Drivers of Health Assessment & Improvement Planning

Different drivers have led health agencies and organizations to institutionalize community health assessment and community health improvement planning in recent years.

National Voluntary Accreditation Requirements

In 2011, the Public Health Accreditation Board (PHAB), in partnership with key public health organizations, launched a new national voluntary accreditation program for state, tribal, local, and territorial health departments.

The standards and measures encompass 12 domains of performance and include a comprehensive community health assessment (Domain 1, Standard 1.1) and a community health improvement plan (Domain 5, Standard 5.2).

A documented community health assessment and improvement plan are two of the three prerequisites for applying to PHAB. PHAB requires that these processes be conducted collaboratively and that the documents be dated within the last five years.

More information is available from PHAB and CDC.

CDC Grant Requirements

CDC grants often require or encourage completing a community health assessment or improvement plan. In some cases, these plans provide valuable information for identifying priority health issues or needs. Examples include

• National Public Health Improvement Initiative (NPHII)
• Community Transformation Grants
• REACH Core

State-Specific Requirements or Mandates

A number of states, including those listed here, require or support their local health departments to conduct community health assessments and/or improvement plan:

• Florida
• Illinois
• New York
• North Carolina
• Washington

Summaries of states’ mandates and requirements on community health assessments and improvement plans are hosted on the Public Health Alliance of Colorado’s website.

IRS Requirements for Tax-Exempt Healthcare Facilities

The Patient Protection and Affordable Care Act of 2010 (ACA) revised the federal tax-exempt status requirements for nonprofit hospitals. To claim tax-exempt status, community benefit work must be transparent, concrete, measurable, and both responsive and accountable to identified community need. Therefore, at least once every three years, hospitals must conduct a community health needs assessment and adopt an implementation strategy—often called community benefit, Schedule H, or Form 990, which refer to the required tax forms.

An implementation strategy for a hospital facility is a written plan that addresses each of the significant community health needs identified through a community health needs assessment. A hospital organization must adopt a separate implementation strategy for each hospital facility it operates.

Collaboration between facilities on community health needs assessment and implementation strategy development is encouraged, and implementation strategies submitted by separate facilities may be substantively similar.

The community health needs assessment and the implementation strategy must take into account input from

• At least one state, local, tribal, or regional governmental public health department
• Members of medically underserved, low-income, and minority populations in the community
• Written comments received on the facility’s most recent community health needs assessment and implementation strategy

See the Federal Register, the Federal Register, Volume 78, No. 66 [PDF - 320KB] or this IRS website for more information concerning specific requirements.

Additionally, the CDC Office of Associate Director for Policy’s Resources for Implementing the Community Health Needs Assessment Process lists resources related to community benefit requirements and partnership opportunities.

Links to nonfederal materials are provided as a public service and do not constitute an endorsement of the materials by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of materials not generated by CDC.