Nevada AB 342 Reporting Template Guidelines



Nevada Hospital Reporting Guidelines - Pursuant to NRS 449.490, Sections 2 through 4NRS 449.490, requires the reporting of certain costs and policies by Nevada hospitals with 100 or more beds. The Nevada Hospital Association (NHA) has agreed to act as a clearinghouse for these reports, providing the forms and guidelines, and summarizing the information for filing with the Division of Health Care Financing and Policy (DHCFP). Below are the guidelines for completing the report.Filing Date: This report is filed annually on July 31 of each year and must cover the hospital’s most recent fiscal year ended 6 months or more prior to the filing date. For example, the report filed on July 31, 2019, would cover the fiscal year ended during 2019. Filing Location: Please complete the requested forms and provide an electronic copy may to me, sarah@. NHA will summarize the information for all filing hospitals and will submit a summarized report and attachments to the State of Nevada’s Department of Healthcare Finance and Policy (DHCFP). Capital Improvements Section: Major Service Lines: Report only a major service line (costing in excess of $500,000) put into service during the period. This must be a new service line never before offered. The actual cost would be included under either “Expansion” or “Equipment”. Major Facility Expansion: Report only major expansions (this could include a replacement of facilities if significant), costing in excess of $500,000, added during the reporting period. If the expansion was part of Construction in Progress and was not completed during the period, place an “X” in the “Construction in Progress” box. If this was a multi-year project, enter amount expended in prior years on the project. (Note: In many cases, this can be carried forward from the prior period’s report.) If individual equipment (or an aggregate purchase of similar equipment) costing in excess of $500,000 was part of the major expansion, do not include in this section, but do include in the Equipment section below. Major Equipment: Report only major equipment (or aggregate purchase of similar major equipment) costing in excess of $500,000 added during the reporting period. Report if this is a replacement of retired equipment (R) or new equipment (N). If this equipment was part of a major facility expansion reported above, this is where the equipment related to the expansion should be reported and mark the “Expansion” column with an X. Other Additions and Total Additions for the Period: Report expenditures for the period for other additions not included in the previous sections (did not meet the $500,000 threshold). Report the total additions to property, plant and equipment expended for the reporting period (not prior periods) which should include all additions regardless of amount. You should exclude retirement of assets and include capital leases for all reporting in the Capital Improvements Section. Home Office Allocation Methodology: Enter a brief description of the method used to allocate costs from the home office to the hospital and list the services which are included in your hospital’s home office allocation. Community Benefit Reporting:Note: A Guide for Planning and Reporting Community Benefit developed by, the Catholic Health Association of the United States in cooperation with VHA, Inc. was used as the guideline for community benefit reporting except for the section entitled Subsidized Health Services. For the Subsidized Health Services section, this report utilizes the State’s Uncompensated Cost Report as the reporting basis in order to maintain consistency in reporting to the State. Community Health ServicesCommunity health services include activities carried out to improve community health. They extend beyond patient care activities and are usually subsidized by the health care organization. Community services do not generate inpatient or outpatient bills, although there may be a nominal patient fee and/or sliding scale fee. Activities carried out for marketing purposes are not includable as a community benefit. Forgiving inpatient and outpatient care bills to low income persons needs to reported separately as charity care.Specific community health services to quantify include:Community health educationCommunity-based clinical services, such as health services and screenings for underinsured and uninsured personsSupport groupsHealth care support services, such as enrollment assistance in public programs, and transportation effortsSelf-help programs, such as smoking-cessation and weight-loss programsPastoral outreach programsCommunity-based chaplaincy programs and spiritual careSocial services programs for vulnerable populations in the communityCommunity Health EducationCommunity health education includes lectures, presentations, and other programs and activities provided to groups, apart from clinical or diagnostic services. Community benefit in this area can include staff time, travel, materials, and indirect costs. Count:Baby-sitting coursesCaregiver training for persons caring for family members at homeCommunity calendars and newsletters primarily intended to educate the community about community health programs and free community eventsConsumer health libraryEducation on specific disease conditions (diabetes, heart disease, etc.)Health fairsHealth promotion and wellness programsHealth education lectures and workshops by staff to community groupsParish congregational programsPrenatal/childbirth classes serving at-risk and low-income personsInformation provided through news releases and other modes to the media (radio, television, and print) to educate the public about health issues (wearing bike helmets, new treatment news, health resources in the community, etc.)Public service announcements with health messagesRadio call-in programs with health professionalsSchool health education programs (Note: Report school-based programs on health care careers and workforce enhancement efforts as Community Building Activities; report school-based health services for students as Community-Based Clinical