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Holding Nonprofit Hospitals Accountable Act
To amend the Internal Revenue Code of 1986 to establish new community benefit standards for tax-exempt hospital organizations, and for other purposes.
Summary
This bill establishes new community benefit standards for tax-exempt nonprofit hospitals, effective for taxable years after December 31, 2025. Hospitals must have boards drawn from their communities, treat patients covered by Medicare and Medicaid without limiting their numbers, and spend an amount equal to at least 100 percent of their tax exemption value on training, research, facility improvements, or free and discounted care. Facility improvements may account for no more than 50 percent of this minimum spending requirement, and acquisitions of physician practices or other care delivery organizations do not count as facility improvements. The bill requires financial assistance policies to be billed according to Medicare rates and mandates annual reports from the Treasury Inspector General on hospital financial assistance policy compliance and periodic reports from the Comptroller General on IRS enforcement of these standards.
AI-generated plain-language summary of the bill text — neutral, and may be imperfect. See the full text below for the exact wording.
Sponsor (1)
Money behind the sponsor
Top reported contributors to Victoria Spartz’s campaign committee (2024 cycle) — who funds the bill’s sponsor, not a claim about this bill. Data from FEC.
- NULL $78,636
- INDIANA SPINE GROUP $22,800
- CDR HEALTH CARE, INC $6,600
- DILLON GAGE $6,600
- OGRE HOLDINGS $6,600
Organizations whose employees gave the most — itemized individual contributions grouped by the donor’s reported employer (FEC Schedule A). Full finance for Victoria Spartz → · Outside spending →
Actions (2)
- Apr 24, 2025 Referred to the House Committee on Ways and Means. · house
- Apr 24, 2025 Introduced in House
Similar bills (6)
Bills with similar text or summary — includes reintroductions across Congresses. Ranked by semantic similarity of the bill text (computed locally); a neutral discovery aid, not a claim the bills are duplicates.
Text versions (1)
Bills are re-published as they move (Introduced → Reported → Engrossed → Enrolled …). Each stage below is a separate text; pick two to see what changed. Data from Congress.gov.
Full text
IN THE HOUSE OF REPRESENTATIVES
April 24, 2025
Mrs. Spartz introduced the following bill; which was referred to the Committee on Ways and Means
A BILL
To amend the Internal Revenue Code of 1986 to establish new community benefit standards for tax-exempt hospital organizations, and for other purposes.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the “Holding Nonprofit Hospitals Accountable Act”.
SEC. 2. ADDITIONAL REQUIREMENTS FOR CERTAIN HOSPITALS.
(a) In General.—Section 501(r) of the Internal Revenue Code of 1986 is amended—
(1) in paragraph (1), by striking “and” in subparagraph
(C), by striking the period at the end of subparagraph (D) and inserting “, and”, and by adding at the end the following new subparagraph:
“(E) meets the community benefit standard described in paragraph (7).”,
(2) by redesignating paragraph (7) as paragraph (8), and
(3) by inserting after paragraph (6) the following new paragraph:
“(7) Community benefit standard.—
“(A) In general.—A hospital organization meets the requirements of this paragraph if such organization—
“(i) has a board of directors drawn from the community in which such organization is located,
“(ii) both—
“(I) treats patients who pay their bills through public programs, including under the Medicare program under title XVIII of the Social Security Act or under the Medicaid program under title XIX of such Act, and
“(II) does not limit the number of such patients served at any clinical site owned or controlled by such organization, and
“(iii) spends an amount which meets or exceeds the expenditure threshold for the taxable year on any combination of—
“(I) training, education, or research designed to improve patient care,
“(II) improvements to facilities and equipment except as provided in subparagraph (C), and
“(III) free or discounted care pursuant to a financial assistance policy.
“(B) Expenditure threshold.—For purposes of this paragraph, the term ‘expenditure threshold’ means 100 percent of the value of the Federal, State, and local tax exemptions of the hospital organization for the taxable year.
“(C) Special rules for improvements to facilities and equipment.—
“(i) In general.—For purposes of clause
(iii)(II) of subparagraph (A)—
“(I) expenditures under such clause may not be used to account for more than 50 percent of the minimum spending requirement under such subparagraph, and
“(II) expenditures for the acquisition of a physician practice, hospital, ambulatory surgical center, or any other care delivery organization shall not be taken into account as an improvement to facilities or equipment under such clause.
“(ii) Care delivery organization.—For purposes of clause (i), the term ‘care delivery organization’ means an organization of people, institutions, and resources whose primary mission is to deliver health care services to meet the health needs of a target population.”.
(b) Effective Date.—The amendments made by this section shall apply to taxable years beginning after December 31, 2025.
SEC. 3. HOSPITAL ORGANIZATION FINANCIAL ASSISTANCE POLICY COMPLIANCE REQUIREMENTS.
(a) In General.—Section 501(r) of the Internal Revenue Code of 1986, as amended by the preceding provision of this Act, is further amended in paragraph (5)(A) by inserting “according to Medicare rates with respect” after “billed”.
(b) Effective Date.—The amendment made by this section shall apply to taxable years beginning after December 31, 2025.
SEC. 4. FINANCIAL ASSISTANCE POLICY REVIEW AND REPORT.
(a) Review.—The Treasury Inspector General for Tax Administration shall conduct a review of financial assistance policies of hospital organizations under section 501(r)(4) of the Internal Revenue Code of 1986.
(b) Report.—Not later than 365 days after the date of the enactment of this Act and annually thereafter, the Treasury Inspector General for Tax Administration shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the results of the review conducted under subsection (a), including—
(1) the content of financial assistance policies of hospital organizations,
(2) compliance of hospital organizations with the financial assistance policy requirements of section 501(r)(4) of the Internal Revenue Code of 1986, and
(3) such other topics as are determined by the Treasury Inspector General for Tax Administration to be relevant to financial assistance policies.
SEC. 5. INTERNAL REVENUE SERVICE ENFORCEMENT REVIEW AND REPORT.
(a) Review.—The Comptroller General of the United States shall conduct a review of the effectiveness of the Internal Revenue Service in enforcing compliance with the community benefit standard for hospital organizations under section 501(r)(7) of the Internal Revenue Code of 1986.
(b) Report.—Not later than 365 days after the date of the enactment of this Act and no later than every three years thereafter, the Comptroller General of the United States shall submit to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate a report on the results of the review conducted under subsection (a). <all>
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