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© 2015 by the Catholic Health Association of the United States © 2015 by the Catholic Health Association of the United States
Community Benefit and Community Health Needs Assessments
National Association of Counties (NACo)
February 22, 2015
Julie Trocchio Senior Director, Community Benefit and Continuing Care
Catholic Health Association
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© 2015 by the Catholic Health Association of the United States March 13, 2015 6
Mother Joseph, born in Montreal, led a group of five missionaries to the Pacific Northwest. She was responsible for the completion of 11 hospitals, 7 academies, 5 Indian schools and 2 orphanages. As architect and artist, she designed and supervised their construction as well as fund raising.
© 2015 by the Catholic Health Association of the United States March 13, 2015 7
Community Benefit Objectives Programs or activities that provide treatment or promote
health as a response to community needs
and meets at least one community benefit objective:
Improve access to health services
Enhance public health
Advance knowledge
Relieve government burden
© 2015 by the Catholic Health Association of the United States 8
Identified by:
CHNA
Request by NFP or government or other documentation
Partnership with NFP or government
Community Health Needs
© 2015 by the Catholic Health Association of the United States 3/13/2015 9
I. Financial Assistance II. Government-sponsored indigent health
care – unpaid costs of public programs -- Medicaid -- State Children’s Health Insurance Program -- Medically indigent programs
III. Community Benefit Services
What Is Community Benefit??
© 2015 by the Catholic Health Association of the United States 3/13/2015 10
Categories of Community Benefit Services
Community health services -- Community health education
-- Community-based clinical services -- Health care support services -- Social and environmental improvement activities
Health profession education -- Physicians, medical students -- Nurses, nursing students -- Other health professions
What is Community Benefit?
© 2015 by the Catholic Health Association of the United States 3/13/2015 11
Categories of Community Benefit Services
Subsidized health services -- Emergency and trauma services -- Behavioral health
Research -- Clinical research -- Community health research -- Health care delivery innovation
What is Community Benefit?
© 2015 by the Catholic Health Association of the United States 3/13/2015 12
Categories of Community Benefit Services
Cash and in-kind contributions -- Cash donations -- Grants -- In-kind donations
Community building activities -- Physical improvements/housing -- Economic development -- Environmental improvements -- Coalition building -- Advocacy for community health improvement
What is Community Benefit?
© 2015 by the Catholic Health Association of the United States 3/13/2015 13
A Process:
Community Benefit is a planned, managed, organized and measured approach to health care organizations’ participation in meeting identified community health and health-related needs.
What is Community Benefit?
© 2015 by the Catholic Health Association of the United States 3/13/2015 14
Building a Sustainable Infrastructure
Assessing Need
Planning
Evaluating
Communicating
Determining What Counts
Accounting for Costs
The Process
© 2015 by the Catholic Health Association of the United States 3/13/2015 15
Questions Raised By Congress
Should the playing field be leveled for not-for-profit and for-profit healthcare?
Are hospitals sufficiently charitable?
Is the community benefit standard for tax-exemption adequate?
Should the revenue ruling for hospital tax-exemption be changed?
© 2015 by the Catholic Health Association of the United States 3/13/2015 16
Affordable Care Act
Community health need assessment
Implementation strategy
Financial assistance
Charges
Billing/collections
Reporting
© 2015 by the Catholic Health Association of the United States 3/13/2015 17
Overview of IRC 501(r) New Penalties
– $50,000 excise tax
– Potential loss of Section 501(c)(3) status with respect to any noncompliant facility
Meeting New Requirements for Tax-Exempt Hospitals
© 2015 by the Catholic Health Association of the United States 3/13/2015 18
IRS: How is a Community Health Needs Assessment Conducted?
Identify and prioritize significant health needs of the community served by the hospital
May be conducted in collaboration or jointly with others
Must solicit and take into account input from persons who represent the broad interests of the community served including those with special knowledge of or expertise in public health
Written report must adopted by authorized body
Must be made publicly available
© 2015 by the Catholic Health Association of the United States 3/13/2015 19
Description of the community served by the hospital
Description of the process used to conduct the assessment • Sources and dates of the data and other information used;
• Methods of collecting and analyzing data
Description of how information was solicited and used
If the hospital collaborated with others – who?
If the hospital contracted with a consultant – include qualifications
IRS: How is Community Health Needs Assessment Documented?
