California requires nonprofit hospitals to provide community benefits.

California law expressly recognizes that nonprofit hospitals receive "favorable tax treatment by the government... [i]n exchange [for assuming] a social obligation to provide community benefits …” Cal. Health & Safety Code 127340(a). California defines “community benefit” as hospital activity “intended to address community needs and priorities primarily through disease prevention and improvement of health status.” The statute lists, as non-exclusive examples of community benefit, the unreimbursed costs of providing health care services to vulnerable populations (including both Medicaid and Medicare shortfall); medical research; health professions education; adult day care; child care; sponsoring food, shelter, and clothing for the homeless; support of public health programs; contributions to a community priority; health care cost containment; enhancing access to care; and education, transportation, and other goods or services that help maintain a person’s health. Cal. Health & Safety Code §127345(c).

In addition, California’s certificate of need (CON) law exempts from certain specified CON requirements a health care project proposed by a hospital that agrees to provide free health care services to indigents, over a five year period, equivalent in dollar value to that of the proposed health care project. Cal. Health & Safety Code §127190.

California does not require nonprofit hospitals to provide a specified minimum level of community benefits.

California requires nonprofit hospitals to annually submit community benefit plans specifying the economic value of the community benefits to be provided.

Nonprofit hospitals must annually submit their community benefit plans which, “to the extent practicable,” report the economic value of the community benefits provided, mechanisms for evaluating the plan’s effectiveness, and measurable objectives to be achieved within specified timeframes. The plans must be submitted to the Office of Statewide Health Planning and Development (OSHPD), which makes them available to the public. Cal. Health & Safety Code §127350(d).

In addition, every two years—or when a significant change to the policy is made—a nonprofit hospital must provide copies to OSHPD of its discount payment policy, charity care policy, procedures for determining eligibility under those policies, review process, and the application for charity care or discounted payment programs. Cal. Health & Safety Code §127435.

California requires nonprofit hospitals to conduct assessments to evaluate the health needs of the communities they serve.

A hospital may conduct—either alone, with other health care providers, or through other organizational arrangements—an assessment that evaluates the health needs of the community the hospital serves. At a minimum, the assessment must describe the process employed by the hospital to consult with community groups and local government officials in identifying and prioritizing community needs that can be addressed directly by the hospital, and those that the hospital can address in collaboration with other entities, or through other organizational arrangements. The assessment must be updated at least every three years. Cal. Health & Safety Code §127350(b).

California requires nonprofit hospitals to submit annual community benefit plans that include the activities undertaken by the hospital to address community needs that are within the hospital’s mission and financial capacity. Cal. Health & Safety Code 127350(d).

The plan must also include a statement as to the economic value of the community benefits provided, mechanisms for evaluating the plan’s effectiveness, and measurable objectives to be achieved within specific timeframes. Community benefits are to be categorized into the following framework: 1) medical care services, 2) other benefits for vulnerable populations, 3) other benefits for the broader community, 4) health research, education, and training programs, and 5) nonquantifiable benefits. Cal. Health & Safety Code §127355.

California requires all hospitals to adopt financial assistance policies.

California’s Hospital Fair Pricing Policies Act establishes, as a condition of licensure, minimum standards to be used in determining eligibility for free or discounted care under a hospital’s charity care and discounted care policies. Cal. Health & Safety Code §§127400 – 127466. Hospitals have discretion to extend eligibility for their discount payment and charity care policies to patients with incomes over 350 percent of the federal poverty level. Cal. Health & Safety Code §127400(a)-(g). Hospitals have discretion to extend eligibility for their discount payment and charity care policies to patients with incomes over 350 percent of the federal poverty level. Cal. Health & Safety Code §127405(a)(1)(A).

Among the additional elements that financial assistance policies must include is a requirement that emergency room physicians provide discounted emergency services to patients who are uninsured or have high medical costs and whose incomes do not exceed 350 percent of the federal poverty level. Cal. Health & Safety Code §§127400 – 127466.

California requires hospitals to provide patients written notice of their financial assistance plans and to post notices of the hospital’s financial assistance policies for financially qualified and self-pay patients in specified locations in the hospital.

Each hospital’s written notice must contain information about the availability of the hospital’s discount payment and charity care policies and contact information for an individual or office from which additional information may be accessed. The notice must also advise that emergency room physicians in the hospital must provide discounted emergency services to uninsured patients and patients with high medical costs. Cal. Health & Safety Code §127405(a)(1)(B). Notice of the hospital’s policy for financially qualified and self-pay patients must be conspicuously posted in locations that are visible to the public, including in the emergency department, billing office, admissions office, and other outpatient settings. Cal. Health & Safety Code §127410.

California law limits hospital billing and collection practices.

California limits the amounts hospitals may charge patients with income not exceeding 350 percent of the federal poverty level. Cal. Health & Safety Code §12705. Hospitals must have written policies specifying when and under whose authority patient debt is referred for collection. Cal. Health & Safety Code §127425(a). For uninsured patients and those with high medical costs, the hospital or assignees of hospital debt owed by a “financially qualified” patient may not, until 150 days after the initial billing, report adverse information concerning the patient to a consumer credit reporting agency and may not commence an action against the patient in civil court. Cal. Health & Safety Code §127425(d). Additional details concerning a patient’s property rights and limits on hospital payment practices are set forth in Cal. Health & Safety Code §§127425-127430.

California exempts federally tax-exempt nonprofit hospitals from state income tax.

exclusively for charitable purposes and recognized exempt from federal income tax under §501(c)(3) of the Income Tax Code. In addition, a charitable corporation may not attempt to influence legislation or campaign on behalf of any candidate for public office. Cal. Rev. & Tax. Code §23701d.

California exempts from taxation the property of qualifying nonprofit hospitals.

California law exempts property used exclusively for charitable hospital purposes where, during its immediately preceding fiscal year, the hospital’s operating revenues (exclusive of gifts, endowments, and grants-in-aid) did not exceed operating expenses by an amount equivalent to 10 percent of those operating expenses. Cal. Rev. & Tax Code §214(a)(1).

California law includes no express statutory exemption from sales tax for purchases by nonprofit hospitals. California State Board of Equalization, Sales and Use Taxes: Exemptions and Exclusions (2012).

Illinois requires nonprofit hospitals to provide charity care or other “health services to low-income or underserved individuals” as a condition of property and sales tax exemption.

Illinois specifies a minimum level of charity care or other “health services to low-income or underserved individuals” that a nonprofit hospital must provide to qualify for property and sales tax exemption.

