Tax Exempt Hospital Transparency Act

under the Medicare program under title XVIII of the Social Security Act), and ``(D) technical assistance. ``(3) Nonclinical programming.--For purposes of this subsection, the term `nonclinical programming' means any program, initiative, or department, with a purpose other than the purpose of improving health outcomes for patients of the organization and which is related to-- ``(A) administrative support and management, ``(B) information technology, hospital administration, human resources, medical billing and coding, public affairs and communications, government affairs and lobbying, regulatory compliance, or financial planning and budgeting, ``(C) operations and facilities management, ``(D) programming related to patient experience, patient education, family support, or financial counseling, or ``(E) discharge planning and appointment scheduling. ``(4) Separate reporting with respect to each facility.-- Except as otherwise provided by the Secretary, the information described in paragraph (1) shall be provided with respect to the organization and separately stated with respect to each hospital facility operated by such organization. ``(c) Additional Reporting by High Revenue Tax Exempt Hospital Organizations.-- ``(1) In general.--Every high revenue tax exempt hospital organization shall include on the return filed under section 6033(a) for the taxable year-- ``(A) the specified advertising information, ``(B) the specified health service line information, and ``(C) in the case of an organization which is a covered entity described in section 340B(a)(4) of the Public Health Service Act, the specified Federal 340B drug discount program information. ``(2) Specified advertising information.--For purposes of this subsection, the term `specified advertising information' means-- ``(A) the allowable advertising costs as reported to the Centers for Medicare & Medicaid Services for purposes of cost reimbursement, and ``(B) the unallowable advertising costs (as so reported). ``(3) Specified health service line information.-- ``(A) In general.--For purposes of this subsection, the term `specified health service line information' means-- ``(i) a description of each health service line of the organization, ``(ii) the amount of gross receipts generated by each such health service line, and ``(iii) the costs of each such health service line (and in the case of costs that are shared by 1 or more health service lines, an explanation of how such costs are allocated). ``(B) Health service line.-- ``(i) In general.--For purposes of this paragraph, the term `health service line' means a discrete clinical program, department, or care category operated by the organization that-- ``(I) serves a defined patient population grouped by disease category, organ system, care setting, or clinical specialty, ``(II) delivers a distinct set of medical or health services through dedicated or allocated staff, facilities, or equipment, and ``(III) is separately tracked or identifiable in the organization's internal cost accounting, service line management, or operational reporting systems. For purposes of this paragraph, any cost center separately identified on the organization's most recently filed cost report under section 1815 of the Social Security Act shall be presumptively treated as a health service line. If the organization asserts that such a cost center does not constitute a health service line, the organization shall bear the burden of demonstrating that such cost center does not satisfy the requirements of subclauses (I) and (II). ``(ii) Standardized health service line taxonomy.--For purposes of this paragraph-- ``(I) In general.--Not later than the date that is 2 years after the date of the enactment of this section, the Secretary of Health and Human Services, in consultation with the Secretary, shall publish and maintain a standardized health service line taxonomy to which high revenue tax exempt hospital organizations shall map their internally defined health service lines on their returns under section 6033. ``(II) Updates.--The Secretary of Health and Human Services, in consultation with the Secretary, shall update the taxonomy described in subclause (I) no less frequently than every 5 years to reflect changes in clinical care delivery, hospital organization, and cost accounting practices. ``(III) Compliance obligation.--A high revenue tax exempt hospital organization's compliance with the reporting requirements of this subsection with respect to a health service line enumerated in the taxonomy published, maintained, and updated under this clause shall not be conditioned on whether the organization separately tracks such service line under clause (i)(III). A high revenue tax exempt hospital organization that does not separately track such an enumerated health service line shall disclose that fact and provide an explanation on their return under section 6033. The Secretary of Health and Human Services, in consultation with the Secretary, may, by regulation, designate categories of clinical activity that shall be treated as a single health service line for reporting purposes notwithstanding any difference in how a high revenue tax exempt hospital organization tracks such activity in its internal systems. ``(4) Specified federal 340b drug discount program information.-- ``(A) In general.--For purposes of this subsection, the term `specified Federal 340B drug discount program information' means-- ``(i) the total number of individuals, by their type of insurance coverage, who were dispensed or administered covered outpatient drugs during the taxable year that were subject to an agreement under section 340B of the Public Health Service Act, ``(ii) the aggregate net 340B payment amount with respect to such drugs subject to such an agreement dispensed or administered by the organization during such taxable year, and ``(iii) the aggregate costs incurred by the organization during such taxable year that were necessary for such organization to participate in the program under such section and to comply with such program's requirements (including program-related compliance, legal, educational, and administrative costs, and compensation paid to independent contractors to carry out program-related functions). ``(B) Covered outpatient drug.--For purposes of this paragraph, the term `covered outpatient drug' has the meaning given such term in section 340B(b) of the Public Health Service Act. ``(C) Aggregate net 340b payment amount.