(a) Annual report of the Community Benefits Plan (CBP).      
        (1) The annual CBP report may be filed with the department on a hospital or hospital system basis. A CBP developed by a hospital serves as a hospital's operational plan for serving the community's health care needs and sets out goals and objectives for providing community benefits that include charity care and government-sponsored indigent health care.       
        (2) A nonprofit hospital or hospital system shall file an annual CBP report with the department no later than April 30 of the following year.       
        (3) The nonprofit hospital's or hospital system's annual CBP report must include, at a minimum:                  (A) the hospital's or hospital system's mission statement;                   (B) a disclosure of the health care needs of the community that were considered in developing the CBP;                   (C) a disclosure of the amount and types of community benefits, including charity care, actually provided. Charity care shall be reported as a separate item from other community benefits;                   (D) a statement of its total operating expenses computed in accordance with generally accepted accounting principles for hospitals from the most recent completed and audited prior fiscal year of the hospital; and                   (E) a completed worksheet that computes the ratio of cost to charge for the fiscal year referred to in subparagraph (D) of this paragraph and that includes the same requirements as Worksheet 1-A adopted by the department in August 1994 for the 1994 "Annual Statement of Community Benefits Standard".         
        (4) In addition to the annual CBP report, a nonprofit hospital or hospital system shall file a completed worksheet as required by paragraph (3)(E) of this subsection no later than ten working days after the date the hospital or hospital system files its Medicare cost report.       
      (b) Annual statement of community benefits standard (ASCBS).      
        (1) Each nonprofit hospital or hospital system shall also report the following information to the department as the ASCBS part of the online survey form:                  (A) the amount of charity care provided;                   (B) the amount of government-sponsored indigent health care provided;                   (C) the amount of community benefits provided;                   (D) the amount of net patient revenue and the amount constituting 4.0% of net patient revenue;                   (E) the dollar amount of the hospital's or hospital system's charity care and community benefits requirements met;                   (F) the amount of tax-exempt benefits provided, if the hospital is required to report tax-exempt benefits under subsection (b)(3)(A) or (B) of this section;                   (G) the amount of charity care expenses reported in the hospital's or hospital system's audited financial statement; and                   (H) a brief summary of the charity care policy and community benefits provided by each hospital unless the hospital is a public hospital or for-profit hospital participating in the Medicaid disproportionate share program.         
        (2) The ASCBS shall be filed online with the department on a hospital or hospital system basis.       
        (3) A nonprofit hospital or hospital system is required to file an annual statement with the department no later than 120 days after the hospital's or hospital system's fiscal year ends; however, the department will accept the ASCBS as partially fulfilling the requirement to submit an annual report of the hospital or hospital system CBP. The ASCBS filed under this subsection shall be based on the most recently completed and audited prior fiscal year of the hospital and shall state which of the standards for providing community benefits has been satisfied. A nonprofit hospital or hospital system may elect to provide community benefits according to any of the following standards:                  (A) charity care and government-sponsored indigent health care are provided at a level which is reasonable in relation to the community needs, as determined through the community needs assessment, the available resources of the hospital or hospital system, and the tax-exempt benefits received by the hospital or hospital system, and other factors that may be unique to the hospital or hospital system, such as the hospital's or hospital system's volume of Medicare and Medicaid patients;                   (B) charity care and government-sponsored indigent health care are provided in an amount equal to at least 100% of the hospital's or hospital system's tax-exempt benefits, excluding federal income tax; or                   (C) charity care and community benefits are provided in a combined amount equal to at least 5.0% of the hospital's or hospital system's net patient revenue, provided that charity care and government sponsored indigent health care are provided in an amount equal to at least 4.0% of net patient revenue.         
        (4) For purposes of satisfying paragraph (3)(C) of this subsection, a hospital or hospital system may not change its existing fiscal year unless the hospital or hospital system changes its ownership or corporate structure as a result of a sale or merger.       