Effective in 2012, an Illinois statute requires that nonprofit hospitals seeking property tax exemption provide charity care or other specified services or activities at levels at least equivalent to what the hospital otherwise would be required to pay in property taxes. S.B. 2194, codified at 35 ILCS 200/15-86(c) (2012). For-profit hospitals are eligible to receive an income tax credit in an amount that is the lesser of 1) real property taxes paid during the tax year on property used for hospital purposes during the previous tax year and 2) the cost of free or discounted services provided pursuant to the hospital’s financial assistance policy. S.B. 2194, codified at 35 ILCS 5/223(a) (2012).

The Illinois Community Benefits Act requires that each nonprofit hospital to which it applies develop a community benefit plan and file an annual report of the plan with the Office of the Attorney General. 210 ILCS 76/20 (2003).

The Act does not apply to 1) government hospitals, 2) hospitals located outside of a metropolitan statistical area, or 3) hospitals with 100 or fewer beds. 210 ILCS 76/5 (2003).

Illinois requires that a nonprofit hospital to which the Illinois Community Benefits Act applies develop a community benefit plan that identifies the populations and communities the hospital serves and outlines the hospital’s goals and objectives for providing community benefits, including charity care and government-sponsored indigent health care. 210 ILCS 76/15 (2003).

A nonprofit hospital to which the Act applies must develop and submit to the Attorney General an annual report of its community benefits plan disclosing the amount and types of “community benefits actually provided, including charity care.” The hospital must include with its report an audited annual financial report for the preceding fiscal year. 210 ILCS 76/20 (2003). The hospital must include a financial assistance report disclosing, among other things, the number of financial assistance applications received, approved, and denied as well as the total amount of financial assistance provided. Ill. Admin. Code tit. 77 §4500.60 (2013).

Hospitals to which the Illinois Community Benefits Act applies must include in annual reports of their community benefits plans “a disclosure of the health care needs of the community that were considered in developing the hospital’s community benefits plan.” 210 ILCS 76/20(a)(2) (2003).

The Act does not apply to 1) government hospitals, 2) hospitals located outside of a metropolitan statistical area, or 3) hospitals with 100 or fewer beds. 210 ILCS 76/5 (2003).

A nonprofit hospital to which the Illinois Community Benefits Act applies is required to develop a community benefit plan.

The community benefit plan must identify the populations and communities served by the hospital and set out goals and objectives for providing community benefits that include charity care and government-sponsored indigent health care. 210 ILCS 76/15 (2003).

The Act does not apply to 1) government hospitals, 2) hospitals located outside of a metropolitan statistical area, or 3) hospitals with 100 or fewer beds. 210 ILCS 76/5 (2003).

Illinois requires both nonprofit and for-profit hospitals to provide discounts to uninsured patients.

The 2012 amendments to the Illinois Hospital Uninsured Patient Discount Act mandate that hospitals provide patient discounts that take into account hospital type and family income once an application for a discount is made. 210 ILCS 89/10. The law requires that hospitals provide:

Charitable discount of 100 percent of charges for medically necessary health care services exceeding $300 for uninsured patients with family incomes of not more than 125 percent of the federal poverty level. Note: This applies to rural and critical access hospitals. 210 ILCS 89/10, (a)(4).

Charitable discount of 100 percent of charges for medically necessary health care services exceeding $300 for uninsured patients with family incomes of not more than 200 percent of the federal poverty level. Note: This applies to hospitals other than rural and critical access hospitals. 210 ILCS 89/10, (a)(2).

Discount from charges for medically necessary health care services exceeding $300 to any uninsured patient with a family income of not more than 300 percent of the federal poverty level. Note: This applies to rural and critical access hospitals. 210 ILCS 89/10, (a)(3)(2012).

Discount from charges for medically necessary health care services exceeding $300 to any uninsured patient with a family income of not more than 600 percent of the federal poverty level. Note: This applies to hospitals other than rural and critical access hospitals. 210 ILCS 89/10, (a)(1) (2012).

The 2012 amendment to the Fair Patient Billing Act (S.B. 3261, codified as 210 ILCS 88/27) also directed the Office of the Attorney General to develop rules requiring hospitals to include specifically prescribed language in financial assistance applications. The final rules require, among other things, that financial assistance applications include an opening statement advising applicants that they may be eligible for free or discounted care and that they are not required to provide a Social Security number. A required certification at the end of financial assistance applications must include the text that the rule prescribes, and none other. 77 Ill. Admin. Code §4500.30(a), (h) (2013); (38 Ill. Reg. 12673) (June 20, 2014).

The statute also required the Attorney General to promulgate rules setting forth appropriate methodologies for determining “presumptive eligibility” under which patients would be deemed “eligible for hospital financial assistance without further scrutiny.” S.B. 3261, codified as 210 ILCS 88/27 (2012). Ill. Admin. Code tit. 77 §4500.40(a) (2013). Under those rules, patients in rural or critical access hospitals will be deemed presumptively eligible if they are homeless, deceased with no estate, mentally incapacitated, or Medicaid eligible—but not on the date of service or for a non-covered service. Ill. Admin. Code tit. 77 §4500.40(b);(d) (2013). In addition to the above criteria, patients in hospitals that are not rural or critical access hospitals will also be presumptively eligible if enrolled in a public assistance program for individuals below 200 percent of the federal poverty level such as the Women, Infants and Children Nutrition Program, and the Supplemental Nutrition Program. Ill. Admin. Code tit. 77 §4500.40(b) (2013). A hospital may include additional presumptive eligibility criteria, provided it expands a patient’s presumptive eligibility. Ill. Admin. Code tit. 77 §4500.40(c);(e)(2013).

Illinois requires both nonprofit and for-profit hospitals to post and otherwise disseminate their financial assistance plans.

Each hospital must post a sign containing specified language conspicuously in the admission and registration areas. 210 ILCS 88/15 (2007). Each hospital that has a website must also post notice there and make a brochure, an application for financial assistance, or other written material available in the hospital admission or registration area. 210 ILCS 88/15(d) (2007). In addition, each patient bill or other summary of charges to an uninsured patient must include a prominent statement that an uninsured patient meeting specified income requirements may qualify for an uninsured patient discount, and information about how to apply for the discount. S.B. 3261, codified as 210 ILCS 89/10(d) (2012).

Illinois law limits nonprofit and for-profit hospital collection practices.

Generally, Illinois hospitals may collect as payment for health care services no more than 25 percent of the family income of a patient eligible for an uninsured patient discount. S.B. 3261, codified as 210 ILCS 89/10(c) (2012).