--For purposes of this paragraph, the term `aggregate net 340B payment amount' means, with respect to a covered outpatient drug purchased by an organization under an agreement under section 340B of the Public Health Service Act and dispensed or administered to an individual by such organization, the excess (if any) of-- ``(i) the total amount of payments received from any payor by the organization for such drug, over ``(ii) the ceiling price (as described in subsection (a)(1) of such section) for such drug (or, if less, the price at which such organization acquired such drug). ``(5) Separate reporting with respect to each facility.-- Except as otherwise provided by the Secretary, the information described in paragraph (1) shall be provided with respect to the organization and separately stated with respect to each hospital facility operated by such organization. ``(6) Agency coordination.--The Secretary shall coordinate with-- ``(A) the Administrator of the Centers for Medicare & Medicaid Services to carry out the purposes of paragraphs (2) and (3), and ``(B) the Administrator of the Health Resources and Services Administration to carry out the purposes of paragraph (4). ``(d) Definitions.--For purposes of this section-- ``(1) Tax exempt hospital organization.--The term `tax exempt hospital organization' means, with respect to any taxable year, any organization-- ``(A) to which the requirements of section 501(r) apply for such taxable year, and ``(B) which is required to file a return under section 6033(a) for such taxable year. ``(2) Large tax exempt hospital organization.--The term `large tax exempt hospital organization' means, with respect to any taxable year, any organization which-- ``(A) is a tax exempt hospital organization for such taxable year, ``(B) is not a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act) for such taxable year, ``(C) is not a rural emergency hospital (as defined in section 1861(kkk)(2) of the Social Security Act) for such taxable year, and ``(D) has more than 100 staffed inpatient beds (as reported in any cost report under section 1815 of the Social Security Act with respect to any portion of such taxable year or any portion of any of the 3 preceding taxable years). ``(3) High revenue tax exempt hospital organization.-- ``(A) In general.--The term `high revenue tax exempt hospital organization' means, with respect to any taxable year, any organization which-- ``(i) is a tax exempt hospital organization for such taxable year, ``(ii) is not a critical access hospital (as defined in section 1861(mm)(1) of the Social Security Act) for such taxable year, ``(iii) is not a rural emergency hospital (as defined in section 1861(kkk)(2) of the Social Security Act) for such taxable year, and ``(iv) has net patient revenue (determined in such manner as the Secretary may provide) for such taxable year of more than $100,000,000. ``(B) Inflation adjustment.-- ``(i) In general.--In the case of any taxable year beginning in a calendar year after 2028, the $100,000,000 amount in subparagraph (A)(iv) shall be increased by an amount equal to-- ``(I) such dollar amount, multiplied by ``(II) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in which the taxable year begins, determined by substituting `calendar year 2027' for `calendar year 2016' in subparagraph (A)(ii) thereof. ``(ii) Rounding.--Any increase determined under clause (i) shall be rounded to the nearest multiple of $100,000. ``(e) Treatment as Part of Annual Return.--For purposes of this title, the information required to furnished under this section shall be treated as information required to be furnished under section 6033. ``(f) Regulations.--The Secretary may issue such regulations or other guidance as may be necessary or appropriate to carry out the purposes of this section, including regulations or other guidance providing a methodology for allocating costs between the categories described in subsections (a)(1)(A), (a)(1)(D), (b)(1)(A), (b)(1)(B)(i), (b)(1)(B)(ii), and (b)(1)(B)(iii).''. (b) Conforming Amendments.-- (1) Section 6033(b) of such Code is amended-- (A) by adding ``and'' at the end of paragraph (14), (B) by striking paragraph (15), and (C) by redesignating paragraph (16) as paragraph (15). (2) The table of sections for subpart A of part III of subchapter A of chapter 61 of such Code is amended by inserting after the item relating to section 6033 the following new item: ``Sec. 6033A. Reporting by tax exempt hospital organizations.''. (c) Effective Date.-- (1) In general.--The amendments made by this subsection shall apply to taxable years beginning after the date that is 1 year after the date of the publication of the first standardized health service line taxonomy under section 6033A(c)(3)(B)(ii)(I) of the Internal Revenue Code of 1986 (as added by this section). (2) Exception.--In the case of any tax exempt hospital organization which is neither a large tax exempt hospital organization nor a high revenue tax exempt hospital organization, subparagraphs (D) and (E) of section 6033A(a)(1) of the Internal Revenue Code of 1986 (as added by this section) shall (notwithstanding paragraph (1)) apply to taxable years beginning after the date that is 3 years after the date of the enactment of this Act. Terms used in this paragraph which are also used in section 6033A of such Code (as so added) shall have the same meaning as when used in such section. (d) No Inference.--Nothing in this Act or the amendments made by this Act shall be construed to create any inference with respect to the proper application of section 340B of the Public Health Service Act, of section 501(c)(3) or 501(r) of the Internal Revenue Code of 1986, or of any operational test or the private benefit doctrine. SEC. 3. GAO REPORT. During the 1-year period beginning 3 years after the date of the enactment of this Act, the Comptroller General of the United States shall initiate a study and subsequently report to the Committee on Ways and Means of the House of Representatives and the Committee on Finance of the Senate on the following: (1) An estimate of the additional labor and resource costs of the Department of the Treasury to administer, and of the additional costs of tax exempt hospital organizations (as defined in section 6033A(d)(1) of the Internal Revenue Code of 1986, as added by this Act) to comply with, the reporting requirements added by the amendments made by this Act. (2) With respect to the 25 tax exempt hospital organizations (as so defined) which have the highest amount of gross revenue, the estimated amount of tax which would be imposed under chapter 1 of such Code with respect to each such organization if such organization were not exempt from such tax. <all>