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Tax Issues for Health Care Organizations 2021

Schedule

AHLA is pleased to offer two options for attending:

  • You can choose to attend in-person and benefit from valuable networking opportunities in addition to the in-depth presentations. For those participants ready to join us in-person, October 18 will include extended time for check-in and a networking reception. October 19 will include a full day of breakout sessions and lots of time for networking with your colleagues.
  • For those who are unable to attend the Tax Issues program in-person, AHLA is pleased to announce that we will be live streaming the sessions using Zoom.

Find more detailed information about the format of the program here.

AHLA is committed to providing a safe and healthy environment for program participants and staff. AHLA has adopted preventative measures to reduce the potential spread of the COVID-19 virus, including requiring masks, and is following guidance provided by the US Centers for Disease Control and local authorities. Attendees are also expected to do their part and abide by AHLA’s Duty of Care.

Monday, October 18, 2021

4:00-6:00 pm
Registration and Check-In
5:00-6:00 pm
Networking Reception
(This event is included in the program registration. Attendees, faculty, and guests are welcome.)

 

Tuesday, October 19, 2021

7:00 am-5:30 pm
Registration and Check-In
7:00-8:00 am
Continental Breakfast
(This event is included in the program registration. Attendees, faculty, and guests are welcome.)
8:00-10:10 am General Session

8:00-8:10 am
Welcome and Introduction
Cindy Reisz, AHLA President

8:10-9:10 am
1. IRS Update
Catherine E. Livingston (Moderator)
Geoffrey M. Campbell
Rachel D. Leiser Levy
Rob Malone
Randall S. Thomas

  • Overview of current IRS administration of exempt organizations, including rulings and determinations and enforcement activity
  • Review of legislative developments affecting tax-exempt health care entities, including provisions from American Rescue Plan Act and pandemic response legislation
  • Update on priority guidance plan projects

9:10-10:10 am
2. When Good Governance Goes Bad
Gerald M. Griffith
Charles A. Wilhoite

  • It’s 2021, do you know where your COI policy (and disclosure questionnaire) stands?
  • Boards gone wild–notable governance learning opportunities
  • Lawyers on boards–part of the solution or part of the problem?
  • Interplay of proper disclosure procedures, fiduciary duties, and regulatory/community expectations
  • “The Dude” and the bottom line cannot abide bad governance
10:10-10:30 am
Break
10:30-11:30 am

3. In the Weeds: Negotiating Joint Venture Agreements at Ground Level
(not repeated)
Linda S. Moroney
Donald B. Stuart

  • Typical joint venture arrangements being implemented in health care today
  • Parameters derived from prior rulings and case law
  • Implications of IRC Section 501(r) at the joint venture level
  • Specific provisions regarding joint venture purposes, governance, management rights, allocations and distributions, and transfer of interests
  • Extent of interplay between provisions–absolute requirements versus a balancing exercise, and how much is enough?
 

4. Hospital UBTI Update
James J. Janssen
Preston J. Quesenberry

IRS examinations of hospitals with UBTI losses have picked up around the nation, hospitals are struggling to implement the new UBTI “silo-ing” regulations, and COVID and other developments in the health care landscape have created difficult new UBTI questions. This panel will discuss these and other issues, including:

  • What issues and arguments IRS exam agents have been raising with respect to expense allocation methods and profit motive and how to prepare and fight back
  • Questions hospitals are having in implementing the UBTI “silo-ing” regulations
  • COVID testing, specialty clinical pharmacies, and other new services for “non-patients” and whether and when they might give rise to UBTI
  • Whether hospitals can now qualify as “schools” under Mayo and what UBTI impact that might have

 

11:45 am-12:45 pm

5. State Oversight of Hospital Community Benefits
(not repeated)
Michael N. Fine
Cynthia Woodcock

  • Community benefit developments both at the federal and state level, with a focus on Oregon's recently implemented standards
  • At a federal level–Updates on recent developments from the Senate Finance Committee, the Government Accountability Office and the Internal Revenue Service on hospital community benefits and Section 501(r)
  • At a state level–Explore Oregon’s new requirements and compare and contrast them with other states that mandate minimum community benefits from nonprofit hospitals in exchange for tax exemption

 

 

6. Remote Work Tax Compliance and Reporting Considerations
Edward Berkovitz
Kenneth Hausser

  • Updated status of remote worker legislation and current activity at the federal, state and local levels
  • Impact to organizations in industry where geographic footprint has changed legal, tax and payroll landscape
  • Remote worker reimbursement considerations such as primary place of business, tax home,  commuting costs, etc.
  • Other considerations regarding overall remote work policies, “tracking” employees and program governance 
  • As time permits and as applicable, brief update regarding the employee retention credit – including IRS processing and audits
12:45-1:45 pm
Lunch on your own
2:00-3:00 pm