Before pursuing a collection action against an uninsured patient, a hospital must afford the patient an opportunity to assess the accuracy of the bill, apply for financial assistance, and agree to a reasonable payment plan offered by the hospital. In addition, for an uninsured patient who has indicated the inability to pay the full amount of the bill in a single payment, the hospital must give the patient at least 60 days after discharge to submit an application for financial assistance/charity care. 210 ILCS 88/30(a)(1)-(3) (2007). A hospital may not refer a bill to a collection agency without first offering the patient an opportunity to request a reasonable payment plan within 30 days of the date of the initial bill, and giving the patient another 30 days from the request to agree to a reasonable payment plan offered by the hospital. 210 ILCS 88/30(b) (2007).

Additionally, a hospital may not pursue legal action for non-payment against an uninsured patient who has clearly demonstrated a lack of sufficient income or assets to pay the bill and who has acted reasonably and cooperated with the hospital in good faith. 210 ILCS 88/35 (2007).

Illinois law exempts the income of nonprofit hospitals from state income tax.

Illinois law exempts from state income tax the income of charitable or similar organizations that are exempt from federal income tax. 35 ILCS 5/205(a) (2011).

For-profit hospitals are eligible to receive an income tax credit in an amount that is the lesser of a) real property taxes paid during the tax year on property used for hospital purposes during the previous tax year and b) the cost of free or discounted services provided pursuant to the hospital’s financial assistance policy. 35 ILCS 5/223(a) (2012).

Illinois law requires nonprofit hospitals to provide charity care/community benefits as a condition of property tax exemption.

Illinois’ statute, adopted in 2012, requires that nonprofit hospitals seeking property tax exemption (real property and tangible personal property) provide specified services and activities (charity care, health services to low-income and underserved individuals, etc.) at levels at least equivalent to what the hospital otherwise would be required to pay in property taxes. S.B. 2194, codified as 35 ILCS 200/ 15-86(c); 2012 Ill. Pub. L. No 97-0688 (2012).

For-profit hospitals are eligible to receive an income tax credit in an amount that is the lesser of a) real property taxes paid during the tax year on property used for hospital purposes during the previous tax year and b) the cost of free or discounted services provided pursuant to the hospital’s financial assistance policy. S.B. 2194 codified as 35 ILCS 5/223(a) (2012).

Illinois law requires nonprofit hospitals to provide charity care/community benefits as a condition of sales and use tax exemption.

Illinois’ statute, adopted in 2012, requires that nonprofit hospitals seeking sales tax and use tax exemptions provide specified services and activities (charity care, health services to low-income and underserved individuals, etc.) at levels at least equivalent to what the hospital otherwise would be required to pay in property taxes. 35 ILCS 120/2-9; 35 ILCS 105/ 3-8 (2012).

Indiana requires nonprofit hospitals to provide community benefits.

Indiana law requires nonprofit hospitals to develop a community benefit plan that sets out goals and objectives for providing community benefits that include charity care and government-sponsored indigent health care. Ind. Code §16-21-9-4.

Indiana does not require nonprofit hospitals to provide a specified minimum level of community benefits.

Indiana requires nonprofit hospitals to file with the Indiana Department of Health an annual report of their community benefit plans.

A nonprofit hospital’s annual report to the Indiana Department of Health must include a copy of the hospital’s community benefit plan and the hospital’s mission statement. It must disclose the community health needs considered in developing the hospital’s community benefit plan and the amount and types of community benefits provided, including charity care. Ind. Code §16-21-9-7.

Indiana requires nonprofit hospitals to perform community health needs assessments.

In developing its community benefit plan, a nonprofit hospital must consider its community’s health care needs, as determined by a community-wide needs assessment. Ind. Code §16-21-9-5.

Indiana requires nonprofit hospitals to develop a community benefit plan/implementation strategy.

A nonprofit hospital must develop a community benefit plan that sets out goals and objectives for providing community benefits, including charity care and government-sponsored indigent health care, and identifies the populations and communities the hospital serves. Ind. Code §16-21-9-4. The plan must also include a budget, measurable objectives with a specified time frame, an evaluation mechanism for assessing the plan’s effectiveness, and a method for soliciting input from the community the hospital serves. Ind. Code §16-21-9-6.

Indiana hospitals set their own eligibility guidelines for charity care and financial assistance.

Indiana requires nonprofit hospitals that operate charity care programs to develop written notices about such programs and how to apply for them. Ind. Code §16-21-9-7(d).

Indiana requires nonprofit hospitals that operate charity care programs to conspicuously post written notice of any charity care program they offer and how to apply.

The notice must be conspicuously posted in the hospital’s general and emergency room waiting areas, in the business office, and in other areas the hospital considers appropriate. Ind. Code §16-21-9-7(d).

Indiana law does not expressly limit nonprofit hospital charges, billing, or collection practices.

However, persons eligible for services under the state’s Hospital Care for the Indigent Program are not obligated to pay for covered services provided under the program and identified in a claim filed by the provider. Ind. Code §12-16-7.5-1.2.

Indiana law exempts non-profit hospitals from state income tax.

Indiana law exempts from state income tax the income of any organization that is exempt under Internal Revenue Code §501(a). Ind. Code §6-3-2-2.8(1).

Indiana law exempts nonprofit hospitals from state property tax.

Indiana exempts from taxation the buildings, land, and personal property of a nonprofit hospital when owned, occupied, and used for charitable purposes. Ind. Code §6-1.1-10-16.

Indiana law exempts nonprofit hospitals from state sales taxes.

Indiana law exempts from taxation sales made to nonprofit corporations if the property or service is primarily used to carry on—or to raise money to carry on—its nonprofit purpose. Ind. Code §6-2.5-5-25; Indiana Department of Revenue, Information Bulletin #10, Sales Tax, April 2012.

Maryland requires nonprofit hospitals to provide free or discounted care based on need to specified populations. Md. Code Ann. Health-Gen. §19-214-1(b); COMAR 10.37.10.26.

Maryland does not specify a minimum level of community benefits that a nonprofit hospital must provide.

Maryland requires that each nonprofit hospital submit an annual community benefit report to the Maryland Health Services Cost Review Commission (HSCRC).

Maryland requires that each nonprofit hospital’s annual community benefit report include the hospital’s mission statement and a list of each community benefit initiative undertaken by the hospital, a specification of its cost and objectives, and a description of the hospital’s efforts to evaluate the initiative’s effectiveness. Each hospital’s community benefit report must also include descriptions of gaps in the availability of specialist providers to serve the uninsured and of the hospital’s efforts to track and reduce health disparities in the community that the hospital serves. Md. Code Ann. Health-Gen., §19-303(c).

