups: (1) P. sureyanus and P. kocaki (+ P. athos),(2) P. turcicus + P. turciae and (3) P. bidens, P. bischoffi, P. bosphoricus, P. cervus, P. demirsoyi, P. geoktschajcus, P. hei-nrichi, P. istanbul, P. miramae, P. pliginskii, P. proximus, P. roseoviridis sp. n., P. scythicus, P. similis and P. tauricus (+ P.djakonovi). The following nomenclatural actions were made: (1) P. roseoviridis Chobanov & Kaya sp. n. described, (2)P. similis proximus Ünal, 2010 raised to species level as P. proximus stat. n., (3) P. naskrecki Ünal, 2001 syn.n. syn-onymised with P. demirsoyi Sevgili, 2001 (4) P. diversus Ünal, 2010 syn.n. and P. anatolicus Ramme 1933 syn.n. put insynonymy with P. sureyanus Uvarov, 1930, (5) P. oligacanthus Miram, 1938 syn.n. and P. tereckensis Stshelkanovtzev,1910 stat.rev. resynonymised with P. similis Retowski, 1889, (6) P. beybienkoi Tarbinsky, 1932 syn.n. and P. kusnezoviMiram, 1929 syn.n. synonymised with P. tauricus Retwoski, 1888, and (7) P. boldyrevi Miram, 1938 syn.n. synonymised with P. pliginskii Miram, 1929.

scholarly journals Strategic reporting by nonprofit hospitals: an examination of bad debt and charity care

2021 ◽  
Author(s):  
Amanda Beck ◽  
Collin Gilstrap ◽  
Jordan Rippy ◽  
Brian Vansant
Keyword(s):  
Cost Of Debt ◽  
Charity Care ◽  
Nonprofit Hospitals ◽  
Social Good ◽  
Hospital Managers ◽  
Community Benefits ◽  
Stakeholder Pressure ◽  
Tax Exempt ◽  
Using Data ◽  
Bad Debt

AbstractIn this paper, we examine bad debt and charity care reporting by nonprofit hospitals around bond issuance. Given the tax advantages afforded to nonprofit hospitals, including the ability to issue tax-exempt debt, hospital managers encounter stakeholder pressure to provide community benefits. When nonprofits issue debt, they also face economic pressure to meet creditors’ financial performance expectations. We document a reporting strategy that allows nonprofit hospitals to reduce the cost of bond debt while simultaneously alleviating regulators’ and community members’ concerns about inadequate provision of charity care. Using data from public bond issues for California nonprofit hospitals, we find that hospital managers shift costs from bad debt expense to charity care in periods prior to a public bond issuance and that the strategy is associated with a lower cost of debt. Our results inform those relying on accounting measurements to infer nonprofit hospitals’ social good provisions and financial health.

scholarly journals Holophyly and associated concepts if the unknown is unclassifiable

2021 ◽  
Author(s):  
Yegor Shɨshkin
Keyword(s):  
Current System ◽  
Natural Sciences ◽  
Vital Activity ◽  
Unknown Species ◽  
Group Members ◽  
Physical Particle ◽  
Basic Concepts ◽  
Definition Of ◽  
Concise Definition

In natural sciences, the key criterion for proving the existence of an object (like a physical particle of a previously unknown kind, an atom of a previously unknown element or an organism of a previously unknown species) is its observation and/or observation of traces of the existence of this object (radiation, remains of vital activity etc.). Only objects that meet this criterion can be classified (e.g. introduced in the periodic table of elements or described as a species). Single unknown organisms or species can not enter the classification. Despite this, the current system of phylogenetic terms (holo-/monophyly, paraphyly, and polyphyly as they are currently defined) is not adapted to the separation of known and unknown organisms (as well as populations, species, etc.) including ancestral ones. There are longstanding confusion and controversy regarding these “phyletic states”. There seem only two ways in such a situation. The first way is to directly include unknown ancestors in taxa somehow, describe species for them and unavoidably to introduce at least one paraphyletic subtaxon during dividing each taxon. The second way is do not include unknown ancestors in taxa directly and amend the system of concepts and terms. Here the second way was followed and the possible definitions of the main phylogenetic concepts for the views of dealing only with known group members were proposed. Inability to provide a concise definition of holophyly using the existing terms indicates the lack of more basic concepts. These concepts were also proposed here and holophyly was defined using them near the end of the paper. The intersection of four basic “phyly” (enophyly, merophyly, kollitophyly, and schizophyly) results in the unambiguous triad of holophyly, paraphyly, and schizophyly. The definitions of the terms in this triad are believed to be unambiguous unlike the widespread definitions of holo-(mono-), para- and “polyphyly”. Here, many terms were defined using others in order not to make the definitions too cumbersome. Nevertheless, the “primary phyly” seem not less useful in phylogenetic discussions than the phyly of the triad. The same is true for the terms inprestor, rendestor, ancessure, drade and skade as well as for the more precisely defined term clade. The first two terms seem to be necessary and important regardless of the views on the classification of unknown organisms.