7. Spotlight on Captive Insurance Companies
(not repeated)
Kristen E. Hazel
Elizabeth M. Mills

  • Structure and jurisdiction options for captives
  • Foundational tax principles for the insurer and the insured
  • Regulatory issues
  • Update on new tax rules impacting captives and their owners
 

8. Provider Relief Funds and Hospital Community Benefit: Schedule H Reporting and Beyond
Deborah O. Ernsberger
Karen L.P. Wolfson

  • The various sources of funding with Provider Relief Funds and other COVID-19 related legislation, including FEMA funds
  • Use of funds and tracking usage of funds
  • Recommendations of whether each type of fund and expenditure is considered part of the community benefit calculation-including the expense and the direct offsetting revenue
  • Schedule H reporting of the Provider Relief Funds, as applicable, and discussion in the narrative portions of Schedule H
  • Impact of COVID-19 through the lens of IRC 501(r), including financial assistance and billing and collections policies
  • Planning for unexpended funds and consideration of funds that may need to be repaid to the funding agency
  • Potential future or pending legislation (if applicable as of the date of the presentation)

 

3:15-4:15 pm

9. Is Your Hospital-Physician Relationship at Fair Market Value? Ensuring Tax-Exemption in an Evolving Regulatory Landscape
(not repeated)
Jennifer Reedstrom Bishop
Mary Heymans

  • Legal standards of FMV, tax-exemption requirements, and implications for nonprofit hospitals and health care systems
  • Commercial reasonableness and the roles of legal counsel and valuation expert in making FMV determinations
  • Impact of the new AKS safe harbors / Stark Law exceptions for value-based arrangements and interplay with tax-exemption requirements–impact and consequences on conventional FMV analysis–what remains relevant and implications for traditional contractual relationships
  • How past prosecutions involving FMV, commercial reasonableness, and the volume / value of referrals are likely to inform enforcement actions in the current environment
  • Selected complex scenarios–for example, outlining an analytical framework for designing and implementing call coverage payments where such payments are layered on an overarching professional services agreement, hospital subsidies to physician groups, coupling value-based arrangements with traditional service arrangements, and implementing creative incentive programs
    • What’s new and hot in the industry? An update from the valuation perspective on the type of arrangements that are gaining momentum—and those that are falling out of favor
    • Key issues and considerations in developing an analytical framework, process and solutions
    • Application of legal analysis and standards and view of valuation expert—and making judgments when a proposed relationship falls into a gray area
 

4. Hospital UBTI Update
(repeat)
James J. Janssen
Preston J. Quesenberry

IRS examinations of hospitals with UBTI losses have picked up around the nation, hospitals are struggling to implement the new UBTI “silo-ing” regulations, and COVID and other developments in the health care landscape have created difficult new UBTI questions. This panel will discuss these and other issues, including:

  • What issues and arguments IRS exam agents have been raising with respect to expense allocation methods and profit motive and how to prepare and fight back
  • Questions hospitals are having in implementing the UBTI “silo-ing” regulations
  • COVID testing, specialty clinical pharmacies, and other new services for “non-patients” and whether and when they might give rise to UBTI
  • Whether hospitals can now qualify as “schools” under Mayo and what UBTI impact that might have

 

4:30-5:30 pm

6. Remote Work Tax Compliance and Reporting Considerations
(repeat)
Edward Berkovitz
Kenneth Hausser

  • Updated status of remote worker legislation and current activity at the federal, state and local levels
  • Impact to organizations in industry where geographic footprint has changed legal, tax and payroll landscape
  • Remote worker reimbursement considerations such as primary place of business, tax home,  commuting costs, etc.
  • Other considerations regarding overall remote work policies, “tracking” employees and program governance 
  • As time permits and as applicable, brief update regarding the employee retention credit – including IRS processing and audits
 

8. Provider Relief Funds and Hospital Community Benefit: Schedule H Reporting and Beyond
(repeat)
​Deborah O. Ernsberger
Karen L.P. Wolfson

  • The various sources of funding with Provider Relief Funds and other COVID-19 related legislation, including FEMA funds
  • Use of funds and tracking usage of funds
  • Recommendations of whether each type of fund and expenditure is considered part of the community benefit calculation-including the expense and the direct offsetting revenue
  • Schedule H reporting of the Provider Relief Funds, as applicable, and discussion in the narrative portions of Schedule H
  • Impact of COVID-19 through the lens of IRC 501(r), including financial assistance and billing and collections policies
  • Planning for unexpended funds and consideration of funds that may need to be repaid to the funding agency
  • Potential future or pending legislation (if applicable as of the date of the presentation)

 

On Demand Offerings

The sessions below are included with the In-Person registration and are not sold separately. The On Demand sessions will be available to watch prior to the In-Person event.

