Public Finance: U.S. Not-For-Profit Healthcare Rating Methodology

Executive Summary

This document describes KBRA’s rating methodology as it pertains to the U.S. Not-for-Profit Healthcare sector. The Methodology identifies the key determinants that may be used in the assignment of a credit rating and is intended to provide guidance and insight to market participants for how these determinants are applied when making a rating assignment. It is important to note that KBRA applies judgment in the application of all of its methodologies. This may result in situations where certain aspects of the methodology are not employed, deemphasized or modified to address additional considerations in the analytical process, where deemed appropriate.

Healthcare delivery in the United States has entered a period of dramatic and unprecedented change. Not since President Johnson’s landmark legislation establishing Medicare and Medicaid has the industry faced a more ambitious reform than the Affordable Care Act (ACA). The Centers for Medicare and Medicaid Services (CMS) is…