Services)Web-based consumer health informationWork site health education programsDo not include - Health education classes designed to increase market share (such as prenatal and childbirth programs for insured patients)Community calendars and newsletters if they are primarily used as marketing toolsPatient educational services understood as necessary for comprehensive patient care (e.g., diabetes education for patients)Health education sessions offered for a fee for which a profit is realizedVolunteer time for parish and congregation-based servicesSupport GroupsSupport groups typically are established to address social, psychological, or emotional issues related to specific diagnoses or occurrences: diseases and disabilities, grief, infertility, support for patients’ families, or others. These groups may meet on a regular or an intermittent basis.Count:Costs to run support groups Do not count:Support given to patients and families in the course of their inpatient or outpatient encounterChildbirth education classes that are reimbursed or designed to attract paying or insured patientsSelf-Help ProgramsWellness and health promotion programs, such as smoking-cessation, exercise, and weight-loss.Count:Anger management programsExercise classesSmoking cessation programsStress management classesWeight loss and nutrition programsDo not count:Employee wellness and health promotion provided by your organization as an employee benefit.The use of facility space to hold meetings for community groups (reportable as In-Kind Donations)Community-Based Clinical ServicesThese are health services and screenings provided on a one-time basis or as a special event in the community.They do not include permanent subsidized hospital outpatient services; report these as Subsidized Health Services. As with other categories of community benefit, these services and programs should be counted only if they are designed to meet identified community needs or to improve community health.ScreeningsScreenings are health tests that are conducted in the community as a public clinical service, such as blood pressure measurements, cholesterol checks, and school physicals. They are a secondary prevention activity designed to detect the early onset of illness and disease and can result in a referral to any community medical resource. To be considered community benefits, screenings should provide follow-up care as needed, including assistance for persons who are uninsured or underinsured.Count:Behavioral health screeningsBlood pressure screeningLipid profile and/or cholesterol screeningEye examinationsGeneral screening programsHealth risk appraisalsHearing screeningsMammography screenings (If these are done at a separate, free-standing breast diagnostic center, report as Subsidized Health Services.)Osteoporosis screeningsSchool physical examinationsSkin cancer screeningStroke risk screeningDo not count:Health screenings associated with conducting a health fair (already reported as Community Health Education)Screenings for which a fee is charged, unless there is a negative marginScreenings where referrals are made only to the health care organization or its physiciansScreenings provided primarily for public relations or marketing purposesOne-Time or Occasionally Held ClinicsCount:Blood pressure and/or lipid profile/cholesterol screening clinicsCardiology risk factor screening clinicsColon cancer screening clinicsDental care clinicsImmunization clinicsMobile units that deliver primary care to underserved populations on an occasional or one-time basisOne time or occasionally held primary care clinicsSchool physical clinicsStroke screening clinicsDo not count:Screenings in which a fee is charged, and a profit is realized (Do report if there is a negative margin.)Permanent, ongoing programs and outpatient services (These should already be counted in Subsidized Health Services.)Clinics for Underinsured and Uninsured PersonsThese programs, which in the past may have been called “free clinics,” provide free or low-cost health care to medically underinsured and uninsured persons through the use of volunteers who donate their time, including physicians and health care professionals.Count:Hospital subsidies such as grantsCosts for staff time, equipment, overhead costsLab and medication costsDo not count:Volunteers’ time and contributions by other community partnersMobile Units Count:Vans and other vehicles used to deliver primary care services Do not count:Mobile specialty care services that are an extension of the organization’s outpatient department, e.g., mammography, radiology, lithotripsy, reportable as Subsidized Health Services.Health Care Support ServicesHealth care support services are provided by the hospital to increase access and quality of care in health services to individuals, especially persons living in poverty and those in other vulnerable populations.Count:Information and referral to community services for community members (not routine discharge planning)Case management of underinsured and uninsured persons that goes beyond routine discharge planningTelephone information services (Ask a Nurse, medical and mental health service hotlines, and poison control centers)Transportation programs for patients and families to enhance patient access to care (include cab vouchers provided to patients and families)Assistance to enrollment in public programs, such as SCHIP and MedicaidPersonal response systems, such as LifelineDo not count:A physician referral, if it is primarily an internal marketing effort. However, you may count a physician referral from a call center if the call center makes referrals to other community organizations or physicians from across an area, without regard to admitting practicesHealth care support given to patients and families in the course of their inpatient or outpatient encounterRoutine discharge planningEnrollment assistance programs designed to increase facility revenueHealth Professions EducationHelping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit.Physicians/Medical StudentsBe sure to subtract government subsidies (e.g. GME payments) from these