workshops to increase understanding of community benefit requirements associated with New Hampshire’s statute. In addition, the state Department of Health and Human Services and the Office of the New Hampshire Attorney General secured funding from a private foundation40 to conduct an evaluation of first-year report filings and to hold a state conference to highlight exemplary practices. Findings from the evaluation are consistent with experience in other states; there are numerous examples of promising programs, but substantial variability in the quality and specificity of reporting make it impossible to conduct a reliable comparative analysis of performance. As is the case with California’s community benefit statute, further action is required by the state legislature in order to promulgate uniform guidelines for reporting.41

In states with minimum financial thresholds (PA, TX, UT), monitoring is a less challenging prospect, but experience to date suggests that compliance with requirements has not yielded the intended outcome, that is, improved access for medically indigent populations. Two predictable trends have emerged. First, hospitals have devoted increased attention to the development of sophisticated accounting methods to maximize the compilation of contributions. Second, there has been a de-emphasis on more proactive approaches to address persistent health problems in partnership with local community stakeholders. The first trend presents a challenge for state agencies in determining whether specific elements of reported contributions are consistent with the letter and intent of the statute. The second trend raises concerns that community hospitals may be moving toward a more inward focus, limiting the allocation of charitable resources to the provision of costly emergency and inpatient care for what are often preventable illnesses among the medically indigent populations.

Until recently, the implementation of community benefit statutes at the state level has been a relatively benign process with submissions of annual reports and a cursory review by state monitoring agencies. Federal funding of state programs to increase coverage for children and families in the 1990s produced measurable gains42 and may have reduced pressure for


Grant from the NH Endowment for Health to the Community Health Institute, in partnership with the Office of Planning and Research, NH Department of Health and Human Services to conduct a statewide study of community benefit reports submitted in compliance with Senate Bill 69.


Section 312:3 of Senate Bill 69 indicates that “the provisions of this act shall be subject to further legislative review and amendment based upon the results of the statewide health planning process to be implemented during the fiscal year ending June 30, 2000 and the initial reports by the health care charitable trusts in compliance with this act.”


Title XXI of the Social Security Act, the State Children’s Health Insurance Program (SCHIP), Centers for Medicare and Medicaid Services (CMS).

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