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HR 9504 119th Congress · House

New Transparency Rules for Tax-Exempt Hospitals

Advocate

Official title: Tax Exempt Hospital Transparency Act

The Tax Exempt Hospital Transparency Act would add new reporting rules for tax-exempt hospital organizations on their annual IRS return under section 6033. Hospitals would have to report how they are addressing needs from their community health needs assessments, their audited financial statements, the value and volume of financial assistance they provide, and, for larger systems, more detailed spending and service-line information. It also creates special reporting for high-revenue hospitals that participate in the 340B drug discount program. The bill applies mainly to tax-exempt hospital organizations, with extra obligations for those with more than 100 inpatient beds or more than $100 million in net patient revenue.

  • Adds a new IRS reporting section, 6033A, for tax-exempt hospital organizations.
  • Requires disclosure of financial aid provided, including the number of applications received, granted, and denied.
  • Large hospital systems must report the top 3 priority health needs and spending tied to them.
  • High-revenue hospitals must report advertising costs, service-line revenue and costs, and some 340B program data.
  • Most provisions apply after a standardized health service line taxonomy is issued; aid-reporting for smaller hospitals begins 3 years later.
Public Relevance 25 / 100
Niche Modest scope Broad

If you are a patient or taxpayer, this bill would mainly affect you indirectly by making tax-exempt hospitals disclose more about how they spend money, how much charity care they provide, and how they use 340B drug program savings. If you work for or run a nonprofit hospital, it would mean new annual reporting burdens, including facility-level disclosures for many systems, cost allocation methods, and additional data on advertising, service-line revenue, and financial assistance. The bill does not change who can get hospital care or alter the 340B program itself, but it could increase transparency and scrutiny around hospital finances.

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FOR
  • Patients and community advocates They may argue the bill gives the public a clearer view of whether nonprofit hospitals are addressing community needs and providing meaningful financial assistance. The required reporting on denied aid applications, unmet needs, and spending on priority health issues could reveal gaps that are hard to see now.
  • Tax policy watchdogs They may support the bill because tax-exempt hospitals receive a public subsidy, and the legislation requires more detailed documentation of how that subsidy is used. Audited financial statements, facility-level reporting, and 340B disclosures can help compare hospitals and identify outliers.
  • Payers and employers They may favor more disclosure of advertising costs, service-line costs, and nonclinical spending because those categories can affect hospital pricing and negotiations. More transparency could strengthen oversight without directly changing reimbursement rules.
AGAINST
  • Nonprofit hospital systems They may argue the bill adds significant reporting and compliance burdens, especially the facility-level and service-line breakdowns for large and high-revenue hospitals. Hospitals may also object that cost allocation rules and a new taxonomy could be complex and expensive to implement.
  • Hospital finance and compliance staff They may say the definitions of quality improvement, nonclinical programming, and health service lines require detailed accounting changes and could create disputes over how costs are classified. The requirement to explain why certain cost centers are not health service lines may lead to administrative risk and inconsistent reporting.
  • 340B-covered hospitals They may worry that the new 340B disclosures invite scrutiny of a program that the bill explicitly says it does not change. Reporting total 340B users, net payment amounts, and compliance costs could be used to question hospitals’ participation or draw policy pressure onto the program.
  • “Every tax exempt hospital organization shall include on the return ...”

    This turns the annual IRS filing into a much more detailed public-facing accountability document for nonprofit hospitals. Hospitals that previously disclosed less of this information would have to expand what they report each year.

  • “the value, at cost, of the financial assistance provided”

    Hospitals would have to quantify the value of charity care or financial aid using cost-based reporting, not just broad descriptions. That makes it easier to compare how much help hospitals actually provide to low-income or uninsured patients.

  • “the 3 highest priority health needs”

    Large tax-exempt hospitals would have to identify their top community health priorities and show how much they spent on each. This can expose whether hospitals are focusing on local health needs or spending elsewhere.

  • “the aggregate net 340B payment amount”

    For covered hospitals, the bill would require a dollar calculation tied to the gap between payments received and the 340B ceiling price or acquisition price. That creates a more specific record of the financial value hospitals may gain from the drug discount program.

  • “Not later than ... 2 years ... publish and maintain a standardized health service line taxonomy”

    HHS would have to create a common reporting framework for service lines, which could make hospital comparisons easier. It also means hospitals may need to remap their internal accounting systems to fit the federal taxonomy.

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Bill
HR 9504
Congress
119th Congress
Official title
Tax Exempt Hospital Transparency Act
Policy area
Healthcare
Latest action
Referred to the House Committee on Ways and Means. (June 29, 2026)
Last updated
June 30, 2026

June 29, 2026

Referred to the House Committee on Ways and Means.

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