costs before counting. You may count the unpaid costs of:CountA clinical setting for undergraduate trainingInternships, clerkships, and residenciesResidency educationContinuing medical education (CME) offered to physicians outside of the medical staff on subjects for which the organization has special expertiseDo not count:Expenses for physician and medical student in-service trainingJoint appointments with educational institutions, medical schoolsOrientation programsContinuing medical education (CME) costs restricted to members of the medical staffNurses/Nursing StudentsCount:Providing a clinical setting for undergraduate/vocational training to students enrolled in an outside organizationInternships or externships when on-site training of nurses (e.g., LVN or LPN) is subsidized by the health care organizationCosts associated with underwriting faculty positions in schools of nursing in response to shortages of nurses and nursing facultyDo not count:Education required by staff, such as orientation, in-service programs and new graduate trainingExpenses for standard in-service training and in-house mentoring programsIn-house nursing and nursing assistantsOther Health Professional EducationCount:A clinical setting for undergraduate training and internships for dietary professionals, technicians, physical therapists, social workers, pharmacists, and other health professionalsTraining of health professionals in special settings, such as occupational health or outpatient facilitiesUnpaid costs of medical translator training beyond what is mandatedProgram costs associated with high-school student job shadowing and mentoring projectsDo not count:Education required by staff, such as orientation and standard in-service programsExpenses for standard in-service trainingJoint appointments with educational institutions or schools of physical therapy (unless in response to community-wide shortages)On-the-job training, such as pharmacy technician and nursing assistant programsStaff time delivering care concurrent with job shadowingScholarships/Funding for Professional Education Count:Funding, including registrations, fees, travel, and incidental expenses for staff education that is linked to community services and health improvementNursing scholarships or tuition payments for professional education to non-employees and volunteersOther health professional and technical training scholarships for community membersSpecialty in-service and videoconferencing programs made available to professionals in the communityDo not count:Costs for staff conferences and travel other than those listed aboveFinancial assistance for employees who are advancing their own educational credentialsStaff tuition reimbursement costs provided as an employee benefitSubsidized Health ServicesSubsidized health services include costs for billed services that are subsidized by the health care organization. These services generate a bill for reimbursement, and include clinical patient care services that are provided despite a negative margin because they are needed in the community and other providers are unwilling to provide the services, or the services would otherwise not be available to meet patient demand. This section of the report is used to report the cost of care less any payments received by the hospital for those classifications of patients who were unable to pay the full cost of care either by themselves or through a third-party payer. Line 1: Since hospitals already file a separate Uncompensated Care Cost Report with the State for the purpose of calculating Medicaid Disproportionate Share (DSH), this report will also use the amount from that report as a starting point in determining subsidized health services cost to retain consistency with other Nevada reporting.Lines 2 and 3: The amount reported on your Uncompensated Cost Report needs to be reduced by payments received for Medicaid DSH and other payments (e.g. indigent accident fund (IAF), County Supplemental Fund, or other state and local payments).Line 4: Enter the result of line 1 minus lines 2 and 3.The following lines account for any other subsidized health care costs which are not included on the Uncompensated Cost Report.Line 5: The Uncompensated Cost Report filed for both Medicare and Medicaid Disproportionate Share purposes does not allow the inclusion of SCHIP accounts, because the Nevada SCHIP program is considered a stand-alone program. However, the SCHIP claims, payment and benefit design are almost the same as those for the Medicaid program in Nevada, making it difficult for the hospital to differentiate SCHIP from Medicaid. Since SCHIP accounts are not includable for disproportionate share purposes on the Uncompensated Cost Report, any shortfall needs to be added to this report on Line 5. Nevada Checkup accounts can be identified in your accounting records by the patient billing number. All Nevada Checkup patients have a billing number with “999” as the last three digits of the number. To calculate SCHIP Uncompensated Cost, use the Average Ratio of Cost to Charges (RCC) shown on your Uncompensated Cost Report for this period and apply that percentage to the billed charges for your SCHIP accounts. From this amount subtract all payments received for SCHIP services. Do not determine this on an account-by-account basis. Instead, any amount reported as Uncompensated SCHIP Cost must be based on the entire block of SCHIP business.Line 6: When calculating Medicare Uncompensated Cost, use the Average Ratio of Cost to Charges (RCC) shown on your Uncompensated Cost Report for this period to obtain Medicare cost. From this amount subtract all payments received for Medicare services, including claim payments received from Medicare, payments received from the patient, the Medicare disproportionate share payments, and any amount due from Medicare based on the cost report filed, including any pass-through payments. Do not determine this on an account-by-account basis. Instead, any amount reported as Uncompensated Medicare Cost must be based on the entire block of Medicare business.Line 7: Offsite Clinic costs are not includable