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Not-for-profit hospitals, in order to maintain their tax-exempt, or "charitable," status, under section 501(c)(3) of Federal Internal Revenue Code, have long been required to provide benefit to the community that they serve. Recent changes in legislation now require that such hospitals explicitly and publicly demonstrate community benefit by conducting a community health needs assessment (CHNA) and adopting an implementation strategy to meet the identified community health needs. (IRS).
Section 9007 of the Patient Protection and Affordable Care Act, Public Law 111-148 (the "Affordable Care Act"), created section 501(r) of the Code adding new requirements effective beginning with the first tax year on or after March 23, 2012, that 501(c)(3) hospitals must conduct a CHNA at least once every three years in order to assess community need and annually file information (by means of Schedule H (Form 990)) regarding progress toward addressing identified needs. (IRS). This can involve partnerships with other clinical, public health, and population health focused organizations. Section 9007 furthermore established tax penalties for hospitals that do not comply, as well as reporting requirements regarding national compliance on the IRS. (IRS).
The IRS has provided initial guidance concerning the CHNA requirement (see legislative and tax information); this guidance has been further augmented by individual states to accommodate their state-specific requirements for tax-exempt status (Hilltop). A growing set of tools, examples, and analyses are provided below to assist both those tasked with preparing a CHNA, as well as those interested in reviewing national progress.
The Innovations Exchange offers health professionals and researchers the opportunity to share, learn about, and ultimately adopt evidence-based innovations and tools suitable for a range of health care settings and populations.
Assess the health of your community with this easy-to-use Community Health Needs Assessment (CHNA) tool.
This website is aimed at those who participate in CHI work within hospitals and health systems, public health agencies, and other community organizations. It provides vetted tools and resources for community health improvement.
This toolkit includes a series of webinars to assist in the CHNA development, an instructional video on creating a report with this tool, and a map creation tool (or use an existing map).
This website features a selection of tools, reports and forms to assist organizations in fulfilling the community benefit requirements. News feeds alert users to new data, relevant to the area.
A comprehensive, searchable tool for community benefit data, enabling local organizations to assess how hospital resources are allocated. The tool includes community benefit expenditures as reported by tax-exempt hospitals from all fifty states and the District of Columbia.
Resources to assist hospitals in planning and implementing community benefit programs and services, including community health needs assessment, implementation strategies, and evaluation.
This site helps state, tribal, local, and territorial (STLT) health departments as they develop community health assessments and health improvement plans, whether for accreditation preparation, nonprofit hospital collaboration, or other reasons.
Intended as a resource for community health planners, practitioners, and policy developers both in counties and hospitals in New York State but relevant to other states and settings, this website contains health data, local health planning, and examples of Community Health Assessments and Hospital Community Service Plans (CHNAs).
The Association for Community Health Improvement's Community Health Assessment Toolkit offers a nine-step pathway for conducting a CHA and developing implementation strategies. It is designed to assist in planning, leading and using community health needs assessments to understand and improve health of communities.
This website provides access to resources in support of both assessment of community benefit and accreditation, from from the perspective of Local Health Departments. Included are sections on community benefit, the Community Health Status Indicators Project, and accreditation prerequisites: CHAs and CHIPs.
This self-paced online course from the National Library of Medicine® (NLM) will help you gain the skills needed to use Community Health Maps to: empower communities, collect health data, and create maps. CE credit is available.
This web-based resource was designed to assist KP hospitals with conducting CHNAs; free registration is required to use the platform.
Index assists in the process of gathering vital socio-economic factors in the community. The CNI is strongly linked to variations in community healthcare needs and is a strong indicator of a community's demand for various healthcare services.
The Community Tool Box is a global resource for free information on essential skills for building healthy communities. Its goal is to promote community health and development by connecting people, ideas and resources.
The Center for Applied Research and Environmental Systems (CARES) provides basic data on counties and states through an online data retrieval system and provides you with a downloadable, and editable, Microsoft Word document which can serve as a basis for conducting a more detailed CCNA. Free registration is required.
Provides county-by-county health rankings for each of the 50 states and Washington DC, explanations of each health factor, and actionable strategies to improve the health of communities across the nation.
Database of ongoing health services research projects. Search for studies relating to access, cost, and quality of health care, including patient outcomes, health services research methods, community needs assessments, etc.
HSRR is a searchable database of information about research datasets, instruments/indices and software employed in Health Services Research, the Behavioral and Social Sciences and Public Health. The database includes brief descriptions of research resources and links to PubMed.
This report presents the results of an analysis of the community health needs assessments from 300 tax-exempt hospitals. It outlines the key drivers to community health needs, including: access to care, lack of health insurance, socioeconomic factors, limited preventive and screening services, limited care coordination, and inadequate chronic condition management.
