10 CCR 2505-10
DEPARTMENT OF HEALTH CARE POLICY AND FINANCING MEDICAL ASSISTANCE - SECTION 8.5000 Hospital Community Benefit Accountability 10 CCR 2505-10 8.5000 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________
8.5000 HOSPITAL COMMUNITY BENEFIT ACCOUNTABILITY
PURPOSE: To require hospitals to report to the Department of Health Care Policy and Financing (the Department) information on their community benefit activities, planning and investments.
8.5001 DEFINITIONS
“Community” means the community that a hospital has defined as the community that it serves pursuant to 26 CFR § 1.501(r)-(b)(3).
“Community Benefit Implementation Plan” means a plan that satisfies the requirements of an implementation strategy as described in 26 CFR § 1.501(r)-3(c). “Community Health Center” means a federally qualified health center as defined in 42 U.S.C. sec. 1395x (aa)(4) or a rural health clinic as defined in 42 U.S.C. sec. 1395x (aa)(2). “Community Health Needs Assessment” means a community health needs assessment that satisfies the requirements of 26 CFR § 1.501(r)-3(b).
“Community Identified Health Need” means a health need of a Community that is identified in a Community Health Needs Assessment.
“Free or Discounted Health Care Services” means health care services provided by the hospital to persons who meet the hospital’s criteria for financial assistance and are unable to pay for all or a portion of the services, or physical or behavioral health care services funded by the hospital but provided without charge to patients by other organizations in the Community. Free or Discounted Health Care Services does not include the following:
1. Services reimbursed through the Colorado Indigent Care Program (CICP), 2. Bad debt or uncollectable amounts owed that the hospital recorded as revenue but wrote off due to a patient’s failure to pay, or the cost of providing care to such patients, 3. The difference between the cost of care provided under Medicaid or other means-tested government programs or under Medicare and the revenue derived therefrom, 4. Self-pay or prompt pay discounts, or 5. Contractual adjustments with any third-party payers. “Health System” means a larger corporation or organizational structure that owns, contains, or operates more than one hospital.
“Programs that Address Health Behaviors or Risk” means programs funded by the hospital and provided by the hospital or other Community organizations that provide education, mentorship, or other supports that help people make or maintain healthy life choices or manage chronic disease, including addiction prevention and treatment programs, suicide prevention programs and mental health treatment, programs to prevent tobacco use, disease management programs, nutrition education programs, programs that support maternal health, including screening, referral and treatment for perinatal and postpartum depression and anxiety, and healthy birth outcomes, and programs that help seniors and people with disabilities live as independently as possible in the Community. “Programs that Address the Social Determinants of Health” means funding or in-kind programs or services that improve social, economic, and environmental conditions that impact health in the Community. Social and economic conditions that impact health include education; employment; income; family and social support; and Community safety. Environmental conditions that impact health include air and water quality, housing, and transit. Programs that Address the Social Determinants of Health include but are not limited to the following:
1. Job training programs, 2. Support for early childhood and elementary, middle, junior-high, and high school education, 3. Programs that increase access to nutritious food and safe housing, 4. Medical Legal Partnerships, and 5. Community-building activities that could be included in Part II of Schedule H of the Form 990.
“Reporting Hospital” means 1. A hospital licensed as a general hospital pursuant to Part 1 of Article 3 of Title 25 of the Colorado Revised Statutes and exempt from Federal taxation pursuant to Section 501(c)(3) of the Federal Internal Revenue code, but not including a general hospital that is federally certified or undergoing federal certification as a long-term care hospital pursuant to 42 CFR § 412.23(e) or that is federally certified or undergoing federal certification as a critical access hospital pursuant to 42 CFR § 485 Subpart F, 2. A hospital established pursuant to § 25-29-103 C.R.S., or 3. A hospital established pursuant to § 23-21-503 C.R.S. “Safety Net Clinic” means a Community clinic licensed or certified by the Department of Public Health and Environment pursuant to Section § 25-1.5-103 (1)(a)(I) or (1)(a)(II), C.R.S.
8.5002 HOSPITAL REQUIREMENTS
8.5002.A PUBLIC MEETING REQUIREMENTS 1. Each Reporting Hospital shall convene a public meeting at least once per year to seek feedback regarding the hospital’s Community benefit activities during the previous year and the hospital’s Community Benefit Implementation Plan for the upcoming year.
2. Reporting Hospitals may convene a joint public meeting with one or more other participating hospitals that share some or all of the hospital’s Community.
3. Reporting Hospitals may conduct a public meeting that meets other purposes, such as the Community Health Needs Assessment requirements under 26 CFR § 1.501(r)-3 or other Community engagement efforts as long as the public meeting meets the minimum requirements in this section.
4. Each Reporting Hospital shall invite, at a minimum, representatives from the following entities to participate in the meeting if any such entities operate in the hospital’s Community:
a. Local public health agencies, b. Local chambers of commerce and economic development organizations, c. Local health care consumer organizations, d. School districts, e. County governments, f. City and town governments, g. Community Health Center, h. Certified rural health clinics or primary care clinics located in a county that has been designated as a rural or frontier county, i. Area agencies on aging, j. Safety Net Clinics, and k. Health care consumer advocacy organizations.
