Tax Exempt Hospital Transparency Act
Sponsored By: Representative Murphy, Gregory F. [R-NC-3]
In Committee
Summary
Comprehensive facility-level reporting by tax-exempt hospitals. This bill would require tax-exempt hospital organizations to file expanded annual data on community needs, financial assistance, facility finances, and program spending. It would create tiered reporting rules by size and revenue and require a standardized health service line taxonomy and cost-allocation guidance.
Show full summary
- Hospitals and health systems would have to add detailed disclosures to their Form 990, with per-facility data and expanded reporting for large and high-revenue organizations. Certain smaller organizations get delayed deadlines for some items, with a key delay at 3 years for specified reports.
- Patients and communities would see more public detail on charity care policies, community health needs, advertised services, 340B program participation, and which services each facility provides.
- Policymakers and auditors would get a GAO study about 3 to 4 years after enactment to estimate administrative and compliance costs and to project tax implications for the top 25 gross-revenue tax-exempt hospitals.
- Regulators would adopt a standardized health service line taxonomy to be published within 2 years and updated at least every 5 years, plus Treasury guidance on cost allocation and coordination with CMS and HRSA.
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 1 benefits, 0 costs, 5 mixed.
Facility and service-line reporting rules
If enacted, this bill would make large and high-revenue systems report key items for each hospital they operate, including community needs descriptions, CMS ID, charity care cost at value, and counts of charity applications. High-revenue hospitals would also report each health service line with a description, gross receipts by line, and costs with explanations of how shared costs are allocated. HHS would have to publish a standardized health service line taxonomy within two years and update it at least every five years. The bill also defines what counts as "nonclinical programming" and "quality improvement" for spending reports.
High-revenue hospitals: ads and drug data
If enacted, high-revenue tax-exempt hospitals would have to report advertising costs on their annual return, showing CMS-allowable and CMS-unallowable advertising costs. High-revenue hospitals that participate in the 340B drug discount program would also have to report counts of individuals dispensed covered outpatient drugs by payor type, the aggregate net 340B payment amount, and aggregate program-related costs like compliance, legal, education, and administrative expenses.
New annual hospital reporting rules
If enacted, this bill would require every tax-exempt hospital to include new items on its annual Form 990. Reports would include a description of work on the latest community health needs assessment and any unmet needs, audited financial statements, the CMS certification number, the value at cost of financial assistance, and the numbers of financial assistance applications received, granted, and denied. Most of the new reporting would start one year after HHS publishes the first standardized service-line list. Hospitals that are neither large nor high-revenue would wait three years after enactment to report charity care counts and costs.
Treasury rules and agency coordination
If enacted, the Secretary of the Treasury would be able to issue regulations or guidance to implement the new hospital reporting. Treasury would set methods for allocating costs across reporting categories and must coordinate with CMS on advertising and service-line reporting and with HRSA on 340B reporting. Those rules would shape how hospitals break out shared costs and what data they must supply.
Which hospitals face extra rules
If enacted, this bill would set clear thresholds for which hospitals face extra reporting. A "large" hospital system would be one that reported more than 100 staffed inpatient beds (excluding critical access and rural emergency hospitals). A "high-revenue" hospital would be one with more than $100,000,000 in net patient revenue for the year. The $100,000,000 threshold would be increased for years after 2028 by a cost-of-living adjustment and rounded to the nearest $100,000.
GAO study on hospital reporting costs
If enacted, the Comptroller General would study the costs of the new reporting three years after enactment and report to the tax committees during the following year. The GAO would estimate added Treasury administrative costs, hospital compliance costs, and the hypothetical tax amounts for the 25 tax-exempt hospitals with the highest gross revenue if they were not tax-exempt.
Sponsors & CoSponsors
Sponsor
Murphy, Gregory F. [R-NC-3]
NC • R
Cosponsors
Rep. Smucker, Lloyd [R-PA-11]
PA • R
Sponsored 6/29/2026
Roll Call Votes
No roll call votes available for this bill.
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