The HSCRC compiles all of the individual hospital community benefit reports into a consolidated Nonprofit Hospital Community Benefit Report for posting on its website. The report also includes a list of the unmet community needs identified in the most recent community needs assessment conducted by the state health department and by the local health department in each jurisdiction. Md. Code Ann. Health-Gen., §; 19-303(d).

Maryland requires nonprofit hospitals to conduct community health needs assessments.

Maryland law requires that each nonprofit hospital identify the health care needs of its community and, as part of the needs assessment process, consider the most recent community needs assessments developed by the state health department or by the local health department for the jurisdiction in which the hospital is located. Maryland law also provides that a hospital’s needs assessment process “may” include consultation with community leaders, local health care providers, and “any appropriate person who can assist the hospital in identifying community health needs.” Md. Code Ann. Health-Gen., §19-303(b).

Maryland requires nonprofit hospitals to submit annual community benefit reports.

Maryland law requires that each hospital’s individual community benefit report describes how the hospital plans to address the health needs of the community that have been identified and prioritized through the community health needs assessment process. Md. Code Ann. Health-Gen., §19-303(c).

Maryland requires nonprofit hospitals to submit annual community benefit reports.

Maryland law requires that each hospital’s individual community benefit report describes how the hospital plans to address the health needs of the community that have been identified and prioritized through the community health needs assessment process. Md. Code Ann. Health-Gen., §19-303(c).

Maryland law requires hospitals to develop and implement a financial assistance policy for “providing free and reduced-cost care to patients who lack health care coverage or whose health care coverage does not pay the full cost of the hospital bill.”

Maryland law and regulation require each acute care and chronic care hospital to develop and implement a financial assistance policy that provides, at a minimum, free medically necessary care to patients with family income at or below 200 percent of the federal poverty level; reduced cost medically necessary care to patients with family incomes between 200 and 300 percent of the federal poverty level “in accordance with the mission and service area of the hospital;” and reduced cost medical care to patients with family income below 500 percent of the federal poverty level who have a financial hardship. In addition, upon request, a hospital must offer a payment plan to uninsured patients with family income between 200 and 500 percent of the federal poverty level. Md. Code Ann. Health-Gen. §19-214.1(b); COMAR 10.37.10.26(A-2)(2)(a).

Maryland law limits hospital charges and billing and collection practices.

Maryland statutes and regulations establish detailed requirements and prohibitions concerning hospital charges, billing, and debt collection practices, including agency review of each hospital’s debt collection policy. A description of these policies must be submitted periodically for review by the HSCRC. The policy must provide a detailed description of its debt collection procedures; indicate the circumstances in which the hospital will seek a judgment against a patient; and include prohibitions on the charging interest on self-pay patients’ bills before obtaining a court judgment, forcing the sale or foreclosure of a patient’s primary residence, and selling patient debt. Md. Code Health-Gen., § § 19-214.1; 19-214.2; COMAR 10.37.10.26 A, A-1.

Maryland law exempts nonprofit hospitals from state income tax.

Maryland law exempts from state income tax organizations that are exempt from federal income tax under Internal Revenue Code §501. Md. Code Ann., Tax-Gen. §10-104(2).

Maryland law may exempt property owned or leased by nonprofit hospitals from state property tax.

Nonprofit hospital property is generally eligible for tax exemption if it is “necessary for and actually used for a charitable … purpose.” Md. Code Ann., Tax-Prop. §7-202(b).

Maryland exempts nonprofit hospitals from state sales and use tax.

Maryland law generally exempts charitable organizations, including nonprofit hospitals, from state sales and use tax. Md. Code Ann. Tax-Gen. §11-204(a) (3).

New Hampshire requires nonprofit hospitals to provide community benefits if the total value of their fund balances exceeds $100,000.

New Hampshire’s community benefit law applies to “health care charitable trusts” (a term that includes nonprofit hospitals) that have total fund balances of over $100,000. N.H. Rev. Stat. Ann. Tit. I, §§ 7:32-d—l. A hospital may seek a waiver of community benefit requirements when “compliance would be a financial or administrative burden,” based on criteria established and administered by the Director of Charitable Trusts. N.H. Rev. Stat. Ann. Tit. I, §§ 7:32-j; Office of the Attorney General, Community Benefits Plan -Criteria for Exemption Pursuant to RSA 7:32-j.

In addition to the general community benefit requirements of N.H. Rev. Stat. Ann. Tit. I, §§ 7:32-d—l (2000), additional community benefit requirements are included in the standards for review of the Certificate of Need (CON) applications of nonprofit hospitals and other health care charitable trusts that propose new institutional health services. These include the provision of free care to uninsured patients with household income at or below 150 percent of the federal poverty level (FPL), subject to a “reasonable and nominal” (not over $100) copayment by the patient. In cases of patient hardship, a hospital must waive any required copayment. N.H. Rev. Stat. Ann. Titl. XI, §151-C; N.H. Code Admin. R. He-Hea 303.04(d). A CON application must indicate the degree to which the proposed project will be accessible to persons who are “medically underserviced,” including persons with disabilities and those with low income. N.H. Rev. Stat. Ann. Tit. XI §151-C:7(III); N.H. Code Admin. R. He-Hea 304.05(v). Effective June 30, 2016, the CON statutes will be repealed. N.H. Rev. Stat. Ann. Titl. XI, §151-C (2013).

New Hampshire does not specify a minimum level of community benefits that nonprofit hospitals must provide.

New Hampshire requires that nonprofit hospitals and other health care charitable trusts report community benefits provided during the previous year as part of community benefit plans filed with the Director of Charitable Trusts.

The plan must include: 1) information about community benefit activities the hospital undertook during the preceding fiscal year; 2) the results, outcomes, and unreimbursed costs of these activities; 3) a description of how the hospital solicited community input; 4) identification of the community groups, members of the public, and local government officials that were consulted in connection with the plan’s development; and 5) an evaluation of the plan’s effectiveness. N.H. Rev. Stat. Ann. Tit. I, §§7:32-e(2000). The state uses a “data-driven” Community Benefits Reporting Form that contains a three-page “List of potential Community Needs.” Included in the list are the following social and economic factors: poverty, unemployment, homelessness, economic development, educational attainment, high school completion, housing adequacy, vandalism/crime, air quality, and water quality (New Hampshire Office of the Attorney General, 2009).