in the Uncompensated Cost Report which is filed for determining Medicaid Disproportionate Share. However, these are services which are often offered by the hospital to the community at a financial loss meeting the definition of a “community benefit”. Therefore, any uncompensated cost for this service is includable on Line 7 of this report at the difference between cost and actual payments received. You also would include on this line any subsidized health services not reported elsewhere (e.g. Intergovernmental Transfer of funds for Upper Payment Limit, etc.). Line 8: For “Other” subsidized health services, you may include bad debts not already reported in the Subsidized Health Services section. However, if the hospital has negotiated a contract with any payer and the rate negotiated is below cost, any shortfall below the cost of care from this payer is not includable as a subsidized health service. Any bad debts reported must be included at cost less collections, not at the amount of uncollected billed charges. Assuming that no contracted payer has a contract negotiated to pay lower than cost, this may be calculated by determining the patient accounts which were included in Bad Debt and eliminating any patient accounts which are already included elsewhere in this section as subsidized. The cost of care for the remaining accounts is determined by applying the Average Ratio of Cost to Charges (RCC) shown on your Uncompensated Cost Report for this period to the charges for this group of accounts as a whole. From this amount, subtract all payments received for these accounts from all sources to determine if there is any uncompensated cost and the amount of the uncompensated cost. Enter this amount on the Other Subsidized Health Services line.Line 9: Costs reported in this Subsidized Health Services Section may need to be reduced to prevent duplication of reporting in more than one section of this report. Any services meeting this criterion need to be accounted for on this line. Examples of this would be eligibility assistance and case management for indigents (reportable as Health Care Support Services), Graduate Medical Education and Residency and Fellowship programs (reportable as Health Professions Education), mobile units (reportable as Community Health Services), etc. The best way to assure no duplication of reporting is to review each item included in the non-Subsidized Health Care categories and eliminate the cost from this category if it was included in the cost in both sections.ResearchResearch includes clinical and community health research, as well as studies on health care delivery that are shared with others outside the organization. Do not count research where findings are used only internally. Priority should be placed on issues related to reducing health disparities and preventable illness. In this category, count the difference between operating costs and external subsidies such as grants.Clinical ResearchCount:Research development costsStudies on therapeutic protocols (Be sure to offset with grants and other funds.)Evaluation of innovative treatmentsResearch papers prepared by staff for professional journalsCommunity Health ResearchCount:Studies on health issues for vulnerable personsStudies on community health, such as incidence rates of conditions for populationsResearch papers prepared by staff for professional journalsStudies on innovative health care delivery modelsFinancial and In-Kind ContributionsThis category includes funds and in-kind services donated to individuals or the community at large. In-kind services include hours donated by staff to the community while on health care organization work time, overhead expenses of space donated to not-for-profit community groups (such as for meetings), and donation of food, equipment, and supplies.Cash DonationsAs a general rule, count donations to organizations and programs that are consistent with yourorganization’s goals and mission.Count:Contributions and/or matching funds provided to not-for-profit community organizationsContributions to charity events of not-for-profit organizations, after subtracting the market value of participation by the employees or organizationContributions provided to individuals for emergency assistanceScholarships to community members not specific to health care professionsDo not count:Employee-donated fundsEmergency funds provided to employeesFees for sporting event ticketsTime spent at golf outings or other primarily recreational eventsGrantsThese include contributions and/or matching funds provided as a community grant to not-for-profit community organizations, projects, and initiatives.Count:? Program, operating and education grants? Matching grants? Event sponsorship? General contributions to nonprofit organizations or community groupsIn-Kind DonationsCount:Meeting room overhead and space for not-for-profit organizations and community (such as coalitions, neighborhood associations and social service networks). Equipment and medical suppliesEmergency medical care at a community eventCosts of coordinating community events not sponsored by the health care organization, such as March of Dimes Walk America (Report health care organization-sponsored community events under Community BenefitOperations)Provision of parking vouchers for patients and families in needEmployee costs associated with board and community involvement on work timeFood donations, including Meals on Wheels and donations to food sheltersGifts to community organizations and community members (not employees)Laundry services for community organizationsTechnical assistance, such as information technology, accounting, human resource process support, planning, and marketingDo not count:Employee costs associated with board and community involvement when these are done on an employee’s own time and he or she is not engaged on behalf of his or her organizationVolunteer hours provided by hospital employees on their own time for community events (belongs to volunteer, not the health care organization)Promotional and marketing costs concerning the health care organization’s services and