[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6420 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 6420

 To amend the Internal Revenue Code of 1986 to impose an excise tax on 
certain medical care providers that fail to provide a minimum level of 
             charity medical care, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            December 8, 2006

  Mr. Thomas introduced the following bill; which was referred to the 
                      Committee on Ways and Means

_______________________________________________________________________

                                 A BILL


 
 To amend the Internal Revenue Code of 1986 to impose an excise tax on 
certain medical care providers that fail to provide a minimum level of 
             charity medical care, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Tax Exempt Hospitals Responsibility 
Act of 2006''.

SEC. 2. REQUIRED POLICIES AND PROCEDURES OF SPECIFIED MEDICAL CARE 
              PROVIDERS.

    (a) In General.--Section 501 of the Internal Revenue Code of 1986 
(relating to exemption from tax on corporations, certain trusts, etc.) 
is amended--
            (1) by redesignating subsection (r) as subsection (s), and
            (2) by inserting after subsection (q) the following new 
        subsection:
    ``(r) Policies and Procedures of Specified Medical Care 
Providers.--
            ``(1) In general.--A specified medical care provider shall 
        not be treated as described in section 501(c)(3) unless such 
        provider has adopted, and normally operates consistently with, 
        policies and procedures for providing, and charging for, 
        specified medically necessary care to low-income uninsured 
        individuals consistent with the requirements of subchapter H of 
        chapter 42.
            ``(2) Denial of deduction.--No deduction shall be allowed 
        under any provision of this title, including sections 170, 
        545(b)(2), 556(b)(2), 642(c), 2055, 2106(a)(2), and 2522, with 
        respect to any contribution to an organization which is not 
        described in section 501(c)(3) by reason of paragraph (1).
            ``(3) Definitions.--Terms used in this subsection shall 
        have the same meanings as when used in subchapter H of chapter 
        42, except that with respect to the term `specified medical 
        care provider' clause (i) of section 4968C(1)(A) shall not 
        apply.''.
    (b) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2007.

SEC. 3. FAILURE BY SPECIFIED MEDICAL CARE PROVIDER TO MEET MINIMUM 
              CHARITY CARE REQUIREMENT.

    (a) In General.--Chapter 42 of the Internal Revenue Code of 1986 
(relating to private foundations and certain other tax-exempt 
organizations) is amended by adding at the end the following new 
subchapter:

  ``Subchapter H--Failure by Specified Medical Care Provider To Meet 
                   Minimum Charity Care Requirements

``Sec. 4968. Excise tax on specified medical care provider for failure 
                            to provide specified medically necessary 
                            care.
``Sec. 4968A. Excise tax on specified medical care provider for 
                            overcharging for specified medically 
                            necessary care.
``Sec. 4968B. Excise tax on specified medical care provider for failure 
                            to disclose charitable medical care 
                            information and negotiated charges.
``Sec. 4968C. Definitions.

``SEC. 4968. EXCISE TAX ON SPECIFIED MEDICAL CARE PROVIDER FOR FAILURE 
              TO PROVIDE SPECIFIED MEDICALLY NECESSARY CARE.

    ``If a specified medical care provider fails to provide specified 
medically necessary care to a low-income uninsured individual who seeks 
such care from such provider in an in-person visit, there is hereby 
imposed on such provider a tax equal to $1,000 for each such failure.

``SEC. 4968A. EXCISE TAX ON SPECIFIED MEDICAL CARE PROVIDER FOR 
              OVERCHARGING FOR SPECIFIED MEDICALLY NECESSARY CARE.

    ``(a) Imposition of Tax.--If a specified medical care provider 
collects from a low-income uninsured individual an amount in excess of 
the maximum allowed charges for specified medically necessary care 
provided to such individual, there is hereby imposed a tax on such 
provider in an amount equal to 3 times such excess.
    ``(b) Maximum Allowed Charges.--For purposes of this section, the 
term `maximum allowed charges' means--
            ``(1) with respect to a low-income uninsured individual 
        whose annual household income is not more than 100 percent of 
        the poverty line applicable to the size of the family involved, 
        $25 for each visit, and
            ``(2) with respect to a low-income uninsured individual 
        whose annual household income is more than 100 percent, but not 
        more than 200 percent, of the poverty line applicable to the 
        size of the family involved, the average amount paid to the 
        specified medical care provider for such medical care under 
        contracts with private health insurers.