New Hampshire requires nonprofit hospitals and other health care charitable trusts to conduct community needs assessments and to update them at least every five years. N.H. Rev. Stat. Ann. Tit. I, §7:32-f.

To assist in determining the activities to be included in its community benefit plan, each nonprofit hospital and other health care charitable trusts must conduct a community needs assessment. A hospital’s needs assessment may be conducted individually or with other health care charitable trusts in its community. The needs assessment process must include “consultation with members of the public, community organizations, service providers, and local government officials.” N.H. Rev. Stat., Tit. I, §7:32-f (2004).

New Hampshire requires nonprofit hospitals to develop and annually submit community benefit plans.

Nonprofit hospitals and other health care charitable trusts must annually submit to the Director of Charitable Trusts a community benefit plan developed on forms supplied by the Attorney General. The plan must take into consideration public input and identify the health care needs considered in developing the plan; identify community benefit activities the hospital will undertake along with an estimate of its cost; and specify which needs identified by the community needs assessment process these activities are intended to address. N.H. Rev. Stat. Ann., Tit. I § 7:32-e (2000).

New Hampshire requires nonprofit hospitals and other health care charitable trusts to submit their written financial assistance plans with CON applications.

New Hampshire requires nonprofit hospitals and other health care charitable trusts applying for CONs to provide with their applications a copy of their written financial assistance plans.

State regulations require hospital financial assistance plans to specify that 100 percent of uninsured individuals with household income less than or equal to 150 percent of the FPL are eligible to receive free care, subject to a reasonable and nominal payment by the patient of up to $100, which will be waived in cases of financial hardship. N.H. Code Admin. R. He-Hea 303.04(d).

An applicant’s written financial assistance plan must also include: application forms and instructions provided to any person who indicates his or her inability to pay for the facility’s services; eligibility determination procedures; appeal procedures for those denied eligibility for financial assistance; and a description of communication procedures to be used to inform the public of the hospital’s financial assistance policy. N.H. Code Admin. R. He-Hea 303.04(e)(1-4).

Effective June 30, 2016, the CON statutes will be repealed. N.H. Rev. Stat. Ann. Titl. XI, §151-C (2013).

New Hampshire requires nonprofit hospitals and other health care charitable trusts to describe, in their CON applications, the communications procedures to be used to inform the public of the hospital’s financial assistance policy.

A health care charitable trust must inform the public of its financial assistance policies by: posting the hospital’s financial assistance policy, referencing it in all public notices of service availability, and informing the public of the availability of staff to assist patients in all aspects of eligibility. N.H. Code Admin. R. He-Hea 303.04(e)(4).

Effective June 30, 2016, the CON statutes will be repealed. N.H. Rev. Stat. Ann. Titl. XI, §151-C (2013).

New Hampshire law does not limit nonprofit hospital charges, billing, or collection practices.

New Hampshire law exempts nonprofit hospitals and other charitable organizations from state income tax.

New Hampshire exempts from taxation income received by a charitable organization incorporated or organized in the state and used “for the purposes for which it is established.” N.H. Rev. Stat., Tit. V, §77:8.

New Hampshire exempts from taxation the property of nonprofit hospitals and other charitable organizations, subject to certain conditions.

The buildings, land, and personal property of a charitable organization are exempt from New Hampshire property tax if the property is owned, used, and occupied by the organization for the charitable purposes for which it was established. New Hampshire law requires that each charitable organization file an annual statement reflecting its financial condition and other information needed to establish its eligibility for the tax exemption. N.H. Rev. Stat., Tit. V, §72:23(V) and (VI).

New Hampshire does not have a sales tax. New Hampshire Department of Revenue Administration.

New York requires for-profit and nonprofit hospitals to provide discounted care as a condition of reimbursement from a state Pool.

As a condition of participation in New York’s General Hospital Indigent Care Pool, nonprofit and for-profit general hospitals must provide discounted care to qualifying patients with low income. The Pool provides reimbursement for a portion of hospital losses associated with unreimbursed care, including both charity care and bad debt expenses. To be eligible for disbursements from the Pool, a hospital must provide discounted care to eligible low-income patients in accordance with a proportional sliding fee schedule. N.Y. Pub. Health Law §§ 2807-k(9-a).

New York does not require nonprofit hospitals to provide a specified minimum level of charity care or other community benefits.

New York requires hospitals to report their costs of providing unreimbursed care and requires nonprofit hospitals to demonstrate their commitment to meeting community health needs.

New York law requires that nonprofit and for-profit hospitals file financial reports detailing, among other things, their costs of providing free or reduced cost services. N.Y. Pub. Health Law §§2805-a(2)(a); 2803-l(2)(iv). In addition, at least every three years the governing body of a nonprofit hospital must demonstrate the hospital’s commitment to meeting community health care needs, providing charity care, and improving underserved individuals’ access to health care services. The governing body must also make available to the public a summary statement of the hospital’s financial resources and allocation to hospital purposes, including its provision of free and discounted care. At least annually, the governing body must make available to the public an implementation report as to the hospital’s efforts to meet community health care needs, provide charity care, and improve access to care. At least every three years, a nonprofit hospital must file with the Commissioner of Health a report detailing changes to its mission statement and its operational and financial commitment to meeting community health care needs, to its provision of charity care, and to improving underserved individuals’ access to care. N.Y. Pub. Health Law §2803-l.

New York requires nonprofit hospitals to conduct community needs assessments in connection with developing a community service plan.

Every three years, as part of each nonprofit general hospital’s community service plan, its governing body must 1) solicit the views of the communities served by the hospital on such issues as the hospital’s performance and service priorities and 2) demonstrate the hospital’s commitment to meeting community health care needs, to providing charity care services, and to improving health care accessibility for the underserved. N.Y. Pub. Health Law §2803-l.

New York requires nonprofit hospitals to develop community benefit plans or implementation strategies.

These publicly available annual reports describe each hospital’s performance in meeting the health care needs of the community, providing charity care services, and improving access to health care services by the underserved. N.Y. Pub. Health Law §2803-l (3).

New York also incentivizes and promotes hospital community benefit initiatives that target community health improvement by expressly linking its State Health Improvement Plan (SHIP), titled Prevention Agenda 2013-2017, to required hospital community benefit plans (termed “community service plans”).

Each tax-exempt hospital’s community service plan must include two state Prevention Agenda priorities (selected jointly with the local health department) and describe strategies to address the priorities in a three-year action plan.

New York requires hospitals that participate in the state’s General Hospital Indigent Care Pool to adopt financial assistance policies.