        (5) A nonprofit hospital or hospital system shall use the ASCBS part of the online survey form and accompanying worksheets developed by the department for reporting under this section. Hospitals electing to report on a system basis shall consolidate the individual hospital information into a single ASCBS form for the online system. A separate set of worksheets shall be completed for each individual hospital included in the system.       
        (6) The department will accept written revisions of the ASCBS for 30 days after the filing date.       
        (7) The department may request missing or incomplete data by written or telephone request. Nonprofit hospitals or hospital systems shall answer all requests received from the department in the time frame specified by the department.       
        (8) A nonprofit hospital that has been designated as a disproportionate share hospital under the state Medicaid program in the current fiscal year or in either of the previous two fiscal years shall be deemed in compliance with these standards.       
        (9) A hospital that satisfies paragraph (3)(A) or (8) of this subsection shall be excluded in determining a hospital system's compliance with the standards provided in paragraphs (3)(B) and (C) of this subsection.       
        (10) A nonprofit hospital or hospital system under contract with a local county to provide indigent health care services under Health and Safety Code, Chapter 61 may credit unreimbursed costs from direct care provided to an eligible county resident toward meeting the nonprofit hospital's or hospital system's charity care and government-sponsored indigent health care requirement.       
      (c) Reporting.      
        (1) The department shall notify nonprofit hospitals in writing that the annual report of the community benefits plan and the online ASCBS form that includes a brief summary of charity care policy and community benefits must be filed in accordance with these rules.       
        (2) Nonprofit hospitals changing to a hospital system reporting basis shall report for a continuous period of time.       
        (3) All hospitals or hospital systems shall report as required under this title if the hospital or hospital system, for the previous fiscal year, reported as a nonprofit hospital or hospital system under §13.15 of this title (relating to Survey Forms and Methods of Reporting Data).       
        (4) All hospitals or hospital systems shall report any change of ownership which may affect the nonprofit status of the hospital or hospital system to the Center for Health Statistics, Hospital Survey Unit, at the department within 60 days of the effective date of the change.       
      (d) Posting of sign. Nonprofit hospitals shall prepare a statement notifying the public that the annual report of the CBP is public information, that it is filed with the department, and that it is available on request from the Center for Health Statistics, Hospital Survey Unit, Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756. The statement must indicate the report's availability date and be posted in prominent places throughout the hospital, including, but not limited to, the waiting areas of the emergency room and the admissions office. Nonprofit hospitals shall also print the statement in the patient guide or other materials that provide the patient with information about the hospital's admissions criteria.     
      (e) Charity care notice. Each hospital shall provide, to each person who seeks any health care service at the hospital, notice, in appropriate languages, if possible, about the charity care program, including the charity care and eligibility policies of the program, and how to apply for charity care. Such notice shall also be conspicuously posted in the general waiting area, in the waiting area for emergency services, in the business office, and in such other locations as the hospital deems likely to give notice of the charity care program and policies. Each hospital shall annually publish notice of the hospital's charity care program and policies in a local newspaper of general circulation in the county. Each notice under this subsection must be written in language readily understandable to the average reader.     
      (f) Exemptions. A nonprofit hospital is exempt from the reporting requirement in subsection (c) of this section if the hospital is located in a county with a population under 50,000 and in which the entire county or the population of the entire county has been designated as a "Federally designated Health Professional Shortage Area (HPSA)" during the current or any previous fiscal year and has continued to maintain that designation.     
      (g) For purposes of this section only (excluding subsection (b)(1)(H) of this section), a nonprofit hospital shall include a nonprofit hospital as defined in §13.13 of this title and:      
        (1) a Medicaid disproportionate share hospital; or       
        (2) a public hospital that is owned or operated by a political subdivision of municipal corporation of the state, including a hospital district or authority.       
     Source Note:        The provisions of this §13.17 adopted to be effective February 23, 1994, 19 TexReg 921; amended to be effective February 28, 1996, 21 TexReg 1282; amended to be effective May 10, 1998, 23 TexReg 4269; amended to be effective February 8, 2001, 26 TexReg 1141; amended to be effective April 14, 2002, 27 TexReg 2827; amended to be effective December 4, 2007, 32 TexReg 8827