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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4804 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 4804

  To amend the Public Health Service Act to require the Secretary of 
Health and Human Services to enforce certain requirements with respect 
to for-profit corporations that own health care systems, and for other 
                               purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 25, 2024

   Mr. Markey (for himself, Ms. Baldwin, Mr. Welch, Mr. Merkley, Ms. 
    Warren, Mr. Sanders, Mr. Booker, Ms. Smith, and Mr. Blumenthal) 
introduced the following bill; which was read twice and referred to the 
                          Committee on Finance

_______________________________________________________________________

                                 A BILL

 
  To amend the Public Health Service Act to require the Secretary of 
Health and Human Services to enforce certain requirements with respect 
to for-profit corporations that own health care systems, and for other 
                               purposes.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Over Wealth Act''.

SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

  ``TITLE XXXIV--REQUIREMENTS RELATING TO PRIVATE OWNERSHIP IN HEALTH 
                                  CARE

``SEC. 3401. DEFINITIONS.

    ``In this title:
            ``(1) Affiliate.--The term `affiliate' means--
                    ``(A) a person that directly or indirectly owns, 
                controls, or holds with power to vote, 20 percent or 
                more of the outstanding voting securities of another 
                entity, other than a person that holds such 
                securities--
                            ``(i) in a fiduciary or agency capacity 
                        without sole discretionary power to vote such 
                        securities; or
                            ``(ii) solely to secure a debt, if such 
                        entity has not in fact exercised such power to 
                        vote;
                    ``(B) a corporation 20 percent or more of whose 
                outstanding voting securities are directly or 
                indirectly owned, controlled, or held with power to 
                vote, by another entity (referred to in this 
                subparagraph as a `covered entity'), or by an entity 
                that directly or indirectly owns, controls, or holds 
                with power to vote, 20 percent or more of the 
                outstanding voting securities of the covered entity, 
                other than an entity that holds such securities--
                            ``(i) in a fiduciary or agency capacity 
                        without sole discretionary power to vote such 
                        securities; or
                            ``(ii) solely to secure a debt, if such 
                        entity has not in fact exercised such power to 
                        vote;
                    ``(C) a person whose business is operated under a 
                lease or operating agreement by another entity, or 
                person substantially all of whose property is operated 
                under an operating agreement with that other entity; or
                    ``(D) an entity that operates the business or 
                substantially all of the property of another entity 
                under a lease or operating agreement.
            ``(2) Corporation.--The term `corporation' means--
                    ``(A) a joint-stock company;
                    ``(B) a company or partnership association 
                organized under a law that makes only the capital 
                subscribed or callable up to a specified amount 
                responsible for the debts of the association, including 
                a limited partnership and a limited liability company;
                    ``(C) a trust; or
                    ``(D) an association having a power or privilege 
                that a private corporation, but not an individual or a 
                partnership, possesses.
            ``(3) Covered firm.--The term `covered firm' means a for-
        profit corporation that owns or is an affiliate of a health 
        care entity.
            ``(4) Health care entity.--The term `health care entity' 
        means an entity that consists of 1 or more of the following 
        health care providers:
                    ``(A) A hospital.
                    ``(B) A physician practice.
                    ``(C) A skilled nursing facility.
                    ``(D) A hospice facility.
                    ``(E) A mental or behavioral health care provider.
                    ``(F) An opioid treatment program.
                    ``(G) A provider of services (as defined in section 
                1861(u) of the Social Security Act (42 U.S.C. 1395x(u)) 
                or a supplier (as defined in section 1861(d) of such 
                Act (42 U.S.C. 1395(d)) enrolled in the Medicare 
                program.
                    ``(H) Any other entity the Secretary determines 
                appropriate.
            ``(5) Private equity fund.--The term `private equity fund' 
        means--
                    ``(A)(i) a person that would be considered an 
                investment company under section 3 of the Investment 
                Company Act of 1940 (15 U.S.C. 80a-3) but for the 
                application of paragraph (1) or (7) of subsection (c) 
                of such section 3;
                    ``(ii) a venture capital fund, as defined in 
                section 275.203(l)-1 of title 17, Code of Federal 
                Regulations (or successor regulations); or
                    ``(iii) a sovereign wealth fund; and
                    ``(B) directly, or through an affiliate, acts as a 
                control person.

``SEC. 3402. HEALTH CARE OWNERSHIP TRANSPARENCY.

