Background on Community Health Needs Assessment

What is a CHNA?                   

The U.S. Patient Protection and Affordable Care Act (PPACA) of 2010 includes a provision requiring all non-profit hospitals to conduct a Community Health Needs Assessment (CHNA). The CHNA is the process by which a non-profit hospital evaluates the health needs of the community it serves. The assessment identifies needs, gaps, assets and resources as they relate to the health of the community. The results can then be used to plan, manage, and evaluate community health initiatives.

The assessment must include an implementation strategy as well. The implementation plan must outline how the hospital proposes to address unmet needs in the coming years. Not-for-profit hospitals are required to conduct a CHNA every three years and implement strategies to address identified priority needs in the interim.

The CHNA process helps not-for-profit health care organizations fulfill their community benefit mission. The provision of community benefit is essential to not-for-profit health care organizations and the basis of tax exemption. The CHNA is a form of community benefit and is designed to improve the health of communities and increase access to needed care.

For all its potential impact, the CHNA section comprises a single page out of over 2,300 pages of Affordable Care Act legislation. The Internal Revenue Service (IRS) is responsible for regulating and enforcing the CHNA section of the PPACA. The IRS provides general guidelines to not-for-profit hospitals regarding fulfilling the requirement.
See IRS Requirements for CHNA

What areas are included in the CHNA requirement?

  • Identifying community health needs
  • Prioritizing community health needs
  • Identifying health and health care resources
  • Developing implementation strategies to address health needs
  • Involving community stakeholders in the assessment process
  • Including members of medically underserved, low-income and minority populations in the assessment process
  • Including public health professionals on the assessment team
  • Reporting results publicly
  • Conducting the assessment a minimum of every three years

How does the hospital define its community?
Generally a hospital’s community is defined geographically but In many cases exist where target populations served (e.g., a primary care program serving deaf individuals) or specialized functions (e.g., a regional burn center) must also be taken into account. While the approach to defining community is somewhat flexible, hospitals may not exclude, for example, medically underserved populations, low-income-persons, minority groups or those with chronic disease needs.

What questions should a CHNA answer for a hospital?

  • What are the health problems in our community?
  • What factors are behind the health problems we have identified?
  • What resources are available to address the health problems?
  • What are the health needs of our community from a population-based perspective?
  • What plan can we put in place to address the identified health needs?


Highlighted CHNA Resources

Health Data Tools and Statistics: Partners in Information Access for the Public Health Workforce - Links to data on the health of a population.

Who must file a CHNA?
All not-for-profit 501 (c) (3) hospitals

What is the penalty for failing to file a CHNA? ?
Failure to complete a CHNA in any applicable three-year period may result in an annual penalty tax of up to $50,000.

How often must a CHNA be conducted? ?
The PPACA requires non-profit hospitals to conduct a CHNA at least once every three taxable years. The assessment is considered “conducted” in the year the written report is made widely available to the public.