II 

118TH CONGRESS 

2D SESSION S. 4777 

To amend title XVIII of the Social Security Act to require hospitals to 

fulfill certain obligations relating to discontinuation of services or closure. 

IN THE SENATE OF THE UNITED STATES 

JULY 25, 2024 

Ms. BALDWIN (for herself and Mr. MARKEY) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XVIII of the Social Security Act to require 

hospitals to fulfill certain obligations relating to discontinuation of services or closure. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Hospital Stability and 

5 Health Services Act of 2024’’. 

6 SEC. 2. MAINTENANCE OF HEALTH CARE ACCESS RELAT7 ING TO HOSPITAL DISCONTINUATION OF 

8 SERVICES OR CLOSURE. 

9 Section 1866 of the Social Security Act (42 U.S.C. 

10 1395cc) is amended— 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
2 

•S 4777 IS

1 (1) in subsection (a)(1)— 

2 (A) in subparagraph (X), by striking 

3 ‘‘and’’ at the end; 

4 (B) in subparagraph (Y)(ii)(V), by striking 

5 the period and inserting ‘‘, and’’; and 

6 (C) by inserting after subparagraph (Y) 

7 the following new subparagraph: 

8 ‘‘(Z) beginning 60 days after the date of the en9 actment of this subparagraph, in the case of a hos10 pital, to comply with the requirements of subsection 

11 (l) (relating to discontinuation of services or clo12 sure).’’; and 

13 (2) by adding at the end the following new sub14 section: 

15 ‘‘(l) REQUIREMENTS FOR HOSPITALS RELATING TO

16 DISCONTINUATION OF SERVICES OR CLOSURE.— 

17 ‘‘(1) REQUIREMENTS.— 

18 ‘‘(A) IN GENERAL.—For purposes of sub19 section (a)(1)(Z), except as provided in sub20 paragraph (B), the requirements described in 

21 this subsection are that a hospital— 

22 ‘‘(i) notify the Secretary, in accord23 ance with paragraph (2), not less than 90 

24 days prior to the discontinuation of serv25 ices or full hospital closure; 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
3 

•S 4777 IS

1 ‘‘(ii) prohibit the discontinuation of 

2 essential services (as defined in paragraph 

3 (6)) during the notification period (as de4 fined in such paragraph) unless there is a 

5 clear harm posed to patient or employee 

6 health or safety in the hospital continuing 

7 to furnish such services; 

8 ‘‘(iii) respond to any inquiries by the 

9 Secretary relating to the implementation of 

10 this subsection, including the determina11 tion of essential services under paragraph 

12 (6)(C); and 

13 ‘‘(iv) if applicable— 

14 ‘‘(I) submit a mitigation plan 

15 and related information as described 

16 in paragraph (3); and 

17 ‘‘(II) participate in the public 

18 comment and review process (includ19 ing, if applicable, the alternative miti20 gation plan) described in paragraph 

21 (4). 

22 ‘‘(B) APPLICATION IN CASE OF CATA23 STROPHIC EVENTS.—In the case where a dis24 continuation of services or closure of a hospital 

25 is due to an unforeseen catastrophic event (as 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
4 

•S 4777 IS

1 defined by the Secretary), the requirements de2 scribed in subparagraph (A) shall apply, ex3 cept— 

4 ‘‘(i) the hospital shall provide the no5 tification under clause (i) of such subpara6 graph not later than 30 days after the cat7 astrophic event or as soon as feasible as 

8 determined by the Secretary; and 

9 ‘‘(ii) clause (ii) of such subparagraph 

10 (relating to prohibiting the discontinuation 

11 of services) shall not apply. 

12 ‘‘(2) NOTIFICATION INFORMATION.—For pur13 poses of paragraph (1)(A)(i), the notification under 

14 such paragraph shall include the following informa15 tion with respect to a hospital: 

16 ‘‘(A) DISCONTINUATION OF SERVICES.—In 

17 the case where the hospital is discontinuing 

18 services (without full hospital closure): 

19 ‘‘(i) The services that will be discon20 tinued and number of hospital beds im21 pacted. 

