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The search for a concise definition of charity care continues to elude both practitioners and healthcare administrators. U.S. legislators recently took action by creating the new Internal Revenue Code (IRC) §501(r), mandating hospitals document and justify their tax-exempt status. The new provisions still do not provide a succinct definition of charity care, but may provide an opportunity to establish a quantifiable baseline of the normal level of charity care for hospitals. This paper looks to the history of charity care in the U.S., recent regulatory challenges, the theory of legal realism, and the institutional method to develop an approach to provide clear guidance on acceptable levels of charity care.

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The Internal Revenue Service issued guidance related to automatic changes in accounting methods for taxpayers taking a §179D deduction for Energy Efficient Commercial Building Property. However, while the accounting treatment of §179D may trigger a change in accounting method for some taxpayers, this is not uniform for all taxpayers. In this paper, we argue that with this guidance, the Treasury Department (and Congress, by initial approval of the tax law) has inadvertently broadened unequal tax treatment between different segments of qualified taxpayers attracted to this important energy efficient building incentive. Further, we suggest that the §179D deduction be modified to achieve taxpayer parity to further incentivize energy efficiency.