Resource Center is designed to advance implementation of CDC's 6|18 Initiative by Medicaid, state and local health departments, and other payers and purchasers. It offers practical resources and state examples to guide stakeholders in spending smarter for healthier populations.
This framework was developed to help organizations create a community needs assessment in conjunction with the Healthy People 2020 goals.
Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans. Healthy People 2020 contains 42 topic areas with more than 1,200 objectives. A smaller set of Healthy People 2020 objectives, called Leading Health Indicators (LHIs), have been selected to communicate high-priority health issues and actions that can be taken to address them.
This tool will allow you to browse maps created by Community Commons members, or build state specific reports for Community Health Needs Assessment and Vulnerable Populations Footprint.
The Building Health Places Network's website contains tools aimed at measuring programs' impact on families and communities and on factors related to health.
Tool allows for rankings of neighborhoods by socioeconomic status disadvantage in a region of interest (e.g. at the state or national level). It includes factors for the theoretical domains of income, education, employment, and housing quality. It can be used to inform health delivery and policy, especially for the most disadvantaged neighborhood groups.
Tool includes several online data and mapping applications, toolkits and how-to-guides, as well as innovative technologies for engaging community residents. It also offers a 360-degree view of any neighborhood, including housing, health, education, employment, transportation, and environment. Free registration is required for use.
Searchable site for public health professionals interested in learning and sharing information about quality improvement (QI) in public health.
This calculator is designed to assist community-based organizations and their medical partners in creating mutually advantageous financial arrangements for funding the delivery of social services to high-need, high-cost (HNHC) populations, by calculating the return on investment (ROI) from integrating social services with medical care.
CDC has compiled a selection of resources to assist hospitals in conducting a community needs assessement.
This website includes links to The Guide to Community Preventive Services, Community Health Resources Database, Community Health Assessment aNd Group Evaluation (CHANGE) Tool and Action Guide, several actions guides, and a series of reports focusing on health education
Designed primarily for Health Center Program grantees, this toolkit explains the process and tools for conducting a CHNA.
The CHA is a systematic assessment of population health in Philadelphia, highlighting key public health challenges and assets and informing local public health programs, policies, and partnerships. The CHA includes indicators reflecting health behaviors, health conditions, health care factors, and social and environmental determinants of health.
An online mapping and data tool that maps Cottage Health's 2016 Community Health Needs Assessment (CHNA) data, census data and other publicly available data for factors that influence health outcomes. The tool provides a view of the specific health needs by demographics, geography and health outcome or influencer. Data is specific to Santa Barbara County, CA. (Cottage Health)
A tool to monitor the health of children and adults who live in Hennepin County. Data includes indicators on chronic disease, mortality, infectious disease, nutrition, substance use, preventive care, child health, and more.
Iowa State University has created a resource that examines regional economic and demographic change.
Reports were developed initially in 2012 and are annually updated to consolidate and improve data linkage for the provided health indicators in the County Health Assessment Indicators (CHAI) for all communities in New York. The CHIRS provide data for over 300 health indicators, organized by 15 health topic and data tables with links to trend graphs and maps.
Interactive site provides data on health indicators at the county- and demographic-levels, graded in relation to national averages.
Website provides links to high quality resources and analyses from a broad set of sources, identified by the National Library of Medicine
A searchable resource created by the University of Vermont. It is divided by Vermont cities, towns, and villages, with information on demographics, transportation, education, and health resources in Vermont.
This data portal was developed to provide a convenient access point for health-related data for Virginia. This portal is a comprehensive source for community health assessment, public, and population health data. Each data portal page provides interactive data at the most granular level available.
An accessible web portal that connects community groups working to improve health to the local area data and information they need to inform and evaluate their work. They aim to provide a comprehensive picture of the multiple factors that impact health, including individual behaviors, policies, systems, and environments.
Tool allows community health improvement stakeholders and the public access to data to identify health factors and outcomes at the ZIP code level across Missouri.
This document from 12/31/14 represents the final regulations that provide guidance regarding the requirements for charitable hospital organizations added by the Patient Protection and Affordable Care Act of 2010.
This document, dated February 2, 2015, contains final regulations that provide guidance regarding the requirements for charitable hospital organizations.
The proposed rule, and actions related to the rule, are described in this Federal Register posting. Subsequent correction are also listed here.
This regularly updated page outlines tax regulations for exempt organizations
This document contains final and temporary regulations that provide guidance to charitable hospital organizations regarding the requirement of a return to accompany payment of the excise tax, enacted as part of the Patient Protection and Affordable Care Act of 2010, for failure to meet the community health needs assessment requirements for any taxable year.