    ``(a) Required Reporting.--
            ``(1) In general.--The Secretary shall require each covered 
        firm to submit to the Secretary, at such times as the Secretary 
        determines appropriate, through the infrastructure established 
        under paragraph (2), a report containing--
                    ``(A) for a covered firm with respect to which 
                there is a private equity fund that is a control person 
                of the covered firm, the information described in 
                subsection (b); and
                    ``(B) for a covered firm not described in 
                subparagraph (A), the information described in 
                subsection (c).
            ``(2) Reporting infrastructure.--The Secretary, in 
        consultation with the Secretary of the Treasury and the Federal 
        Trade Commission, shall establish infrastructure to collect the 
        data submitted under paragraph (1).
            ``(3) Public availability.--The Secretary shall make the 
        data submitted under paragraph (1) publicly available.
            ``(4) Auditing.--The Secretary shall periodically conduct 
        audits to verify the data submitted under paragraph (1).
            ``(5) Annual reports.--The Secretary shall submit to 
        Congress annual reports describing trends identified through 
        analysis of the data submitted under paragraph (1) relating 
        to--
                    ``(A) the financial status of covered firms; and
                    ``(B) how the type of ownership of health care 
                entities impacts access to health care, health care 
                quality, and patient safety.
    ``(b) Reports Submitted by Covered Firms Owned by or Affiliated 
With Private Equity.--For purposes of subsection (a), and with respect 
to a covered firm described in subsection (a)(1)(A) and each private 
equity fund that is a control person of the covered firm, the 
information described in this subsection is the following information 
with respect to each year of the previous 10-year period:
            ``(1) The percentage of the equity of the private equity 
        fund contributed by--
                    ``(A) the general partners of the fund; and
                    ``(B) the limited partners of the fund.
            ``(2) The level of debt of the covered firm at the end of 
        the applicable year.
            ``(3) Information on the debt held by the private equity 
        fund, including--
                    ``(A) the dollar amount of total debt;
                    ``(B) the percentage of debt for which the creditor 
                is a financial institution in the United States;
                    ``(C) the percentage of debt for which the creditor 
                is a financial institution outside of the United 
                States;
                    ``(D) the percentage of debt for which the creditor 
                is an entity that is located in the United States and 
                is not a financial institution; and
                    ``(E) the percentage of debt for which the creditor 
                is an entity that is located outside of the United 
                States and is not a financial institution.
            ``(4) The total amount of debt held by the covered firm 
        that is categorized as--
                    ``(A) liabilities;
                    ``(B) long-term liabilities; and
                    ``(C) payment in kind or zero coupon debt.
            ``(5) The average debt-to-equity ratio of--
                    ``(A) each covered firm with respect to the private 
                equity fund; and
                    ``(B) the private equity fund.
            ``(6) The average debt-to-EBITDA (Earnings Before Interest, 
        Taxes, Depreciation, and Amortization) of each covered firm 
        with respect to the private equity fund.
            ``(7) The total number of covered firms with respect to the 
        private equity fund that experienced a default during the 
        applicable year, and the name of any such covered firm.
            ``(8) The total gross asset value of each covered firm with 
        respect to the private equity fund.
            ``(9) The gross performance of the private equity fund 
        during the applicable year.
            ``(10) The total dollar amount of aggregate fees and 
        expenses collected by the private equity fund, the manager of 
        the fund, or related parties from covered firms with respect to 
        the private equity fund, which shall--
                    ``(A) be categorized by the type of fee; and
                    ``(B) include a description of the purpose of the 
                fees.
            ``(11) Any transaction, monitoring, management, 
        performance, or other fees collected by the private equity fund 
        from the covered firm.
            ``(12) In dollars, the total amount of regulatory assets 
        under management by the private equity fund.
            ``(13) In dollars, the total amount of net assets under 
        management by the private equity fund.
            ``(14) With respect to the applicable year, the difference 
        obtained by subtracting the financial gains of the private 
        equity fund by the fees that the general partners of the fund 
        charged to the limited partners of the fund (commonly referred 
        to as the `performance net of fees').
            ``(15) Any management services agreements between the 
        covered firm and the private equity fund, including a 
        disclosure of fees paid through management services agreements.
            ``(16) Any other services procured by the covered firm from 
        the private equity fund or any other company owned by the 
        private equity fund.
            ``(17) Dividends paid by the covered firm to the private 
        equity fund.
            ``(18) The names of--
                    ``(A) the limited partners of the private equity 
                fund;
                    ``(B) the board members of the private equity fund; 
                and
                    ``(C) the leadership of the covered firm.
            ``(19) All political spending by the covered firm, 
        including contributions, lobbying spending, and contributions 
        to groups that do not share their donor list.
            ``(20) All political spending by the private equity fund, 
        an affiliate of the fund, or an investment professional at the 
        fund, with respect to--
                    ``(A) health care related issues; or
                    ``(B) members of congressional committees with 
                oversight of health care.
            ``(21) Information on the extent to which the covered firm 
        entered into any sale lease back transactions with the private 
        equity fund.
            ``(22) Every asset purchased by the covered firm during the 
        applicable year.
            ``(23) Information that is similar to the information 
        required to be contained in a notification filed pursuant to 
        the rules under subsection 7A(d)(1) of the Clayton Act (15 
        U.S.C. 18a(d)(1)).
            ``(24) Data related to real estate, mortgage, and lease 
        payments.
            ``(25) Interest expenses and payments made by the private 
        equity fund and each covered firm with respect to the private 
