Health Systems Transformation

Community Health Needs Assessments

Community health needs assessments (CHNA) and implementation strategies are newly required of tax-exempt hospitals as a result of the Patient Protection and Affordable Care Act. These assessments and strategies create an important opportunity to improve the health of communities. They ensure that hospitals have the information they need to provide community benefits that meet the needs of their communities. They also provide an opportunity to improve coordination of hospital community benefits with other efforts to improve community health. By statute, the CHNAs must take into account input from “persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health.”

Community-Based Health Needs Assessment Activities: Opportunities for Collaboration Between Public Health Departments and Rural Hospitals

This issue brief  provides an overview of the requirements and standards for some rural hospitals and health departments to conduct community health needs assessments (CHNAs). These exercises can help stakeholder to identify and address health problems in rural communities. They are also an opportunity for health systems and health departments to collaborate on similar activities that may be mandated by separate authorities, and for them to leverage their requirements to become a means of addressing vexing population health challenges in rural areas. The issue briefs includes several state-specific examples of how these partnerships can be created and maintained at the state and local levels.

Successes and Challenges in Community Health Improvement Issue Brief

This issue brief provides a system-wide view of the challenges and opportunities that CHNAs and population health improvement present by sharing the perspectives of those in health systems, nonprofits, and other community organizations, along with those of public health officials, from three states: Massachusetts, Maryland, and North Carolina.

IRS CHNA Requirements

On December 31, 2014, the Internal Revenue Service (IRS) published final rules implementing the “Additional Requirements for Charitable Hospitals” section of the Affordable Care Act (ACA). These rules relate to tax-exempt hospitals’ community health needs assessments (CHNAs); financial assistance policies (FAPs); and hospital charges, billing, and collection practices. Proposed rules addressing these ACA provisions have been pending since 2012 and 2013.

ASTHO's Overview of IRS Final Rules

Notice 2011-52, 2011 IRB 30 (July 25, 2011) addresses the CHNA requirements described in section 501(r)(3) of the Code.

Overview of the new requirements for 501(c)(3) hospitals under the Affordable Care Act

Recently released proposed rule that provides non-profit hospitals further guidance on how to define “community” in conducting a CHNA and requires consultation with at least one state, local, tribal, or regional governmental public health department.

CDC's Public Health Law Program's summary of the IRS notice of proposed rulemaking on CHNAs for charitable hospitals.

More information on a CDC-developed Community Health Improvement (CHI) technical package for 2015 tax year as a unified framework to improve health outcomes and reduce health disparities.

ASTHO CHNA Recommendations

The following documents were created by ASTHO and partners in response to the IRS request for comments regarding the IRS requirements for non-profit hospital organizations to conduct a CHNA every three years and adopt an implementation strategy to meet the needs identified through the CHNA.

Consensus Statement - Consensus recommendations from ASTHO and other partners about how hospitals can most effectively work with public health experts to maximize community benefits.

ASTHO Comments for Notice 26 CFR Parts 1 and 53

ASTHO Comments for Notice 2011-52

CHNA Resources

Hospital Tax-Exempt Policy: A Comparison of Schedule H and State Community Benefit Reporting Systems
A report recently released by Sara Rosenbaum, et al., analyzes state statutes and reporting systems for a sample of 24 states.

CDC Resources for Implementing the CHNA Process
This website provides background information for conducting community health needs assessments and developing strategies that address priority needs.

CHNA.org - A Free Data and Reporting Resource
CHNA.org is a state-of-the-art, FREE, web-based utility designed to assist hospitals, non-profit community-based organizations, state and local health departments, financial institutions, engaged citizens, and other key stakeholders in understanding the needs and assets of their communities.

California Hospital Association's Factsheet on Proposed Guidance
The California Hospital Association has put together a fact sheet with more information on the proposed guidance for charitable hospitals performing CHNAs.

Fact Sheet: What are Hospital Community Benefits?
This fact sheet created by The Hilltop Institute gives a brief overview of hospital community benefits and considerations for state and local decision-makers.

Community Benefit State Law Profiles
A 50-state survey of each state’s community benefit laws and regulations analyzed in the context of the Affordable Care Act’s (ACA’s) community benefit framework. An interactive map links to each state’s Profile and a summary table compares community benefit laws from state to state.

Hospital Community Benefits after the ACA: The State Law Landscape
This issue brief from The Hilltop Institute's Hospital Community Benefit Program presents the Profiles’ findings and begins the analysis to facilitate a better understanding of each state’s community benefit landscape and its significance in the context of national health reform.

Hospital Community Benefits after the ACA: Partnerships for Community Health Improvement
This issue brief from The Hilltop Institute’s Hospital Community Benefit Program explores how several hospitals have collaborated with local community or health agencies to improve health in their communities. State examples from NC, MD, and MN are highlighted.

Hospital Community Benefit Requirements and Primary Care Offices
This powerpoint provides an overview of the IRS Community Benefeit requirements, discusses the impact of the CHNA initative, and concludes with implications for Primary Care Offices.

NIH Health Services Research Info Center: CHNA Resources
A growing set of tools, examples, and analyses are provided on this webpage to assist both those tasked with preparing a CHNA, as well as those interested in reviewing national progress. Also available is a search strategy on "community benefit" and "CHNA" that will assist in finding relevant articles in PubMed.

State Health Assessments and Plans
A resource for state health departments developing a state health assessment.