According to a Government Accountability Office report, Nonprofit Hospitals: Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements (GAO-08-880), released October 14, the IRS’s community benefit standard gives nonprofit hospitals broad latitude to determine what services and activities they provide to meet the agency’s community benefit standard, while state requirements still vary substantially. The report said that while there is consensus about many activities hospitals undertake as charity care, consensus does not exist in other areas, such as the definition of patient bad debt. The GAO report indicates that the IRS needs a bright line test to be able to determine whether hospitals are meeting the standard necessary to maintain their tax exemption. States have stepped in to try to define community benefit for their own purposes, which has caused a lot of variation from state to state. Among the standards and guidance used by nonprofit hospitals, consensus exists to define charity care, the unreimbursed cost of means-tested government health care programs such as Medicaid and many other activities that benefit the community as community benefit, the report stated. However, variations in the activities nonprofit hospitals define as community benefit currently lead to substantial differences in the amount of community benefits they report.