Question

Discuss the interrelationships of local, state, and federal initiatives in addressing community health needs. PLEASE GO INTO AS MUCH DETAIL AS POSSIBLE. This is for a community health class.

Answer 1

Mission-driven, tax-exempt health care organizations have a long tradition of working to improve community health through community benefit activities.
As the field of community benefit has matured and become more science-based, community benefit leaders have recognized that to make an impact on the health of the communities they serve, they need a systematic approach to assessing community needs and planning community benefit programs.
New federal laws requiring health care organizations to assess the health needs of their communities and adopt implementation strategies to address these needs have provided an impetus for these organizations to create more structured assessment and planning processes.
This book was developed to meet these two major needs of mission-driven, tax- exempt health care organizations: first, to continually improve the effectiveness of their community benefit programs; and secondly, to address the new legal requirements. It also looks at ways to work with community members and public health experts in both assessment and community benefit planning.

section i: introduction 15
federAl And stAte requirements
federal law and laws in many states require tax-exempt hospitals to conduct periodic community health needs assessments and adopt plans to meet assessed needs.
in order to comply with federal tax-exemption requirements in the affordable care act, a tax-exempt hospital facility must:
u conduct a community health needs assessment every three years. the assessment must
• take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health.
• be made widely available to the public.
u adopt an implementation strategy to meet the community health needs identified through the assessment.
u report how it is addressing the needs identified in the community health needs assessment and a description of needs that are not being addressed with the reasons why such needs are not being addressed.
in addition to these new federal requirements, many states require tax-exempt hospitals to conduct community needs assessments and develop community benefit plans, in varying degrees of specifications. see appendix B for the text of the federal law that sets new federal requirements.
check the advocacy and Public Policy section of cha’s community benefit website (www.chausa.org/communitybenefit) for the status of federal regulations and instructions and a description of state requirements.
As of the release date of this discussion draft, the Internal Revenue Service (IRS) has not issued final guidance for the new federal requirements. The information on conducting a community health needs assessment and developing an implementation strategy presented in this resource is based on the IRS’s July
2011, “Notice and Request for Comments Regarding the Community Health Needs Assessment Requirements for Tax-Exempt Hospitals,” Notice 2011-52; the proposed rule issued by the IRS in April 2013, “Community Health Needs Assessments for Charitable Hospitals,” 78 Federal Register 66 (5 April 2013), pp.20523-20544 and advice from public health experts and community benefit professionals. It is meant to be educational and does not constitute legal or tax advice on how to fulfill federal requirements.
As hospitals prepare to meet the requirements of the new law, they should consult the most recent guidance from the IRS.

16 Section I: Introduction
what is a community health needs assessment and an imPlementation strategy?
CHA worked with several leading public health experts and community benefit professionals to develop the following definitions:
A community health needs assessment is a systematic process involving the community to identify and analyze community health needs and assets in order to prioritize these needs, and to plan and act upon significant unmet community health needs.
An implementation strategy is the hospital’s plan for addressing community health needs, including significant health needs identified in the community health needs assessment. The implementation strategy is also known as the hospital’s overall community benefit plan.
guiding PrinciPles
CHA’s A Guide for Planning and Reporting Community Benefit details a set of core beliefs that underpin community benefit programs. These core beliefs also guide the assessment and planning processes:
u Those who live in poverty and at the margins of our society have a moral priority
for services. While assessments will look at the health needs of the overall community, low-income and other disadvantaged people deserve special attention and priority. Their needs should be a top priority and implementation strategies should include interventions to address these needs.
u Not-for-profit health care has a responsibility to work toward improved health in the communities they serve. While assessment and planning are key steps in the overall process to improve community health, they are not ends in themselves. Assessment results and the implementation strategy must be put into action and these actions should be evaluated and refined, as needed, to ensure that the community and community partners are achieving their ultimate goal – improved community health.
u Health care facilities should actively involve community members, organizations and agencies in their community benefit programs. Collaboration among providers
and community partners expands the community’s capacity to address health needs through a shared vision, shared resources and skills, and creates a foundation for coordinated efforts to improve community health.

u Health care organizations must demonstrate the value of their community service. Government (at all levels), community members, funders and others committed to improving community health want to know that tax-exempt hospitals are aware of the major needs of the community and that their community benefit planning takes into account these needs.
u Community benefit programs must be integrated throughout health care organizations. The results of the assessment and the community benefit plan should be integrated with the strategic and operational plans of the organization. This will ensure that the organization allocates the necessary resources to carry out these processes effectively.
u Leadership commitment is required for successful community benefit programs.
As leaders of charitable organizations, hospital board members, chief executive officers and senior managers should view access to health care and improved community health as important concerns of their organizations. Leadership commitment helps ensure that assessment and planning processes are viewed as organizational priorities and the results are used to implement programs that will improve community health.

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