Final and temporary regulations (identical to NPRM also published on 8/15/2013) establishing filing requirements for hospital organizations liable for excise tax as a consequence of failure to meet the community health needs assessment requirements for any taxable year.
This fact sheet outlines the requirements for community benefit, and the tax implications for not-for-profit institutions.
Not-for-profit hospitals are required to file this form, which demonstrates their compliance with ACA section 501(r). Link directs to IRS resource pages for form, instructions, notifications and other relevant tax documents,
This publication outlines the key elements of the final regulations in the Affordable Care act related to patient billing related to patient billing-financial assistance, charges, billing and collections.
This website provides issue briefs on each state's regulations related to the community benefit provision of the ACA. (Supported by Kresge Foundation and Robert Wood Johnson Foundation.)
The IRS has provided a set of links to the state government web sites, with information related to the tax regulations for tax-exempt organizations.
This website uses assessment planning models and frameworks to outlines the steps for creating a community health needs assessment
Guide designed to assist organizations in determining community health needs.
A q&a page that addresses implementation strategies for community benefit regulations.
This article looks at the need for public health institutes to contribute to the community health assessment process.
This document identifies the metrics that can help describe the health of a community.
Designed for state level professionals, this toolkit facilitates the community health assessment process in rural hospitals at no or low cost to the hospitals.
Included in this set of resources are several case studies looking at partnerships between hospitals and state public health departments.
This document outlines the ten steps necessary to initiate a community health needs assessment.
Written in the context of Arizona not-for-profits, this guide from the Public Health Improvement Resource Center outlines the major components in effectively preparing for a community health needs assessment.
The methods by which to conduct and screen HIA targets effectively are discussed in this 2014 brief and supplement.
Free registration is required to access this guide, released by the ACHI, HRET, PCORI, and HPOE. It provides information on engaging patients and patient network in CHNA process.
The Health Impact Project’s cross-sector toolkit for health contains resources that help communities, agencies, and other organizations take action to improve public health. The toolkit offers a collection of health impact assessments, guides, and other research to support policymakers’ efforts to consider health when making decisions across sectors, such as housing, planning, and education.
The information contained in this website is designed to support and increase the use of HP 2020 among local health departments, non-profit hospitals, and other organizations related to community health assessment and improvement planning
This blog post provides a comprehensive overview of the major resources related to the issue of the Community Benefit and CHNA.
This article discusses the many hospitals and state and local public health institutions have partnered to address the issues surrounding community health assessments and their implementation.
This issue brief looks at States' regulations regarding community benefit, and its impact on health reform.
The report features a series of case studies, intended to serve as models for other hospitals planning to strengthen their community engagement model. Included in the paper are previous research on anchor institutions, the evolution of the hospital in the U.S. and trends and best practices in community building.
A series of reports from the Flex Monitoring Project that examines the community benefit impact of Critical Access Hospitals in rural areas.
This issue brief looks at the importance of the Community Benefit requirement, and how various hospitals are making it work.
Community wellness framework is focused on equity, person-centeredness, and sustainability. Framework outlines strategies for the main elements of collaboration: governance structure, financing, cross-sector prevention models, data-sharing, and performance measurement and evaluation.
This document outlines the procedures and requirements for creating a Community Health Needs Assessment, and suggests possible partnerships to successfully complete the process.
A national, peer-reviewed journal whose mission is to identify and publicize model programs that use community partnerships to improve public health, promote progress in the methods of research and education involving community health partnerships, and stimulate action that will improve the health of people and communities.
This toolkit explores how ACOs: 1) communicate with providers about the ACO as a value-based care organization, 2) use data to identify and address opportunities for improving care, 3) offer customized support to primary care providers (PCPs) and specialists, and 4) implement financial incentives.
The Summit Report will assist rural hospitals, clinics and network leaders in considering key actions that they can undertake to incorporate community care coordination planning as a strategy to help position the organization for population health. The report is also intended to assist state Medicare Rural Hospital Flexibility (Flex) Programs and state offices of rural health (SORH) by offering timely information to help them develop tools and educational resources that support hospitals and networks in the transition to value-based payment models.
Compilation includes tools and resources related to the HIA process itself and those that can be used to collect and analyze data, establish a baseline profile, assess potential health impacts, and establish benchmarks and indicators for monitoring and evaluation. Resources include literature and evidence bases, data and statistics, guidelines, benchmarks, decision and economic analysis tools, scientific models, methods, frameworks, indices, mapping, and various data collection tools.
This report discusses the complex challenges involved in community health improvement and makes the case for why health systems should take a substantial role in the multi-sector collaboration needed to achieve significant impact.
Congress requested that GAO examine whether nonprofit hospitals provide levels of uncompensated care and other community benefits that are different from other hospitals.