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.

scholarly journals Illegal benefit in anti-corruption legislation: problems of legal regulation

2021 ◽  
Vol 2021 (2) ◽  
pp. 57-66
Author(s):  
О. V. Vynohrad ◽  
◽  
P. H. Kovalska ◽  
Keyword(s):  
Criminal Liability ◽  
Legal Regulation ◽  
Application Of Law ◽  
Long Time ◽  
The Difference ◽  
Definition Of ◽  
To Receive ◽  
Rule Making ◽  
Incorrect Classification

The types and meaning of the main methods of preventing corruption are examined in the article. Administrative methods of combating corruption are identified among them. They are divided into two groups: rule-making (adoption of relevant law); law enforcement (application of law). The importance of proper legislative regulation in liquidating corruption is outlined. The formation of anti-corruption legislation, which has been going on for a long time, is revealed and it is noted that to date anti-corruption legislation has undergone a significant transformation and changed its purpose that is “prevention” instead of “struggle”. Emphasis is placed on innovations and reforms contained in the updated anti-corruption legislation. The provisions of statutary acts, which enshrine illegal benefit, are given. For carrying out a detailed analysis, the scholars’ positions on the current legislation on the definition of “illegal benefit” were analyzed. It revealed differences in existing approaches to the essential features of this phenomenon. The concept and features of a gift are analyzed in order to distinguish it from the illegal benefit and identify the main reasons for this. The importance of clear regulation of illegal benefit and gifts in order to avoid incorrect classification of violated anti-corruption legislation was emphasized. After analyzing the essence of “illegal benefit” and “gift”, it was found out that common to the subject of gift and illegal benefit was to receive both materially defined and things that do not have a monetary equivalent and material reflection. A sign that allows to distinguish a gift from an illegal benefit is the sign “without any legal grounds” for receiving an illegal benefit and “gratuitousness and receipt/gift at a price below the minimum market”. It is the last part of the component definition of a gift that testifies to the value characteristics of a gift. It is noted that taking into account the fact that since the difference between a gift and an illegal benefit is unclear, it may lead to incorrect classification of violated anti-corruption legislation. Key words: illegal benefit, gift, anti-corruption legislation, corruption offense, corruption-related offenses, criminal liability, administrative liability.

Development and Evaluation of Fuzzy Criteria for the Diagnosis of Rheumatoid Arthritis

1996 ◽  
Vol 35 (04/05) ◽  
pp. 334-342 ◽  
Author(s):  
K.-P. Adlassnig ◽  
G. Kolarz ◽  
H. Leitich
Keyword(s):  
Rheumatoid Arthritis ◽  
Reference Model ◽  
American Rheumatism Association ◽  
Uniform Definition ◽  
Sensitivity Rate ◽  
Fuzzy Techniques ◽  
Definition Of ◽  
Different Levels ◽  
Specificity Rate

Abstract:In 1987, the American Rheumatism Association issued a set of criteria for the classification of rheumatoid arthritis (RA) to provide a uniform definition of RA patients. Fuzzy set theory and fuzzy logic were used to transform this set of criteria into a diagnostic tool that offers diagnoses at different levels of confidence: a definite level, which was consistent with the original criteria definition, as well as several possible and superdefinite levels. Two fuzzy models and a reference model which provided results at a definite level only were applied to 292 clinical cases from a hospital for rheumatic diseases. At the definite level, all models yielded a sensitivity rate of 72.6% and a specificity rate of 87.0%. Sensitivity and specificity rates at the possible levels ranged from 73.3% to 85.6% and from 83.6% to 87.0%. At the superdefinite levels, sensitivity rates ranged from 39.0% to 63.7% and specificity rates from 90.4% to 95.2%. Fuzzy techniques were helpful to add flexibility to preexisting diagnostic criteria in order to obtain diagnoses at the desired level of confidence.

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