Instructions For Schedule H (Form 990) - 2016 Page 19
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23programs in pharmacy, occupational
Worksheet 5.
Health Professions
therapy, dietetics, and pastoral care,
Education (Part I, line 7f)
4. and continuing health professions
Keep for Your Records
education open to all qualified individuals
in the community, including payment for
Totals
development of online or other
Total community benefit expense
computer-based training accepted as
continuing health professions education
1. Medical students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1.
by the relevant professional organization.
Scholarships provided by the
2. Interns, residents, and fellows . . . . . . . . . . . . . . . . . . . . . .
2.
organization to community members.
3. Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.
Line 8. Enter Medicare reimbursement
for direct GME, reimbursement for
4. Other allied health professions, students . . . . . . . . . . . . .
4.
approved nursing and allied health
education activities, and direct GME
5. Continuing health professions education . . . . . . . . . . . . .
5.
reimbursement received for services
provided to Medicare Advantage patients.
6. Other students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
For a children's hospital that receives
children's GME payments from Health
7. Total community benefit expense (add lines 1 through
Resources and Services Administration
6; enter on Part I, line 7f, column (c)) . . . . . . . . . . . . . . . .
7.
(HRSA), count that portion of the payment
Direct offsetting revenue
equivalent to Medicare direct GME. Don't
include indirect GME reimbursement
8. Medicare reimbursement for direct GME . . . . . . . . . . . . .
8.
provided by Medicare or Medicaid.
Line 9. Enter Medicaid reimbursement for
9. Medicaid reimbursement for direct GME . . . . . . . . . . . . .
9.
direct GME, including only that portion of
10. Continuing health professions education reimbursement/
Medicaid GME payment equivalent to
tuition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10.
Medicare direct GME and that can be
explicitly segregated by the organization
11. Other revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.
from other Medicaid net patient revenue.
Don't include indirect GME reimbursement
12. Total direct offsetting revenue (add lines 8 through 11;
provided by Medicaid, which is to be
enter on Part I, line 7f, column (d)) . . . . . . . . . . . . . . . . . .
12.
reported on Worksheet 3, Unreimbursed
Medicaid and Other Means-Tested
13. Net community benefit expense (line 7 minus line 12;
Government Programs. Include Medicaid
enter on Part I, line 7f, column (e)) . . . . . . . . . . . . . . . . . .
13.
reimbursement for nursing and allied
14. Total expense (enter amount from Form 990, Part IX,
health education. If your state pays
Medicaid GME reimbursement as a lump
line 25, column (A), including the organization's share of
sum that includes both direct and indirect
joint venture expenses, and excluding any bad debt
payments, use reasonable methods to
expense included in Part IX, line 25) . . . . . . . . . . . . . . . .
14.
estimate the portion of the lump sum that
15. Percent of total expense (line 13 divided by line 14;
is direct (for example, the percent of total
%
enter amount on Part I, line 7f, column (f)) . . . . . . . . . . . .
15.
Medicare GME payments that is direct).
Line 10. Enter revenue received for
continuing health professions education
means-tested government programs.
The service would become the
reimbursement or tuition.
Losses attributable to these items aren't
responsibility of government or another
Line 11. Enter other revenue received for
included when determining which clinical
tax-exempt organization.
health professions education activities
services are subsidized health services
Subsidized health services can include
associated with expenses reported in
because they are reported as community
qualifying inpatient programs (for
Worksheet 5, line 7.
benefit elsewhere in Part I or as bad debt
example, neonatal intensive care,
in Part III. Losses attributable to these
Worksheet 6. Subsidized
addiction recovery, and inpatient
items are also excluded when measuring
psychiatric units) and outpatient programs
Health Services (Part I,
the losses generated by the subsidized
(emergency and trauma services, satellite
health services. In addition, in order to
Line 7g)
clinics designed to serve low-income
qualify as a subsidized health service, the
communities, and home health programs).
Worksheet 6 can be used to calculate the
organization must provide the service
Subsidized health services generally
net cost of subsidized health services.
because it meets an identified community
exclude ancillary services that support
Complete Worksheet 6 for each
need. A service meets an identified
inpatient and ambulatory programs such
subsidized health service and report in
community need if it is reasonable to
as anesthesiology, radiology, and
Part I the total for all subsidized health
conclude that if the organization no longer
laboratory departments. Subsidized health
services combined.
offered the service,
services include services or care provided
The service would be unavailable in the
“Subsidized health services” means
at physician clinics and skilled nursing
community,
clinical services provided despite a
facilities if such clinics or facilities satisfy
The community's capacity to provide
financial loss to the organization. The
the general criteria for subsidized health
the service would be below the
financial loss is measured after removing
services. An organization that includes
community's need, or
losses associated with bad debt, financial
any costs associated with stand-alone
assistance, Medicaid, and other
physician clinics (not other facilities at
Instructions for Schedule H
-19-
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