New York require hospitals to adopt and implement financial assistance policies as a condition of participating in the state’s General Hospital Indigent Care Pool, which provides reimbursement for a portion of hospital losses associated with unreimbursed care, including both charity care and bad debt expenses. To be eligible for disbursements from the Pool, a hospital must provide discounted care to eligible low-income patients based on a sliding fee schedule. N.Y. Pub. Health Law §2807-k(9-a)(a).

New York requires dissemination of hospitals’ financial assistance policies as a condition of participating in the state’s General Hospital Indigent Care Pool.

In order to participate in the state’s General Hospital Indigent Care Pool, hospitals must develop a clear and understandable written financial assistance policy and make patients aware of the policy. Summaries of these policies must be available to patients and to the public. Hospitals that operate 24-hour emergency rooms must also conspicuously post notice of their financial assistance policies in appropriate languages and notify patients of the policies during the intake and registration process. In addition, notice that financial assistance may be available and instructions on how to obtain additional information must be included in bills and statements sent to patients. N.Y. Pub. Health Law § 2807-k(9-a)(c).

New York limits hospital charges and collections as a condition of participating in the state’s General Hospital Indigent Care Pool.

New York requires nonprofit and for-profit hospitals participating in the Pool to reduce charges to uninsured patients with family income below 300 percent of the federal poverty level. N.Y. Pub. Health Law §2807-k(9-a) (a),(f). Hospitals must provide the option of monthly installment plans for payment of outstanding balances, and payments under such plans may not exceed 10 percent of a patient’s gross monthly income. N.Y. Pub. Health Law §2807-k(9-a) (d). In addition, hospitals’ policies may not permit the forced sale or foreclosure of a patient’s primary residence in order to collect an outstanding medical bill. N.Y. Pub. Health Law §2807-k(9-a)(h).

New York law exempts nonprofit hospitals from state income tax.

New York exempts from taxation the net income of a non-stock corporation that is organized and operated on a nonprofit basis if no part of its net earnings inure to the benefit of any officer, director, or member. A nonprofit corporation that is exempt from federal income tax pursuant to Internal Revenue Code §501(a) is presumed to be exempt from state income tax. 20 N.Y. Comp. Codes R. & Regs. §1-3.4(b)(6).

New York law exempts from taxation the property of nonprofit hospitals.

New York exempts from taxation real property owned by nonprofit corporations organized or conducted exclusively for charitable or hospital purposes and used for carrying out that charitable or hospital purpose and not for private inurement. N.Y Real Property Tax Law §§420-a (1)(a)-(b).

New York law exempts nonprofit hospitals from sales and use taxes.

New York law exempts from sales and use tax sales to or by nonprofit corporations operated exclusively for charitable purposes. N.Y. Sales Tax Law § 1116(a)(4).

Rhode Island requires hospitals to provide charity care, uncompensated care, and other community benefits as a condition of licensure.

Rhode Island has established statewide standards for the provision of charity care, uncompensated care, and community benefits as conditions of initial and continued hospital licensure and for hospital conversions. R.I. Gen. Laws §23-17-43; 23-17 R.I. Code R. §8.7; 23-17.14 R.I. Code R. §§11.0 – 11.6.

Rhode Island’s hospital licensing regulations expressly require that hospital charity and uncompensated care and community benefit standards be consistent with the rules and regulations applicable to hospital conversions. 23-17 R.I. Code R. §8.7. These define “community benefit” broadly to include the provision of hospital services that meet the community’s needs, charity care, uncompensated care, programs to meet the needs of medically indigent individuals, non-revenue-producing programs available in the community (e.g., health screenings or transportation services), scientific or medical research, education activities, forming linkages with community partners focused on improving community health, and engaging in community health advocacy. 23-17.14 R.I. Code R. §1.9.

Rhode Island does not specify a minimum level of community benefits that hospitals must provide.

Rhode Island law requires hospitals to submit annual community benefit reports to the Director of the Department of Health (Director).

The reports must include detailed descriptions, with supporting documentation, of the costs of charity care, bad debt, and contracted Medicaid shortfalls. R.I. Gen. Laws Ann. § 23-17.14-15(d). If the Department of Health receives “sufficient information” indicating that a licensed hospital is not in compliance with state community benefit standards, then the Director is required to hold a hearing, issue written findings, and impose appropriate penalties. R.I. Gen. Laws Ann. § 23-17.14-15(e).

Rhode Island requires each hospital to develop a formal Board-approved community benefit plan that includes a comprehensive assessment of the health care needs of its community.

The assessment must include needs related to the goals articulated in A Healthier Rhode Island by 2010: A Plan for Action, and a statement of priorities consistent with the hospital’s resources. 23-17.14 R.I. Code R. §11.5 (b).

Rhode Island requires hospitals to develop a formal Board-approved community benefit plan that considers the health care needs of the community or communities served.

A hospital’s community benefit plan, to be updated every three years, must specify the communities (including racial or ethnic minority populations) that will be the focus of the plan. Representatives of the designated community or communities must be involved in the planning and implementation process. The plan must reflect a comprehensive assessment of the health care needs of these designated communities. It must also specify the actual or planned dates when the activities and proposals included in the plan will be implemented. 23-17.14 R.I. Code R. §11.5(b).

Rhode Island law establishes a statewide community standard for the provision of free and discounted care.

Rhode Island hospitals must make full or partial charity care available to uninsured low-income state residents who are ineligible for government or employer-sponsored health coverage. 23-17.14 R.I. Code R. §11.3(b). Hospitals may expand their financial assistance policies beyond what the state requires but may not reduce the amount of assistance or make their financial assistance eligibility standards more restrictive than the state prescribes.

Hospitals must provide free care for patients with annual income at or below 200 percent of the federal poverty level (FPL) and must provide discounted care for patients with annual income between 200 and 300 percent of the FPL. Each hospital’s discounted care policy must be based on a sliding fee scale that the hospital determines based on its evaluation of the needs of its service area and the hospital’s financial resources. 23-17.14 R.I. Code R. §11.3(f).

In determining a patient’s eligibility for free or discounted care, a hospital has discretion to consider, in addition to income, a patient’s assets pursuant to a criterion establishing an assets protection threshold. If assets are considered in determining whether a patient qualifies for free care, additional restrictions on permissible hospital billing and collections against the patient apply. 23-17.14 R.I. Code R. §11.3(d)-(f).

Rhode Island requires hospitals to develop a public “Notice of Hospital Financial-Aid” and post it prominently in emergency departments, admissions areas, outpatient care areas, and on the hospital’s website.