        equity fund to comply with tax receivable agreements.
            ``(26) Average interest rate paid on secured and unsecured 
        lines of credit by the private equity fund and each covered 
        firm with respect to the private equity fund.
            ``(27) For the private equity fund and each covered firm 
        with respect to the private equity fund, a list of--
                    ``(A) all transactions with the 10 largest vendors 
                or service providers; and
                    ``(B) any new vendors or service providers.
            ``(28) For the private equity fund and each covered firm 
        with respect to the private equity fund, the number of payments 
        to staffing firms.
            ``(29) For the covered firm, the staffing of each health 
        care provider owned by such covered firm, disaggregated by 
        position and ratio of staff to patients.
            ``(30) For the covered firm, the staff retention rates, 
        number of job postings, and vacancy rates, disaggregated by 
        position, with respect to each health care provider owned by 
        such covered firm.
            ``(31) For a covered firm that owns 1 or more hospitals, 
        the number of beds in use and the capacity of each such 
        hospital.
            ``(32) For the covered firm, the number of health care 
        facilities or providers owned by such covered firm that have 
        closed during such year.
            ``(33) For the covered firm, health care costs charged to 
        patients and public and private health plans.
            ``(34) For the covered firm, the percentage and number of 
        non-patient care areas in health care facilities owned by such 
        covered firm that have been converted into patient care areas.
            ``(35) For the covered firm, reductions in the wages or 
        benefits of health workers employed by health care providers 
        owned by such covered firm.
            ``(36) For the private equity fund and each covered firm 
        with respect to the private equity fund, complaints of, or 
        citations for violations of, State or Federal worker protection 
        laws, including charges of unfair labor practices, complaints 
        of violations of State or Federal antidiscrimination laws, 
        complaints of violations of wage and hour laws, and 
        whistleblower complaints.
            ``(37) For the private equity fund and each covered firm 
        with respect to the private equity fund, disclosure of any 
        agreement or arrangement with a labor relations consultant or 
        other independent contractor or organization for which a report 
        is required to be filed under section 203(a)(4) of the Labor-
        Management Reporting and Disclosure Act of 1959 (29 U.S.C. 
        433(a)(4)).
            ``(38) Any other information that the Secretary determines 
        relevant for evaluating the impact of private equity ownership 
        of health care entities on the provision of health care, health 
        care quality, and safety.
    ``(c) Information Submitted by Covered Firms Not Owned by Private 
Equity.--For purposes of subsection (a) and with respect to a covered 
firm described in subsection (a)(1)(B), the information described in 
this subsection is the following information with respect to each year 
of the previous 10-year period:
            ``(1) The level of debt of the covered firm at the end of 
        the applicable year.
            ``(2) The total amount of debt held by the covered firm 
        that is categorized as--
                    ``(A) liabilities;
                    ``(B) long-term liabilities; and
                    ``(C) payment in kind or zero coupon debt.
            ``(3) The average debt-to-equity ratio of the covered firm.
            ``(4) The average debt-to-EBITDA (Earnings Before Interest, 
        Taxes, Depreciation, and Amortization) of the covered firm.
            ``(5) Whether the covered firm experienced a default during 
        the applicable year.
            ``(6) The total gross asset value of the covered firm.
            ``(7) Dividends paid by the covered firm.
            ``(8) The names of the leadership of the covered firm.
            ``(9) All political spending by the covered firm, including 
        contributions, lobbying spending, and contributions to groups 
        that do not share their donor list.
            ``(10) Every asset purchased by the covered firm during the 
        applicable year.
            ``(11) Information that is similar to the information 
        required to be included in a notification filed pursuant to the 
        rules under subsection 7A(d)(1) of the Clayton Act (15 U.S.C. 
        18a(d)(1)).
            ``(12) Data related to real estate, mortgage, and lease 
        payments.
            ``(13) Interest expenses and payments made to comply with 
        tax receivable agreements.
            ``(14) Average interest rate paid on secured and unsecured 
        lines of credit.
            ``(15) A list of--
                    ``(A) all transactions with the 10 largest vendors 
                or service providers; and
                    ``(B) any new vendors or servicer providers.
            ``(16) The number of payments to staffing firms.
            ``(17) The salaries of the executives of the covered firm 
        and each health care entity owned by such covered firm.
            ``(18) The board membership of the covered firm and each 
        health care entity owned by such covered firm.
            ``(19) The staff retention rates, number of job postings, 
        and vacancy rates, disaggregated by position, with respect to 
        each health care provider owned by the covered firm.
            ``(20) The percentage and number of non-patient care areas 
        in health care facilities owned by the covered firm that have 
        been converted into patient care areas.
            ``(21) Reductions in the wages or benefits of health 
        workers employed by health care providers owned by the covered 
        firm.
            ``(22) Complaints of, or citations for violations of, State 
        or Federal worker protection laws, including charges of unfair 
        labor practices, complaints of violations of State or Federal 
        antidiscrimination laws, complaints of violations of wage and 
        hour laws, and whistleblower complaints.
            ``(23) Disclosure of any agreement or arrangement with a 
        labor relations consultant or other independent contractor or 
        organization for which a report is required to be filed under 
        section 203(a)(4) of the Labor-Management Reporting and 
        Disclosure Act of 1959 (29 U.S.C. 433(a)(4)).
            ``(24) Any other information that the Secretary determines 
        relevant for evaluating the impact of for-profit ownership of 
        health care entities on the provision of health care, health 
        care quality, and safety.
    ``(d) Nonduplication; Reduction of Administrative Burden.--To the 
maximum extent practicable, the Secretary shall--
            ``(1) ensure that the reporting requirements under this 
        section are not duplicative of other reporting requirements 
        under Federal law; and
            ``(2) reduce the administrative burden on covered firms of 
        complying with such requirements.