``SEC. 4968B. EXCISE TAX ON SPECIFIED MEDICAL CARE PROVIDER FOR FAILURE 
              TO DISCLOSE CHARITABLE MEDICAL CARE INFORMATION AND 
              NEGOTIATED CHARGES.

    ``(a) Imposition of Tax.--If a specified medical care provider 
fails to meet the requirements of subsection (b), there is hereby 
imposed a tax on such provider equal to $1,000--
            ``(1) for each such failure with respect to a requirement 
        described in subsection (b)(1), and
            ``(2) for each day on which such failure occurred with 
        respect to a requirement described in subsection (b)(2).
    ``(b) Disclosure of Charitable Medical Care Information and Medical 
Care Price Data.--
            ``(1) Disclosure to patients.--The requirements of this 
        paragraph are met if the specified medical care provider 
        discloses its policies with respect to providing, and charging 
        for, specified medically necessary care--
                    ``(A) in the patient admission process, and
                    ``(B) in any attempt by the provider to charge for 
                medical care provided, and
            ``(2) Disclosure to public.--The requirements of this 
        paragraph are met if the specified medical care provider makes 
        available to the public--
                    ``(A) its policies with respect to providing, and 
                charging for, specified medically necessary care, and
                    ``(B) a list of the average prices actually paid to 
                the provider for each procedure or service, grouped by 
                private health insurance, self-pay, and governmental 
                health programs.
    ``(c) Maximum Tax.--The amount of tax imposed under subsection 
(a)(2) with respect to each failure shall not exceed $50,000.

``SEC. 4968C. DEFINITIONS.

    ``For purposes of this subchapter--
            ``(1) Specified medical care provider.--
                    ``(A) In general.--The term `specified medical care 
                provider' means an organization which--
                            ``(i) is described in section 501(c)(3),
                            ``(ii) has as its principal purpose the 
                        provision of medical or hospital care,
                            ``(iii) has as its principal purpose the 
                        provision of medical education or medical 
                        research and is actively engaged in providing 
                        medical or hospital care, or
                            ``(iv) is required under State law to be 
                        licensed as a hospital.
                    ``(B) Exceptions.--Such term shall not include a 
                convalescent home or a home for children or the aged.
            ``(2) Specified medically necessary care.--
                    ``(A) In general.--The term `specified medically 
                necessary care' means any medical care which is within 
                the scope of medical care provided by the specified 
                medical care provider.
                    ``(B) Exceptions.--Such term shall not include--
                            ``(i) any medical care--
                                    ``(I) which is attested to by the 
                                physician or practitioner treating the 
                                low-income uninsured individual as 
                                being not medically necessary, or
                                    ``(II) with respect to which the 
                                low-income uninsured individual signs a 
                                waiver acknowledging such care is not 
                                medically necessary, and
                            ``(ii) any organ transplant, any medical 
                        care that is cosmetic or experimental in 
                        nature, and any treatment to improve the 
                        functioning of a malformed member.
            ``(3) Low-income uninsured individual.--
                    ``(A) In general.--The term `low-income uninsured 
                individual' means any individual who, at the time the 
                medical care is sought--
                            ``(i) is not covered by insurance 
                        constituting medical care, other than coverage 
                        described in section 223(c)(1)(B),
                            ``(ii) has an annual household income equal 
                        to not more than 200 percent of the poverty 
                        line applicable to the size of the family 
                        involved,
                            ``(iii) does not fail the resource 
                        requirement of subparagraph (D) or (E) of 
                        section 1860-14(a)(3) of the Social Security 
                        Act,
                            ``(iv) is a citizen or resident of the 
                        United States, and
                            ``(v) is not eligible for government-
                        sponsored insurance constituting medical care.
                    ``(B) Exception.--An individual shall not be a low-
                income uninsured individual if the individual fails to 
                comply with reasonable requests by a specified medical 
                care provider to provide documentation, or make an 
                attestation, regarding income, assets, citizenship or 
                residency, or insurance status.
            ``(4) Poverty line.--The term `poverty line' has the 
        meaning given such term in section 673 of the Community 
        Services Block Grant Act (42 U.S.C. 9902).''.
    (b) Conforming Amendment.--The table of subchapters for chapter 42 
of such Code is amended by adding at the end the following new item:
  ``subchapter h. failure by specified medical care provider to meet 
                  minimum charity care requirement.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after December 31, 2007.
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