Each hospital is required to develop a “Notice of Hospital Financial-Aid” on a specified template for approval by the Director, as well as include the notice on each patient bill. Each hospital’s financial-aid criteria for financial assistance eligibility, including the sliding fee schedule for discounted care, are also subject to the Director’s approval. Hospitals must also make their financial aid criteria available to all persons upon request. 23-17.14 R.I. Code R. §11.3(h)-(j).

Rhode Island law limits nonprofit hospital billing and collection practices.

Regulations promulgated under Rhode Island’s Hospital Conversions Act, which applies to both hospital licensing and conversions, require each hospital to formally adopt a written collections policy and make it available to all persons upon request. 23-17.14 R.I. Code R. §11.3(n). Although a hospital may attach a patient or guarantor’s primary residence due to non-payment of medical debt, it may not force a foreclosure of the primary residence. 23-17.14 R.I. Code R. §11.4.

Rhode Island exempts non-profit hospitals from state Business Corporation tax. Rhode Island Department of Revenue, R.I. Gen. Laws §44-11-1(1)(c)(4)(iv).

Rhode Island law exempts from taxation the property of a hospital “for the sick or disabled.”

Real and personal property held by or for a hospital for the sick and disabled and used exclusively for that purpose is exempt. R.I. Gen. Laws §44-3-3(12); Lifespan Corporation v. City of Providence, 776 A.2d 1061 (R.I. 2001). State law also exempts intangible personal property owned by, or held in trust for, a charitable organization if the principal or income is used or appropriated for charitable purposes. R.I. Gen. Laws §44-3-3(7).

Rhode Island sales and use tax does not apply to sales of personal property to nonprofit hospitals. R.I. Gen. Laws §44-18-30(5); Rhode Island Sales Regulation SU 07-48.

Texas requires nonprofit hospitals to provide community benefits as a condition of state tax exemption.

Texas law requires that, in order to qualify as tax-exempt “charitable organizations,” nonprofit hospitals and hospital systems must provide “charity care and government-sponsored indigent health care” or “charity care and community benefits” in at least the amount specified in accordance with one of four alternative standards. Nonprofit disproportionate share hospitals, nonprofit hospitals in counties with a population of less than 58,000, and hospitals that exclusively provide free care are exempt from this requirement. Texas Tax Code Ann. §11.1801; Tex. Health and Safety Code Ann. §§311.043 & 311.045.

Texas law directs nonprofit hospitals, as a condition of tax exemption, to provide community benefits in accordance with one of three alternative community benefit standards. Two of these alternative standards specify a minimum level of community benefits that a hospital must provide.

A nonprofit hospital may qualify as a tax-exempt charitable organization by providing community benefits in an amount that satisfies one of the following standards:

(1) Charity care and government-sponsored indigent health care (shortfall) at a level that is “reasonable in relation to the community needs, as determined through the community needs assessment, the available resources of the hospital or hospital system, and the tax-exempt benefits received by the hospital or hospital system;”

(2) Charity care and government-sponsored indigent health care (shortfall) provided in an amount equal to at least 100 percent of the hospital’s or hospital system’s tax-exempt benefits, excluding federal income tax;

(3) Charity care and community benefits provided in a combined amount equal to at least 5 percent of the hospital’s or hospital system’s net patient revenue, provided that charity care and government-sponsored indigent health care are provided in an amount equal to at least 4 percent of net patient revenue. Texas Tax Code Ann.§§11.1801(a); Tex. Health and Safety Code Ann. §§ 311.031(2) & (8); 311.045.

Texas requires nonprofit hospitals to submit annual community benefit reports.

The Texas Department of Health requires that each nonprofit hospital submit an “annual report of its community benefit plan” that includes a specification of: the hospital’s mission statement; the health needs of the community considered in developing the hospital’s community benefit plan; the amount and types of community benefits actually provided; total operating expenses; and the hospital’s cost to charge ratio. Tex. Health and Safety Code Ann. § 311.046(a).

Texas requires nonprofit hospitals to perform community-wide health needs assessments.

Nonprofit hospitals are directed to seek input from representatives in the community, including the local health department, consumers, private business, insurance companies, and health science centers. Tex. Health and Safety Code Ann. §311.044(a)-(d).

Texas requires nonprofit hospitals to develop community benefit plans.

A nonprofit hospital’s community benefit plan must be an operational plan for serving the community’s health care needs as determined by a community-wide health needs assessment. The plan must include mechanisms to evaluate the plan’s effectiveness, measureable objectives to be achieved within a specified time frame, and a budget for implementing the plan. Tex. Health and Safety Code Ann.§311.044.

Texas requires nonprofit hospitals to have a financial assistance policy that incorporates specified eligibility criteria.

Each Texas nonprofit hospital must “develop, implement, and enforce” a written financial assistance policy. The policy must provide that patients who satisfy the statutory definitions of “financially indigent” or “medically indigent” are eligible for financial assistance. A “financially indigent” patient is one with income at or below 200 percent of the federal poverty level; a “medically indigent” patient is one who is unable to pay the remaining balance on hospital bills that, after payment by third-party payers, exceeds a percentage of the patient’s annual gross income (as specified in the hospital’s financial assistance policy). Tex. Health and Safety Code Ann. §§324.101, 311.031(11),(13).

Texas requires a nonprofit hospital to make information available to the public about its community benefit plan and its charity care program.

Texas law requires that a nonprofit hospital provide to each person seeking any health care service at the hospital a notice (in appropriate languages and in language readily understandable to the average reader) about the hospital’s charity care program, including its eligibility policies and how to apply for the program. The notice must be posted in prominent hospital locations, including the general waiting area, the emergency department waiting area, and the business office. A nonprofit hospital must also publish notice of its charity care policies annually in a local newspaper. Tex. Health and Safety Code Ann. §311.046(d).

Texas law requires hospitals to submit patient bills in a timely manner.

Texas law requires that medical providers submit their bills for medical services to patients and health plans in a timely manner. The law specifies the number of days within which billing must occur under various circumstances. Tex. Health and Safety Code Ann. §146.002. Claims billed in violation of these timeliness standards may be unenforceable against a patient who, had the billing been timely, would not have been obligated to pay. Tex. Health and Safety Code Ann. §146.003.

Texas does not levy a corporate income tax.

Texas exempts nonprofit hospitals from property tax if they provide medical care without regard to ability to pay, “which means they provide charity care and community benefits in accordance with Texas law.” Texas Tax Code Ann. §11.18(d)(1).

Texas exempts charitable organizations from state sales tax.