programsSalary expenses paid to employees deployed on military services or jury duty. (These expenses are considered employee benefit.)Cost of Fund-Raising for Community ProgramsCount:Grant writing and other fund-raising costs specific to community programs and resource development assistance not captured under category Community Benefit OperationsCommunity-Building ActivitiesCommunity-building activities include programs that, while not directly related to health care, provide opportunities to address the root causes of health problems, such as poverty, homelessness, and environmental problems. These activities support community assets by offering the expertise and resources of the health care organization. Costs for these activities include cash, in-kind donations, and budgeted expenditures for the development of a variety of community health programs and partnerships. When funds or in-kind donations are given directly to another organization, report in In-Kind Donations. Remember to subtract any subsidies or grant amounts from total expenses incurred in this category.Physical Improvements/HousingCount:Community gardensNeighborhood improvement and revitalization projectsPublic works, lighting, tree planting, graffiti removalHousing rehabilitation, contributions to community-based assisted living and senior and low income housing projectsHabitat for Humanity activitiesSmoke detector installation programsDo not count:Housing costs for employeesProjects having their own community benefit reporting process: (e.g., a senior housing program that issues a community benefit report)Health facility construction and improvements, such as meditation gardens or parking lotEconomic DevelopmentCount:Small business developmentParticipation in economic development council or chamber of commerceDo not count:Routine financial investmentsCommunity SupportThis includes efforts to enhance the operational structures of the community and community networks, such as neighborhood watch groups and child care cooperatives. Activities include both community based initiatives and facility-based initiatives.Count:Childcare for community residents with qualified needMentoring programsNeighborhood systems, such as watch groupsYouth asset development or America’s Promise initiatives, including support of these programs’ principles, such as Safe Places, Healthy Start, Marketable Skills, and Opportunities to ServeDisaster readiness over and above licensure requirements. Be careful not to double-count with in-kind donations. Include costs associated with:Changes made to accommodate prospective disasters, including costs associated with lockdown capability, enhanced security measures, package handling, air machines and filters, water purification equipment, expanded mortuary facilities, facilities for personnel quarantine, expanded patient isolation facilities, shower facilities, and storage space for stockpilesCreating new or refurbishing existing decontamination facilities. This could include water supply communications facility and equipment costs or equipment changes to ensure interoperability of communications systems. (Include depreciation expenses.)Additional disaster-related purchase of pagers, cell phones, mobile data terminals, and laptop computers specific to the communications component of the disaster plan; include depreciation expensesCommunity disease surveillance and reporting infrastructure, updating laboratory diagnostic capability and associated training for laboratory personnel, informatics updating and patient tracking systems, detection instruments and monitors to detect radiation, tests and assays for detection of chemical agents and toxic industrial materials, and tests for identification of biologic agentsPurchase of personal protective equipment (PPE) for stockpiles, including gloves, masks, gowns, and other itemsFacility areas, waste water containment systems, decontamination tables, storage, shower systems, tents, soap dispensers, and linenStockpiling medical, surgical, and pharmaceutical supplies, including barriers, respirators, clothing, IV pumps and poles, IV fluids, suction machines, stretchers, wheelchairs, linens, bandages, and dressingsNew or expanded training, task force participation, and drillsMental health resource costs associated with training, community partnerships, and outreach planningPre- and post-planningDo not count:Costs associated with subsidizing salaries of employees deployed in military action (This is considered employee benefit.)Costs associated with routine and mandated disaster preparednessEnvironmental ImprovementsCount:Efforts to reduce environmental hazards in the air, water, and groundResidential improvements such as lead or radon programsNeighborhood and community improvements such as air pollution and toxin removal in parksCommunity waste reduction and sharps disposal programsHealth care facility environmental responsibility, such as waste and mercury reduction, green purchasing, and other ecology initiativesLeadership Development and Leadership Training for Community MembersCount:Conflict resolution trainingCommunity leadership developmentCultural skills trainingLanguage skills developmentLife or civic skills training programsMedical interpreter training for community membersDo not count:Interpreter training programs for hospital staff as required by lawCoalition BuildingCount:Hospital representation to community coalitionsCollaborative partnerships with community groups to improve community healthCost of community coalition meetings, visioning sessions or task force meetingsCosts for task force–specific projects and initiativesCommunity Health Improvement AdvocacyCount:Local, state, and/or national advocacy on behalf of community health relative to policies and funding to improve:Access to health carePublic healthTransportationHousingDo not count:Advocacy specific to hospital operations/financingWorkforce DevelopmentThese programs address community-wide workforce issues—not the workforce needs of the health care organization, which should be considered human resource activities rather than community