© 2015 by the Catholic Health Association of the United States 3/13/2015 20
Describe input from persons who represent the broad interests of the community:
Summary of the input of these persons; how and over what time period
Names of organizations providing input and nature and extent of input
Describe the medically underserved, low-income, or minority population being represented by organizations or individuals providing input
IRS: How is Community Health Needs Assessment Documented? (con’t)
© 2015 by the Catholic Health Association of the United States 3/13/2015 21
A prioritized description of all the significant community health needs identified through the CHNA, including a description of the process and criteria used in prioritizing such health needs
A description of the potential resources identified through the CHNA to address the significant health needs
Evaluation of impact of actions taken since previous CHNA
IRS: How is Community Health Needs Assessment Documented? (con’t)
© 2015 by the Catholic Health Association of the United States 3/13/2015 22
IRS Form 990 Schedule H
© 2015 by the Catholic Health Association of the United States 3/13/2015 23
The actions the hospital facility intends to take to address the significant health need
The anticipated impact of these actions
The resources the hospital plans to commit to address the health need
Any planned collaboration between the hospital facility and other facilities or organizations
IRS: What Does an Implementation Strategy Include?
© 2015 by the Catholic Health Association of the United States 3/13/2015 24
Must be attached to hospital’s IRS Form 990 or provide on the Form 990 the URL(s) to access online
Not required but recommended: post on website
Questions on IRS Form 990 Schedule H
IRS: How is an Implementation Strategy Documented?
Presentation for the Health Steering Committee National Association of Counties Legislative Conference
February 22, 2015
The 2013 Wake County Community Health Needs Assessment
25 www.wakegov.com Denise Foreman, Assistant to the County Manager Regina Y. Petteway, Interim Human Services Director
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2013 Community Health Needs Assessment (CHNA)
This presentation will cover: Planning and
Implementation Positive Results A Few Tips from Wake
County Plans for the 2016
Assessment – Alignment with the “Healthiest Capital County Campaign”
www.wakegov.com
Sent from my iPhone
1. Establish a community health assessment team (or teams)
2. Collect and analyze existing statistics and data as well as information from a community door to door survey process
3. Determine priorities through a community engagement process
4. Create the CHNA document 5. Develop community health action
plans 6. Make the CHNA document and
action plans available to community partners
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Planning and Implementation Steps
Positive Results
28 www.wakegov.com
Cost savings for the County - $10,000 plus staff time for 2013 Assessment compared to $75,000 and staff time for 2010 Assessment.
Community Ownership – 60+ partners using the same priorities and data (Top 3 priorities – poverty and unemployment; health care access; mental health and substance abuse).
Hospitals met their IRS requirements on time, and used the assessment for strategic planning and their community plans.
Wake County met state requirements. Also met a “Vision 2020”Goal of being data-driven in planning.
A Few Tips for Success
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1. Appoint a Community Co-Chair and County Commissioner Co-Chair as leadership.
2. Start early with a timeline and be clear about deliverables. 3. Make sure to keep your Board of Commissioners informed and
engaged along the way. 4. Start with a small steering team (County staff and representatives from
partners who share fiscal resources). Also have a larger group of partners and stakeholders with specific roles, but who meet less frequently.
5. Contract out the scientific “hard stuff” (data collection and producing final documents).
6. Use the marketing expertise of your partners and connect the final information through their social media and yours.
7. Celebrate!
www.wakegov.com
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…….Moving Forward
Wake County is now aligning the 2016 CHNA Process with our “Healthiest Capital County Collective Impact Campaign”
County Health Rankings Data and Community Health Needs Assessment Data can be reported together
We have a coalition of 40+ partners; a recommended structure and plan to move forward; and are currently seeking fiscal partners
www.wakegov.com
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Moving Forward With The Healthiest
Capital County Initiative - Highlights
Will address 5 indicators (Obesity, Food Insecurity, Children in Poverty; High School Drop Out Rate; Risky Youth Behaviors)
Negotiating with 3 community partners to lead Work Groups (Advocates for Health in Action/YMCA; United Way; Youth Thrive Coalition)
Seeking continued county support through the budget process; community stakeholder fiscal support and a community “home”
Expect to start implementation in July, including planning for the 2016 CHNA
www.wakegov.com
QUESTIONS?
32 www.wakegov.com
33 www.wakegov.com
For More Information For an electronic copy of the 2013 Executive Summary and the Full Report, go to: http://www.wakegov.com/humanservices/data/Pages/default.aspx You may also contact: Edie Alfano-Sobsey, Wake County Human Services Epidemiologist at [email protected] Lechelle Wardell, Wake County Program Manager and CHNA Project Manager at [email protected]
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