Texas law exempts from state sales tax organizations that are exempt from federal income tax under Internal Revenue Code §501(c)(3). Texas Tax Code Ann. §151.310(a)(2). Nonprofit hospitals that qualify for an exemption under that provision must provide community benefits that include charity care and government-sponsored indigent health care. Texas Tax Code Ann. §151.310(e).

Vermont law does not expressly require nonprofit hospitals to provide community benefits.

Vermont law does not expressly require nonprofit hospitals to provide community benefits.

Vermont requires all community hospitals to report certain community benefit expenses in annual “Hospital Community Reports.”

Vermont community hospitals are required to submit Hospital Community Reports to the Commissioner of the Department of Financial regulation. The reports must include as a mandatory reporting category “a summary of the hospital’s budget, including revenue by source and quantification of cost shifting to private payers.” “Cost shifting to private payers” encompasses a hospital’s costs associated with Medicare and Medicaid reimbursement shortfalls and uncompensated care costs. Vt. Stat. Ann. tit. 18 §9405b(a)(5).

Vermont requires hospitals to conduct community health needs assessments.

Vermont law requires each hospital to have a protocol for “meaningful public participation” in its process for “identifying and addressing health care needs that the hospital provides or could provide in its service area.” These needs must be summarized in the hospital’s community report and integrated with the hospital’s long-term planning. Vt. Stat. Ann. tit. 18 §9405a; 9405b(a)(10).

Vermont requires hospitals to develop strategic initiatives to address identified community health care needs.

Vermont requires hospitals to include in their hospital community reports a description of strategic initiatives “discussed with or derived from the identification of health care needs” along with short- and long-term capital expenditure plans and facility depreciation schedules. A summary of identified community needs must be “integrated with the hospital’s long-term planning.” Vt. Stat. Ann. tit. 18 §9405a; 9405b(a)(10).

Vermont does not require hospitals to adopt or implement financial assistance policies.

Although not legally required, the Department of Banking, Insurance, Securities, and Health Care Administration (BISHCA) found in 2007 that every Vermont hospital had its own written uncompensated care policies for providing free care to patients with income not exceeding 100 percent of the federal poverty level. BISHCA, Report on Vermont Community Hospitals Uncompensated Care Policies (Jan., 2007), at 5.

Vermont does not require nonprofit hospitals to adopt, implement, or disseminate financial assistance policies.

Vermont law requires hospitals to provide patients with an “itemized, detailed, and understandable” explanation of charges, regardless of the source of payment. Vt. Stat. Ann. tit. 18 §1852 (12).

Vermont exempts nonprofit hospitals from state income tax.

Vermont law expressly adopts federal income tax law for purposes of computing state income tax liability so that a federally tax-exempt corporation is also exempt from Vermont income tax. Vt. Stat. Ann. tit. 32 § 5824.

Vermont exempts nonprofit hospitals from state property tax.

Vermont exempts from state property tax any real and personal property that is “used for … charitable uses.” Vt. Stat. Ann. tit. 32 §3802(4).

Vermont law exempts nonprofit hospitals from state sales and use taxes.

Vermont law exempts from state sales and use taxes organizations exempt from federal income tax. Vt. Stat. Ann. tit. 32 §9743(3).

Washington requires both nonprofit and for-profit hospitals to provide free and discounted care to indigent patients. Wash. Rev. Code §70.170.060(5).

Washington law does not specify a minimum level of community benefits that nonprofit hospitals must provide.

Washington requires nonprofit and for-profit hospitals to report charity care provided.

Washington law requires hospitals to compile and report to the Washington Department of Health the amount of free and discounted care provided. Wash. Admin. Code §246-453-080.

Washington requires nonprofit hospitals that have been federally recognized under §501(c)(3) of the Internal Revenue Code to make their federally required community health needs assessment widely available to the public within 15 days of its submission to the IRS. Wash. Rev. Code §70.41.470(1).

Washington requires nonprofit hospitals to make community benefit plans and implementation strategies publically available.

Washington requires each federally recognized 501(c)(3) tax-exempt hospital to make widely available to the public, within one year of completing its community health needs assessment, its federally required implementation strategy. Either as part of the implementation strategy or separately, the hospital must explain why any recommendations for community benefit proposals identified in the hospital’s community health needs assessment through stakeholder consultation were not accepted. If data are available, the implementation strategy must be evidence-based; innovative programs and practices should be supported by evaluation measures. Wash. Rev. Code §70.41.470 (2012).

Washington requires nonprofit and for-profit hospitals to adopt and implement financial assistance policies. Wash. Rev. Code §70.170.060(5).

Washington requires hospitals to provide free and discounted care to patients whose responsible parties are identified as indigent, based on specified criteria: responsible parties with family income not exceeding 100 percent of the federal poverty level are indigent and qualify for “charity sponsorship” for the full amount of hospital charges not otherwise covered by public or private sources. Wash. Admin. Code §246-453-040(1). Responsible parties with family income of 101 to 200 percent of the federal poverty level are indigent and qualify for discounted charges in accordance with the hospital’s sliding fee schedule and policies regarding individual financial circumstances. Wash. Admin. Code §246-453-040(2). Hospitals also have discretion to identify responsible parties with higher income as indigent and eligible for discounted charges based on individual financial circumstances. Wash. Admin. Code §246-453-040(3). Hospitals must implement a sliding fee schedule for patients identified as indigent for discounted charges following mandated guidelines. Wash. Admin. Code §246-453-050(1).

Washington requires hospitals to make publicly available notice that hospital charges incurred by indigent responsible parties may be waived or reduced. Wash. Admin. Code 246-453-020(2).

Washington limits nonprofit hospital billing and collection practices.

A nonprofit or for-profit hospital may not begin collection activities until it has made an initial determination of whether the patient has public or private insurance and whether the responsible party is indigent and eligible for free or discounted care. Wash. Admin. Code 246-453-020(1); Wash. Rev. Code §70.170.060(6). If a hospital’s initial determination finds that the patient may be an indigent person, collection efforts must cease until a final determination is made. Wash. Admin. Code 246-453-020(1)(c).

Washington does not have a state income tax.

Washington law exempts nonprofit hospitals from state property tax.

Washington law exempts from taxation the real and personal property used by nonprofit hospitals. Wash. Rev. Code §84.36.040(1)(e).

Washington law exempts nonprofit hospitals from state property tax.

In general, Washington nonprofit organizations must pay sales tax on goods and services they purchase. Wash. Rev. Code §82.08.020(1); Washington State Department of Revenue. However, Washington law exempts sales to hospitals that do not charge patients for health care. Wash. Rev. Code §82.08.02795.