benefit.Count:Recruitment of physicians and other health professionals for areas identified by the government as medically underserved (MUA’s)Recruitment of underrepresented minoritiesJob creation and training programsParticipation in community workforce boards, workforce partnerships, and welfare-to-work initiativesPartnerships with community colleges and universities to address the health care workforce shortageWorkforce development programs that benefit the community, such as English as a Second Language (ESL) trainingPrograms to teach staff members languages spoken in the communitySchool-based programs on health care careersCommunity programs that drive entry into health careers and nursing practiceCommunity-based career mentoring and development supportDo not count:Routine staff recruitment and retention initiativesPrograms primarily designed to address workforce issues of the healthcare organizationIn-service education and tuition reimbursement programs for current employeesScholarships for nurses and other health professionals (count in B, Health Professions Scholarships for community members not specific to health care professions (Report in Financial and In-Kind Contributions.)Employee workforce mentoring, development, and support programsCommunity Benefit OperationsCommunity benefit operations include costs associated with dedicated staff, community health needs and/or assets assessment, and other costs associated with community benefit strategy and operations.Dedicated StaffCount:Staff costs of management/oversight of community benefit program activities that are not included in other community services categoriesStaff costs to coordinate community benefit volunteer programsDo not count:Staff time to coordinate in-house volunteer programs, including outpatient volunteer programsVolunteer time of individuals for community benefit volunteer programsCommunity Health Needs/Health Assets AssessmentCount:Community health needs assessmentCommunity assessments, such as a youth asset surveyDo not count:Costs of a market-share assessment and marketing survey processEconomic impact survey costs or resultsOther ResourcesCount:NRS 439B.340 establishes a minimum free care obligation for hospitals. If that minimum obligation is not met, the resulting fee assessment should be reported in this section.Cost of fund-raising for hospital-sponsored community benefit programs, including grant writing and other fund-raising costsCost of grant writing and other fund-raising costs of equipment used for hospital-sponsored community benefit services and activitiesCosts associated with developing a community benefit plan, conducting community forums, and reporting community benefitOverhead and office expenses associated with community benefit operations exclusive of fundraisingDo not count:Recognition/awards for volunteer staffGrant writing and other fund-raising costs of hospital projects (such as capital funding of buildings and equipment) that are not hospital community benefit programsTotal Community Benefit is the sum of the items above. Reported in the Other Community Support Section are additional ways that hospitals support their communities.Other Community SupportReport in this section all Nevada taxes accrued by the hospital according to the categories identified, i.e. Property, Sales and Use, Modified Business Tax and Commerce Tax. Foundation-Funded Community BenefitA foundation is a separate not-for-profit organization affiliated with the health care organization that conducts fund-raising. A foundation can support health care organization operations and/or may fund community health improvement programs, activities, and research. There are two types of foundations: those that are related organizations, operated and owned by the same parent organization or system, and those that are operated by unrelated or third-party entities. Two principles are suggested regarding support received from foundations:Only one entity should be able to report community benefit expenditures. A foundation’s community benefit support should not be double-counted.Health care systems that operate foundations can and probably should assign the full value of the foundation support to individual hospitals within their communities. In other words, they should not offset the community benefits provided at system hospitals with any foundation or mission grant funds, if those resources are provided by related foundations. This is particularly important for systems that operate hospitals in states requiring the filing of community benefit reports. This approach allows hospitals that receive funding from a related foundation to report the full value of the community benefit program where the benefit actually is being realized, rather than by the foundation, which may be located in another region or state.To report foundation-funded community benefits:Include foundation receipts in direct offsetting revenue for each relevant community benefit category, unless the foundation is operated as a related organization (part of the same health care system)Footnote the amount of support provided by a related foundationA similar accounting methodology should be applied to grants that support research. If the grants are made by an entity corporately related to the hospital, they should not be offset as revenue against the cost of research expenditures.D. Additional Areas Not to CountThroughout this document, we have made numerous references to what to count, and what not to count, when quantifying community benefit. The following are frequently posed scenarios that we recommend NOT COUNTING:Activities specifically geared to increase market shareFacility anniversary celebrationsGrand opening events, dedications, and related activities for new services and facilitiesNurse call lines paid for by payors or physiciansProviding copies of medical records x-raysProviding continuing medical education (CME), orientation, and in-service educationDischarge planningSalary expenses paid to employees deployed for military services or jury duty (employeebenefit)Promotional and marketing information about health care