Project Summary Federal and State-level community benefit (CB) requirements for not-for-profit hospitals (NFP) have been around for decades. Historically, most of hospital CB spending is on unreimbursed patient care despite the expectation that NFPs align their CB spending with broader community needs that often require investments in non-clinical areas. Federal regulations aside, a few states have experimented with CB regulations to increase NFPs’ investment in community health and to focus their CB activities on specific community health priorities. New York, Ohio, and Oregon are among the first states to require NFPs to collaborate with local health departments (LHD) and other community partners in assessing and prioritizing community needs. Additionally, Oregon set a minimum CB spending floor using a formula that calculates the threshold based on the financial health of hospitals. While these NFP regulations and the decision to implement them predated the pandemic, the regulations have the potential to leverage CB investments in alleviating long-standing inequities and addressing social determinants of health (SDOH) worsened by the pandemic. The purpose of the study is to estimate the effect of NY, OH, and OR regulations on NFP spending in non-clinical categories of CB, SUD- focused health outcomes, and health equity. To accomplish this, the study will use different causal inference methods and longitudinal CB spending data, data on emergency department utilization and transitions of care, and information from NFPs’ implementation strategies. The in-depth case studies will elucidate the mechanisms through which the requirement for collaboration works, refine the theoretical framework, inform the improvement of existing policies and implementation in other jurisdictions, and to generate new hypotheses. This K01 support will help me acquire the necessary experience to develop rigorous theoretical frameworks by integrating organizational and management science with economic theory. Additionally, this K01 will support my development in innovative conceptualization of health equity and community-engaged qualitative research. This project will lead to an application for R01 funding to examine the impact of multi-sectoral collaboration on a broader set of population health outcomes and health equity. The R01 proposal will expand the multi-sectoral collaboration to include additional community partners. This K01 is well-aligned with AHRQ’s overarching goals. First, the focus on “the role of partnerships between the community and health systems in impacting SDOH and improving health outcomes” will inform AHRQ’s goal of “achieving a high value healthcare system”. Second, the focus on the effectiveness of NFP-LHD collaboration to address the SUD epidemic is linked to AHRQ’s goal to understand “the SUD crisis and provide solutions for addressing it”. Finally, the study examines the impact of NFP-LHD collaboration on outcomes by race, ethnicity, and geo...