The Internal Revenue Service has started implementing Patient Protection and Affordable Care Act provisions that will require tax-exempt hospitals to do more to justify their exemptions.

IRS officials have put out request for comments on the requirements in IRS Notice 2010-39.

The notice describes mandates imposed by Section 501(r) of the Internal Revenue, which was added earlier this by PPACA, one of the components of the Affordable Care Act package.

Section 501(r) will require a tax-exempt hospital to a conduct community health needs assessment every 3 years; establish a financial assistance policy and a policy relating to charges for emergency care; charge patients eligible for financial assistance a price comparable to what they would charge insured patients; and make reasonable efforts to determine whether a patient is eligible assistance before engaging in “extraordinary collection actions,” such as lawsuits, liens on residences, arrests, or body attachments.

The requirements will apply to taxable years beginning after March 23, 2012.

Comments are due July 22.

The IRS are interested in seeing comments on “what constitutes ‘reasonable efforts’ to determine eligibility for assistance under a financial assistance policy for purposes of the billing and collection requirements,” officials write in the notice.