organization services and programsSocial services for patientsProblem resolution and referral of issues related to health system servicesCardiac rehabilitation services unless subsidized by the organizationToken of sympathy to staff or patients at times of crisis or bereavement (e.g., flowers, cards, meals)Free or discounted immunizations and other health services to staff (employee benefit)Providing information on services provided by the health system at a health fair or mallDecorating facilities for the holidaysIn-house pastoral careFree meals and meal discounts for volunteers and/or employeesFree parking for clergy, volunteersMedical library (include percentage of costs only if there is a significant consumer health library focus)Staff donations to assist other staffPharmacy discounts for employees and volunteersReimbursed home health care servicesStaff volunteering (report only volunteer efforts done on work time)Volunteer time by community volunteers for either in-house OR community efforts (it is their time, not the health care organization’s)Professional education such as in-services and cost for professional conferencesEconomic impact of employee payroll and purchasing dollarsEmployee contributions such as United Way or Adopt a Family at ChristmasPhysician referral, if it is more of an internal marketing effort (include if it refers to many community organizations or to physicians from across an area, without regard to admitting practices)Hospital toursAmenities for visitors such as coffee in the waiting rooms, etc.Costs incurred for inpatient health educationCosts associated with provision of day care services for employeesEmployee costs associated with board and community involvement when it is the employee’s own time for personal or civic interestsCosts associated with subsidizing salaries of employees deployed in military action (employee benefit)Staff presenting to professional organizationsTuition reimbursement costs provided as an employee benefitNurses teaching/delivering papers at professional meetingsCommunity Benefit DefinitionsBad debtUncollectible charges, excluding contractual adjustments, arising from failure to pay by patients whose health care has not been classified as charity care. BioterrorismThe intentional use or threatened use of viruses, bacteria, fungi, toxins from living organisms, or chemicals to produce death and/or disease in humans and living systems.Broader communityPersons outside a target population who benefit from a health care organization’s community services and programs.Charity careFree care and discounted care given to persons deemed unable to pay based on established financial assistance policies. Charity care does not include bad debt. It should be reported in terms of costs, not munityAll persons and organizations within a circumscribed geographic area in which there is a sense of interdependence and munity-based clinical servicesClinical services, such as free clinics, screenings, or one-time events provided to the community. This does not mean permanent subsidized hospital outpatient munity benefitsCommunity benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. They are not provided for marketing purposes. A community benefit must meet at least one of the following criteria:Generates a low or negative marginResponds to needs of special populations, such as minorities, older persons and persons with disabilities who are living in poverty, persons with chronic mental illness, and other disenfranchised personsSupplies services or programs that would likely be discontinued—or would need to be provided by another not-for-profit or government provider—if the decision was made on a purely financial basisResponds to public health needsInvolves education or research that improves overall community healthCommunity benefit operationsCosts associated with dedicated staff, community health needs and/or asset assessments, and other costs associated with community benefit strategy and munity benefit planA document, often produced in conjunction with the health care organization’s annual strategic, financial, and communications plans, that explicitly details how an organization intends to fulfill both its mission of community service and its charitable, tax-exempt purpose. It includes a description of community benefit priorities, programs, staffing and resources, and anticipated munity-building activitiesCommunity-building activities include cash donations, in-kind donations, and budgeted expenditures for the development of community health programs and partnerships. Community-building enhancements include physical improvements, economic development, healthy community initiatives, partnerships, environmental improvements, and community leadership skills munity health assessmentUsually conducted in collaboration with other community groups and organizations, a community health assessment is a structured process for determining the health status and needs of community members and identifying community health improvement programs and services on which to munity health educationIncludes lectures, presentations, and other group programs and activities apart from clinical or diagnostic services. Community benefit costs in this area can include staff time, travel, materials, and indirect munity health improvement servicesActivities carried out for the express purpose of improving community health. They extend beyondpatient care activities and are usually subsidized by the health care organization. Community services do not generate inpatient or outpatient bills, although there may be a nominal patient fee or sliding scale fee. Forgiving inpatient and outpatient care bills to low-income persons should be reported as charity care.Continuing care servicesThese include hospice, home care services, nursing home care, geriatric services, senior day centers, and assisted living facilities.CounselingSupport given on a one-on-one basis to assist a community member in various areas, including referral to community services, public assistance, and crisis intervention.Direct costsSalaries, employee benefits, supplies, interest