A landmark analysis of community benefit, the article is derived from submitted 990 and Schedule H reports for 2009, for more than 1800 non-profit hospitals nationwide.
This Ernst & Young benchmark report for the American Hospital Association examines the results of a survey from 2009 and 2010 of the Schedule H data filed by over 900 hospitals nationwide, identifying a baseline analysis of hospitals' pre-ACA compliance with their community benefit obligation.
This 2008 analysis of federal and state laws, standards and guidance from federal agencies and industry groups was performed to determine the definition of community benefit within the hospital community.
From the Minnesota Hospital Association, this community needs assessment reflects the partnership of individual hospitals, health systems, and local public health and community leaders to create a consolidated CHNA for the state of Minnesota.
An example of a single report from a health system, not-for-profits in 33 counties of eastern North Carolina,
The CHRISTUS Health System Office in Irving, Texas has compiled this report for their hospital system.
This statewide report consolidates CHNA; information is presented in the context of related, ongoing forums and other activities.
Reports from the Cleveland Clinic system in 2018.
CHNAs from a large, multi-state health network.
CHNA's from New York City's large city municipal hospital system, consisting of 12 reports from 4 boroughs.
A report designed to assist county stakeholders in determining the needs of the area.
From a consortium of New Haven organizations, including the Yale-New Haven Hospital, this CHNA provides an example of work of a hospital in a small city.
Community Health Needs Assessments from rural hospitals.
The Oklahoma Office of Rural Health (OORH) at the University of Oklahoma has assembled examples of the CHNAs for rural counties and hospitals.
A series of community health needs assessment from the University of Pittsburgh Medical Center system, representing a variety of 2019 reports, including large and small, rural and urban hospitals.
This interactive course explores how to produce positive population health outcomes through effective collaboration. Using a case study to help share key concepts, the course give directions on breaking down silos, aligning activities, and working productively together.
Online course on how to conduct health impact assessments (HIAs).
The original broadcast was held on November 20, 2013. The webinar (includes CE credits), looks at the librarian's role within the hospital in the era of the Affordable Care Act, meaningful use, and greater scrutiny of not-for-profit status. (Fee required)
This webinar from December of 2013 looks at the community benefit requirements as a powerful and effective framework to drive community economic development. Also included are links to webinar slides and to slides that supplement the webinar information.
This webinar from October 2016 provides an overview of the County Health Rankings & Roadmaps program and how participants can use the data to improve their communities.
Series of webinars and briefs to provide practical examples of successful cross-sector data sharing. These resources cover the importance of building trust when embarking on data-sharing partnerships, navigating legal parameters for cross-sector data sharing, and activating shared data.
An archived webinar and slides from HPOE that discusses how to incorporate community engagement and PCOR into CHNAs.
From the Massachusetts Library Association Annual Meeting, this panel presentation, held on May 7, 2014, discusses the community outreach work of three public librarians.
The primary organization for hospitals, AHA's website contains a number of reports, presentations, and case studies relevant to organizations seeking to comply with the community benefit requirement.
ACHI is a national association for community health, community benefit, and healthy communities professionals.
The Centers for Disease Prevention and Control (CDC) is one of the operating components of the U.S. Department of Health and Human Services. CDC's mission is to promote health and quality of life by preventing and controlling disease, injury, and disability.
The purpose of Community Benefit Connect is to support nonprofit hospitals by building a learning community of practitioners who will translate into action community benefit planning, implementation, reporting and evaluation. Included on the website are suggested links, webinars, and a blog.
NNPHI has assembled a webinars and case studies aimed at assisting public health institutes in becoming familiar with specific community health improvement tools and techniques.
The Community Indicators Consortium advances and supports the development, availability and effective use of community indicators for making measurable and sustainable improvements in quality of community life.
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, is a national initiative designed to promote the use of health impact assessments (HIAs) as a decision-making tool for policymakers. Project site contains reports, articles, and an interactive map of HIAs in the US.
This website features news related to the CHNA regulations, as well as links to documents useful to organizations needing to comply with the regulations.
This website was developed to assist policymakers in locating the necessary resources to ensure continuation of their tax-exempt status.
Funded through the Federal Office of Rural Health Policy (ORHP), the National Center for Rural Health Works provides tools and templates by which community residents can evaluate their health systems.
Provides information about a national voluntary accreditation program for state, local, territorial and tribal public health departments. The goal of the accreditation program is to improve and protect the health of every community by advancing the quality and performance of public health departments.
RWJF's mission is to improve the health and health care of all Americans.
Includes a calendar of events, newsletter, and training information for non-profit organizations.
The Foundation provides grant support for projects that concentrate on early childhood (prenatal to age 8), within the context of families and communities.