5. Each Reporting Hospital shall invite, at a minimum, representatives from the following agencies to participate in the meeting:
a. The Department of Health Care Policy and Financing, b. The Department of Public Health and Environment, c. The Department of Human Services, d. The Colorado Commission on Higher Education, e. The Office of Saving People Money on Health Care, and f. The Division of Insurance within the Department of Regulatory Agencies 6. Each Reporting Hospital shall invite the general public to the annual meeting and shall issue such invitation in an advertisement placed in each major newspaper published in the hospital’s Community.
a. Reporting Hospitals shall undertake the following efforts to promote broad Community notification and participation in the public meetings and to make meetings accessible:
b. Reporting Hospitals may also undertake additional activities including but not limited to the following:
1. Each Reporting Hospital shall complete a Community Health Needs Assessment on or before July 1, 2020, and then on or before July 1 at least every three (3) years thereafter.
a. Acquired or new hospitals must complete their first Community Health Needs Assessment as described under 26 CFR § 1.501(r)-3(d).
2. Each Reporting Hospital shall complete a Community Benefit Implementation Plan that addresses the needs described in the Community Health Needs Assessment on or before July 1, 2020, and then on or before July 1 every year thereafter.
3. Each Reporting Hospital shall submit to the Department on or before July 1, 2020 a report on its most recent public meeting held to satisfy its Community Health Needs Assessment requirements under 26 CFR § 1.501(r)-3.
4. Beginning July 1, 2021 and then on or before July 1 every year thereafter each Reporting Hospital shall submit to the Department a report on the public meetings held during the previous twelve months.
5. Each public meeting report shall include but is not limited to the following:
a. Date, time, and location of the meeting, b. Outreach efforts to ensure broad Community participation and accessibility, c. Individuals and organizations, including the populations served by the organizations, invited to the meeting, d. A list of individual meeting attendees and organizations represented, e. Meeting agenda, f. A summary of the meeting discussion, and g. Actions taken as a result of feedback from meeting participants.
6. Each Reporting Hospital shall submit to the Department on or before July 1, 2020 and then on or before July 1 every year thereafter a report on Community benefits, costs, and shortfalls that must include the following:
a. The most recent Community Health Needs Assessment.
b. The most recent Community Benefit Implementation Plan for the coming year.
c. A copy of the most recent submitted form 990 to the Federal Internal Revenue Service including Schedule H.
d. A description of investments made by the Reporting Hospital or a related entity that were included in Parts I, II, and III of Schedule H of form 990 that includes at a minimum the following:
e. The Reporting Hospital’s total expenses included in Line 18 of Section 1 of the submitted form 990. Reporting Hospitals not required to submit form 990 to the Federal Internal Revenue Service shall complete Line 18 of Section 1 of form 990 available on the Federal Internal Revenue Service’s website.
f. The Reporting Hospital’s revenue less expenses included in Line 19 of Section 1 of the submitted form 990. Reporting Hospitals not required to submit form 990 to the Federal Internal Revenue Service shall complete Line 19 of Section 1 of form 990 available on the Federal Internal Revenue Service’s website.
7. In the event that the due date falls on a weekend or state holiday the due date shall fall on the next business day.
8. Each Reporting Hospital shall post the report to their public website and submit to the Department the website address where the report has been posted.
9. A hospital licensed as a general hospital pursuant to part 1 of Article 3 of Title 25 that is not a Reporting Hospital may report on Community benefits, costs, and shortfalls consistent with this section.
8.5003 DEPARTMENT REQUIREMENTS
1. The Department shall develop a website for each Reporting Hospital to submit their reports and ensure the reports are available to the public.
2. As part of the report authorized in Section 25.5-4-402.8, C.R.S., the Department shall submit to the General Assembly a summary report of the hospital reports submitted that includes the following:
a. Community benefits as defined in Part I and Part II of the Schedule H as a percentage of total expenses.
b. The amount each Reporting Hospital invested in the following areas, including that amount as a percentage of total Community benefit spending in Part I and II of Schedule H:
c. Summary of each Reporting Hospital’s investments and evidence that that shows how the investment improves Community health outcomes.
d. Legislative recommendations for the General Assembly.
3. The Department shall post the reports submitted to the General Assembly to a public web page created solely for this purpose.
_________________________________________________________________________ Editor’s Notes 10 CCR 2505-10 has been divided into smaller sections for ease of use. Versions prior to 3/4/07, Statements of Basis and Purpose, and rule history are located in the first section, 10 CCR 2505-10. Prior versions can be accessed from the All Versions list on the rule's current version page. To view versions effective on or after 3/4/07, select the desired section of the rule, for example 10 CCR 2505-10 8.100, or 10 CCR 2505-10 8.500.
History [For history of this section, see Editor’s Notes in the first section, 10 CCR 2505-10]