22 ‘‘(ii) The number of individuals fur23 nished such services annually and a break24 down of the type of insurance used by such 

25 individuals for such services. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
5 

•S 4777 IS

1 ‘‘(iii) The number of impacted em2 ployees and what labor organization rep3 resents them (and the contact information 

4 for such organization). 

5 ‘‘(iv) The names and addresses of any 

6 organized health care coalitions and com7 munity groups that represent the commu8 nities impacted by the discontinuation of 

9 such services. 

10 ‘‘(v) Alternative providers of such 

11 services, including provider type, contact 

12 information, and distance and transpor13 tation time by car and public transit from 

14 the hospital. 

15 ‘‘(B) FULL HOSPITAL CLOSURE.—In the 

16 case of full hospital closure: 

17 ‘‘(i) Hospital ownership entities. 

18 ‘‘(ii) The full extent of services that 

19 will no longer be furnished by the hospital. 

20 ‘‘(iii) The number of individuals fur21 nished services annually by the hospital, a 

22 description of the services furnished, and a 

23 breakdown of the type of insurance used 

24 by such individuals for such services. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
6 

•S 4777 IS

1 ‘‘(iv) The number of impacted employ2 ees and, if applicable, what labor organiza3 tions represent them (and the contact in4 formation for each such organization). 

5 ‘‘(v) The names and addresses of any 

6 organized health care coalitions and com7 munity groups that represent the commu8 nities impacted by the closure. 

9 ‘‘(vi) Alternative providers, including 

10 provider type, contact information, and 

11 distance and transportation time by car 

12 and public transit from the hospital. 

13 ‘‘(vii) Steps taken prior to the deci14 sion to close in order to avoid closure. 

15 ‘‘(viii) Distribution of liquidation pro16 ceeds (cash or assets) or any payments 

17 (cash or assets) made to employees, own18 ers, or contractors related to the closure. 

19 ‘‘(3) SUBMISSION OF MITIGATION PLAN AND

20 RELATED INFORMATION FOR ESSENTIAL SERV21 ICES.— 

22 ‘‘(A) NOTIFICATION BY SECRETARY.—If 

23 the Secretary determines that the discontinu24 ation of services or closure of an applicable hos25 pital would negatively impact access to essential 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
7 

•S 4777 IS

1 services, the Secretary shall notify the applica2 ble hospital of such determination. 

3 ‘‘(B) SUBMISSION OF MITIGATION PLAN

4 AND RELATED INFORMATION.—If an applicable 

5 hospital receives a notification under subpara6 graph (A), the applicable hospital shall, not 

7 later than 15 days after receiving such notifica8 tion, submit to the Secretary, the State health 

9 department, and the local department of public 

10 health— 

11 ‘‘(i) a plan to— 

12 ‘‘(I) preserve access to essential 

13 services for impacted communities 

14 through partnerships, commitments 

15 from surrounding facilities, transpor16 tation plan access, and preparation 

17 for surge response; and 

18 ‘‘(II) support employees in 

19 transitioning to new positions within 

20 health care; 

21 ‘‘(ii) information on workforce and 

22 public engagement to ensure awareness of 

23 the discontinuation of services or closure; 

24 ‘‘(iii) a description of potential alter25 natives to the discontinuation of services or 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
8 

•S 4777 IS

1 closure that the hospital considered and an 

2 explanation of why those alternatives are 

3 not a viable option; and 

4 ‘‘(iv) a local market study to ascertain 

5 regional bed supply, payor mix distribution 

6 among all providers, demographic trends, 

7 and remaining health systems in the area. 

8 ‘‘(C) PUBLIC AVAILABILITY.—The Sec9 retary shall make a mitigation plan and related 

10 information submitted by an applicable hospital 

11 under this paragraph available to the public on 

12 the internet website of the Centers for Medicare 

13 & Medicaid Services. 

14 ‘‘(4) PUBLIC COMMENT AND REVIEW PROCESS; 

15 ALTERNATIVE MITIGATION PLAN.— 

16 ‘‘(A) PUBLIC COMMENT PERIOD.— 

17 ‘‘(i) IN GENERAL.—The Secretary 

18 shall provide a public comment period of 

19 not less than 45 days with the opportunity 

20 to submit written comments regarding the 

21 impact of the potential discontinuation of 

22 services or closure of an applicable hos23 pital. 

