美國慈善醫院慈善要件之初探

The Requirements for Charitable Hospitals in the United States

依照《內地稅法》（Internal Revenue Code） I.R.C. §501(c)(3)條款之規定，公司、社區福利基金、基金或基金會設立並專門致力於宗教、慈善、科學、公共安全測試、文學、教育、促進國內或國際業餘運動賽事或防止虐待兒童或動物等，且盈餘不得受益予其所有人和任何他人；大部分的活動不得做為宣傳或者試圖影響立法機關；不得參加或介入（包括發表聲明或者散發聲明）任何政治競選活動，代表（或者反對）某位競選公職的候選人者，其稅捐免徵。慈善醫院長久以來被視為I.R.C. §501(c)(3)非營利組織，因此享有免稅身分之待遇。然而，「慈善」具體的定義從未被訂定過，因為「慈善」實難以定義及標準化，因此使「慈善醫院」遊走在模糊地帶，造成有關衡量慈善醫院的標準形同虛設，流於具文。許多輿論批評慈善醫院的行為不符合社會大眾的期待，政府不應再給予慈善醫院非營利組織的免稅待遇。為此，國會在《病人權益保護與可負擔醫療保健法》（The Patient Protection and Affordable Care Act）規定《內地稅法》新增I.R.C.§501(r)條款，特別針對醫院欲取得I.R.C.§501(c)(3)非營利組織身分額外增加四個條件：社區健康需求評估、財務補助、收費限制、帳單與催收作業規定，以落實慈善的精神。本文將針對依照《病人權益保護與可負擔醫療保健法》之規定而新增的I.R.C. §501(r) 條款四個條件分別討論，探討新規對慈善醫院之影響。 Under I.R.C. §501(c)(3), “corporations, and..., organized and operated exclusively for religious, charitable, …＂ are exempt from federal income taxation. Charitable hospitals qualify as nonprofit organizations under I.R.C. §501(c)(3); therefore, are exempt from federal income taxation. However, there is no definition in the I.R.C. for the term “charitable.＂ The reason is that it is difficult, if not impossible, to formulate a definition for “charitable＂ for the purpose of I.R.C. §501(c)(3). Because of lack of clarity on “charitable＂, many charitable hospitals are providing sub-par charity care to indigents. There are criticisms relating to whether charitable hospitals should continue to enjoy tax-exempt status. In 2010, Congress passed the Patient Protection and Affordable Care Act, and imposed four new requirements for hospitals to obtain and maintain tax-exempt status under I.R.C. §501(c)(3). These four requirements are “community health needs assessments＂, “financial assistance policy＂, “limitation on charges＂, and “billing and collection requirements＂. This paper will examine each of these four new requirements, and tax consequences when the hospitals fail to meet the requirements.