on financing, travel, and other costs that are directly attributable to a specific service or department that would not exist if the service or effort did not exist. DonationsFunds and in-kind services donated to individuals and/or the community at large. In-kind services include hours donated by staff to the community while on health care organization work time; overhead expenses of space donated to not-for-profit community groups (such as for meetings), and donation of food, equipment, and supplies.Financial assistanceThis includes charity care and discounts granted on established criteria for an inability to pay. It does not include contractual allowances or quick pay discounts.FoundationA separate not-for-profit organization affiliated with the health care organization that conducts fundraising. A foundation can support core health care organization operations and/or may fund community health improvement programs, activities, and research.Free clinicA free clinic provides free or low-cost health care to medically uninsured or underinsured persons through the use of volunteers who donate their time, including physicians and health care ernment-sponsored indigent health careServices for low-income persons that are reimbursed or partially reimbursed through federal, state, and local programs, such as Medicaid and public indigent and health care programs.Health care support servicesSupport given on a one-on-one basis to assist community members.Health educationThe negative margin (the difference between cost and reimbursements) incurred in providing clinical settings, internships, and programs for physicians, nurses, and health professionals. It also refers to scholarships for health professional education.ImmunizationsPersonnel, equipment, and supplies necessary to provide immunizations to community members and groups.IndigentDescribes an uninsured or underinsured person who meets financial assistance criteria.Indirect costsCosts not attributed to products and/or services that are included in the calculation of costs for community benefit. These could include, but are not limited to, human resource and finance departments, insurance, support departments, and overhead expenses. An indirect cost factor is determined by dividing total indirect costs by total direct costs.In-kind servicesHours donated by staff to the community while on health care organization work time, as well as overhead expenses of space donated to not-for-profit community groups for meetings.Mobile unitVans and other vehicles used to deliver primary care services.Negative marginThe negative difference between what it costs to offer programs, health care, or services and any cash or reimbursements received.Non-billed servicesActivities and services for which no individual patient bills exist, although there may be a nominalpatient fee and/or a sliding scale fee. These services are not expected to be financially self-supporting, although some may be supported by outside grants or funding. They can be designed to be offered as a public benefit with charitable or community service intent.Patient educationHealth education provided to inpatients, outpatients, and their families as part of a plan of care. (Although Texas law identifies this as a community benefit, for the purposes of standardized reporting, we recommend considering patient education a standard component of health care and not a community benefit.)Persons living in povertyPersons who cannot afford health care because they have inadequate resources and/or are uninsured or underinsured. The income benchmark is typically considered to be 150% to 200% of the federal poverty level, although many health care organizations use a higher percentage.ResearchStudies shared with persons outside of the organization on health care delivery, un-reimbursed studies on therapeutic protocols, evaluation of innovative treatments, and research papers prepared by staff for professional journals.ScreeningsHealth tests conducted in the community as a public clinical service, such as blood pressure measurements, cholesterol checks, and school physicals. They are a secondary prevention activity designed to detect the early onset of illness and disease and can result in a referral to a community medical resource.Self-helpWellness and health promotion programs such as exercise classes, smoking cessation clinics, and nutrition educationSubsidized health servicesClinical services provided despite a financial loss. The financial losses are so significant that negative margins remain after removing the effects of charity care and Medicaid shortfalls. Nevertheless, the service is provided because it meets an identified community need and if no longer offered would either be unavailable in the area or fall to the responsibility of government or another not-for-profit organization to provide the care.Support groupsGroups typically established to address social, psychological, or emotional issues related to specific diagnoses or occurrences. These groups may meet on a regular or intermittent basis.Target groupThe primary audience for which a program is intended, such as infants, children, adolescents, adults, seniors, or persons living with disabilities.Discounted Services & Reduced Charges Policy & Procedures: No amounts need to be reported in this section, since these amounts will be reported on your NHQR. Complete the questionnaire and add any additional comments to assure a complete understanding of your policy. If this is the first time you have filed this report, or if the policy has changed since your last filing of the report, attach the written policies to your submission.Collection of Accounts Receivable Policy and Procedures: Complete the questionnaire and add any additional comments to provide a complete understanding of your hospital's collection practices. If this is the first time you have filed this report, or if the policy has changed since your last filing of the report, attach the written policies to your submission. Chargemasters: Fill in the blanks. ................
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