24 ‘‘(ii) NOTICE.—Notice of the oppor25 tunity to submit comments shall be pubVerDate Sep 11 2014 03:33 Aug 22, 2024 Jkt 049200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S4777.IS S4777

kjohnson on DSK7ZCZBW3PROD with $$_JOB
9 

•S 4777 IS

1 lished in the Federal Register and distrib2 uted to— 

3 ‘‘(I) providers of services and 

4 suppliers that may be impacted by the 

5 discontinuation of services or closure 

6 of the applicable hospital; 

7 ‘‘(II) any labor organization that 

8 represents any subdivision of employ9 ees of the applicable hospital; 

10 ‘‘(III) organized health care coa11 litions and community groups that 

12 represent the communities impacted 

13 by the discontinuation of services or 

14 closure; 

15 ‘‘(IV) the State health agency; 

16 and 

17 ‘‘(V) the local department of pub18 lic health. 

19 ‘‘(iii) RECOMMENDATIONS OF STATE

20 HEALTH AGENCY AND LOCAL DEPART21 MENTS OF PUBLIC HEALTH.—In reviewing 

22 a mitigation plan submitted by an applica23 ble hospital under paragraph (3), the Sec24 retary shall take into consideration any 

25 recommendations submitted by the State 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
10 

•S 4777 IS

1 health agency and local departments of 

2 public health, as applicable, regarding 

3 whether such plan should be approved. 

4 ‘‘(B) ALTERNATIVE MITIGATION PLAN.— 

5 ‘‘(i) IN GENERAL.—If, after reviewing 

6 the mitigation plan submitted by an appli7 cable hospital under paragraph (3) and the 

8 comments submitted during the public 

9 comment period under subparagraph (A) 

10 with respect to the discontinuation of serv11 ices or closure of the applicable hospital, 

12 the Secretary finds that the discontinu13 ation of services or closure of the applica14 ble hospital would have a significant im15 pact on access to essential services, the 

16 Secretary shall work with the applicable 

17 hospital or other providers of services and 

18 suppliers in the area, as appropriate, to de19 velop and implement an alternative plan to 

20 the plan submitted by the applicable hos21 pital under paragraph (3) (referred to in 

22 this subsection as the ‘alternative mitiga23 tion plan’) in order to ensure continued ac24 cess to essential services, which may in25 clude an agreement to delay the disVerDate Sep 11 2014 03:33 Aug 22, 2024 Jkt 049200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S4777.IS S4777

kjohnson on DSK7ZCZBW3PROD with $$_JOB
11 

•S 4777 IS

1 continuation of services or closure of the 

2 applicable hospital until the alternative 

3 mitigation plan is complete. 

4 ‘‘(ii) TECHNICAL ASSISTANCE.—An 

5 alternative mitigation plan under clause (i) 

6 may include technical assistance or infor7 mation on available funding mechanisms to 

8 support the furnishing of essential services. 

9 ‘‘(iii) COLLABORATION.—The Sec10 retary should, to the extent practicable, 

11 collaborate with State and municipal gov12 ernment officials in the development of an 

13 alternative mitigation plan under clause 

14 (i). 

15 ‘‘(iv) PUBLIC AVAILABILITY.—The 

16 Secretary shall make any information sub17 mitted and the alternative mitigation plan 

18 developed under this paragraph available 

19 to the public on the internet website of the 

20 Centers for Medicare & Medicaid Services. 

21 ‘‘(C) IMPLEMENTATION.—The Secretary 

22 shall promulgate regulations to detail the re23 quired response time by an applicable hospital 

24 and the speed of the review process under this 

25 paragraph in order to ensure that such process 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
12 

•S 4777 IS

1 can be completed with respect to an applicable 

2 hospital prior to the proposed service dis3 continuation date or closure date of the applica4 ble hospital. 

