The IRS recently released long-awaited final regulations to section 501(r) of the Internal Revenue Code. This Section covers the additional requirements on tax-exempt hospitals imposed by the Affordable Care Act. The final regulations maintain a majority of the IRS’s guidance that existed prior to the final regulations. However, the final regulations include several important modifications to previous IRS guidance. Some of the major changes include the following:

1. Community Health Needs Assessments (CHNAs) must address significant public health and preventative health issues in the community.
2. For second and subsequent CHNAs, the CHNA must evaluate the impact of any actions the hospital took to address the significant health needs.
3. Hospitals are required to provide only one plain-language summary of its financial assistance policy (FAP) in post-discharge mailings to patients. However, they are required to provide notice of the FAP in every mailing.
4. The FAP must also now contain a list of all providers delivering emergency or other medically necessary care and whether each provider is covered under the FAP.
5. A hospital may change its method of calculating “amounts generally billed.” Previous guidance said that hospitals were locked into one method.
6. The FAP and limitation of charges now reaches certain subsidiaries of the hospital. For example, wholly-owned medical practices must comply with the FAP and limitation on charges rules.