I. Legal Ethics: The Post-Pandemic Boardroom—Legal, Practical, and Ethical Issues in Post-COVID Corporate Governance (Session was Pre-Recorded for the Health Care Transactions Program, April 2021)
Anjali Bajaj Dooley
William W. Horton

The events of the past year have required a rethinking of many things about our health care delivery system, including how the traditional governance systems of hospitals and health systems function when the ground is shifting underneath them. At the same time, new start-ups have emerged to meet the immediate demands for testing, PPE supplies and other pandemic-related items, often without taking the time to implement effective governance and compliance structures. This session will explore lessons from the pandemic for corporate governance, as well as professional responsibility issues for lawyers advising on governance issues, including:

  • How boards have adapted to crisis decision-making
  • What changes will survive the pandemic
  • Retrofitting the start-up for effective corporate governance
  • Ethical and professional responsibility issues in advising the board during (and after) a crisis

II. Demystifying the Tax Laws: Understanding the Basics for Nonprofit Health Care Organizations (Session was Pre-Recorded for the Fundamentals of Health Law Program, November 2020)
Travis F. Jackson

  • Basics of tax-exempt status under Sections 501(c)(3) and 501(c)(4)
  • Private benefit, private inurement and excess benefit transactions
  • Unrelated business income taxation
  • Section 501(r) and the impact of the Affordable Care Act on charitable hospitals
  • Executive compensation excise tax and other implications of federal tax reform
  • Interacting with the IRS

III. Real Talk: A Crucial Conversation About Diversity, Equity, and Inclusion (Session was Pre-Recorded for the Health Care Transactions Program, April 2021)
Clevonne M. Jacobs
Mark S. Kopson
Jay A. Martus
Kelly J. Pollock

We have been working on "diversity" for almost 60 years (the Civil Rights Act became law in 1964) and have made very little progress on the matter. So, what's getting in the way?

  • The value proposition for DEI has been repeatedly proven in study after study. So, why hasn’t the “business case” for DEI been enough to spur meaningful change in the bar?
  • How much consideration do business leaders really give to DEI initiatives when selecting outside counsel? Are people really putting their money where their mouth is or is this all just for show? Is this kind of pressure actually an effective motivator for law firm leadership? What does accountability look like here?
  • Does our failure as a bar to find a way to make DEI work in our own house limit our ability to effectively advise our clients?
  • How do we make this work? What is it going to take?

In-Person Program Format

How It Works

  • We will offer in-depth breakout sessions where speakers and attendees can interact and collaborate with each other in-person.
  • We consider the health and safety of all those onsite at in-person programs our top priority. AHLA will follow guidance and requirements issued by the CDC as well as by state and local government and are working with the hotel to ensure your health and safety as we transition back to in-person programming. 
  • All attendees, who register for the in-person program, will be required to commit to our Duty of Care agreeing to follow the protocols we establish and monitor their own health for the health and safety of all. 
  • On October 18, to minimize crowding, we are offering extended time for registration. We have adopted a new onsite registration system by providing seamless, touchless check-in, onsite badge printing, and safety supplies to all attendees to use while in attendance.
  • Built-in extended time between sessions for moving from room to room, networking with colleagues, and personal breaktime.  
  • Socially distanced seating arrangements in breakout rooms, regular cleaning in and around meeting spaces, and appropriate signage/floor decals to reinforce spatial distancing and other safety reminders.
  • The program sessions will be recorded. Audio of the presentations, along with the materials will be available for purchase after the program. More information on our ePrograms.

Benefits of the In-Person Program

  • After a year of virtual programming, you will finally be able to step out from behind your computer and network face-to-face with other health law professionals.
  • Interact with colleagues at in-depth breakout sessions.

Live Stream

How It Works

  • On the day of the program, attendees will login to the attendee site and select which sessions they would like to watch just as they would if they were in-person.
  • For the Live Stream sessions, keep track of the Attendance Verification Code for each session you are requesting credits for. The codes will be randomly shown during each session in the powerpoint slides. Participants will need to write the code to fill in on the request form. Indicate each session attended and the number of minutes attended. If the full session was attended, please put in the maximum number of minutes available (number only). You will receive credit based on the actual amount of time in each session. If you do not indicate the amount of time, you will not receive credit.
Program Accessibility and Special Needs

Click here for more information regarding accessiblitiy accommodations for our in-person programs.

Thank You to Our Tax Issues for Health Care Organizations Sponsors

If your organization is interested in sponsoring AHLA's Tax Issues for Health Care Organizations program, please contact Valerie Eshleman.