5 ‘‘(D) PROHIBITION.—In the case where 

6 the Secretary finds that a hospital has violated 

7 the requirements of this subsection, the Sec8 retary may prohibit the hospital and any hos9 pital under the same hospital ownership entity 

10 from being eligible to enroll or reenroll under 

11 the program under this title under section 

12 1866(j) until the earlier of— 

13 ‘‘(i) the date that is 3 years after the 

14 date on which the hospital discontinues 

15 services or closes; 

16 ‘‘(ii) the date on which the Secretary 

17 determines essential health services that 

18 were negatively impacted by the dis19 continuation or closure have been restored; 

20 or 

21 ‘‘(iii) such time as the Secretary is 

22 satisfied with the mitigation plan sub23 mitted by the hospital under paragraph (3) 

24 or the alternative mitigation plan under 

25 paragraph (4). 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
13 

•S 4777 IS

1 ‘‘(5) ANNUAL REPORTS.—The Secretary shall 

2 submit an annual report to Congress on the dis3 continuation of services and full closure of hospitals. 

4 Each report submitted under the preceding sentence 

5 shall include— 

6 ‘‘(A) a description of trends in the dis7 continuation of services and closures of hos8 pitals, including hospital ownership type, geo9 graphic location, types of services furnished, de10 mographic served, and insurance type; 

11 ‘‘(B) an analysis of the impact of the dis12 continuation of services and closures on health 

13 care access and ability to meet surge demand 

14 due to emergency (such as a pandemic or cli15 mate disaster); 

16 ‘‘(C) recommendations for such adminis17 trative or legislative changes as the Secretary 

18 determines appropriate to preserve access to es19 sential services nationwide. 

20 ‘‘(6) DEFINITIONS.—In this subsection: 

21 ‘‘(A) APPLICABLE HOSPITAL.—The term 

22 ‘applicable hospital’ means a hospital that sub23 mits a notification under paragraph (1)(A)(i) of 

24 a discontinuation of services or full hospital clo25 sure. 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
14 

•S 4777 IS

1 ‘‘(B) DISCONTINUATION.—The term ‘dis2 continuation’ may include any reduction or dis3 continuation of services furnished by an appli4 cable hospital, including those that occur as 

5 part of a merger or acquisition agreement. 

6 ‘‘(C) ESSENTIAL SERVICES.—The term ‘es7 sential services’ means, with respect to an ap8 plicable hospital, services that are necessary for 

9 preserving health care access (as determined by 

10 the Secretary), including services for which the 

11 Secretary determines— 

12 ‘‘(i) there are no equivalent services 

13 available within the same travel time; 

14 ‘‘(ii) that loss of the services would re15 sult in meaningful reductions in surge ca16 pacity that will negatively impact access to 

17 services; 

18 ‘‘(iii) that loss of the services would 

19 limit health care access for specific demo20 graphics of individuals based on sex, sexu21 ality, race, nationality, age, or disability 

22 status; 

23 ‘‘(iv) that loss of the services would 

24 have a meaningful impact on the ability of 


kjohnson on DSK7ZCZBW3PROD with $$_JOB
15 

•S 4777 IS

1 health systems to respond to impacts of 

2 climate change; or 

3 ‘‘(v) there is a health or health care4 related emergency declaration status appli5 cable to the surrounding geographical area 

6 of the hospital on the date on which the 

7 hospital submits notification under para8 graph (1)(A)(i) of a discontinuation of 

9 services or full hospital closure. 

10 ‘‘(D) NOTIFICATION PERIOD.—The term 

11 ‘notification period’ means, with respect to an 

12 applicable hospital, the period beginning on the 

13 date on which the hospital submits notification 

14 under paragraph (1)(A)(i) of a discontinuation 

15 of services or full hospital closure and ending 

16 on the date of such discontinuation of services 

17 or closure. 

18 ‘‘(7) NO PREEMPTION OF STATE LAW.—Noth19 ing in subsection (a)(1)(Z) or this subsection shall 

20 be construed to limit any rights or remedies under 

21 State or local law relating to protecting access to es22 sential services or reviewing proposed hospital clo23 sures or reduction of services.’’. 

Æ 


kjohnson on DSK7ZCZBW3PROD with $$_JOB