``SEC. 3403. RISK MITIGATION AND ACCOUNTABILITY.

    ``(a) Risk Mitigation.--
            ``(1) Definition of essential services.--In this 
        subsection, the term `essential services', with respect to a 
        health care provider of a health care entity owned by or 
        affiliated with a covered firm, means services that are 
        necessary for preserving health care access, health care 
        quality, and patient safety, as determined by the Secretary, 
        including services for which the Secretary determines--
                    ``(A) there are no equivalent services available 
                within the same travel time;
                    ``(B) that loss of the services would result in 
                meaningful reductions in surge capacity that will 
                negatively impact access to services, health care 
                quality, and patient safety;
                    ``(C) that loss of the services would limit health 
                care access, health care quality, and patient safety 
                for specific demographics of individuals based on sex, 
                sexuality, race, nationality, age, or disability 
                status; or
                    ``(D) that loss of the services would have a 
                meaningful impact on the ability of health care 
                entities to provide care in the surrounding 
                geographical area of the health care provider.
            ``(2) Mechanism to ensure risk mitigation.--The Secretary 
        shall establish a mechanism to ensure that the risks of covered 
        firms with respect to which there is a private equity fund that 
        is a control person of the covered firm are mitigated. Such 
        mechanism may require each such covered firm--
                    ``(A) to establish an escrow account with 
                sufficient funding to cover operating and capital 
                expenditures for not less than 5 years, including, in 
                the case of the closure of a health care provider of a 
                health care entity owned by or affiliated with such 
                covered firm or if there are reductions of essential 
                health services at such a health care provider, 
                sufficient funding--
                            ``(i) to pay out contract obligations to 
                        health care providers and other staff of such 
                        health care entity; and
                            ``(ii) to provide supplemental funding to 
                        community health care or non-profit health care 
                        providers in the surrounding geographical area 
                        impacted by such closure or service reductions;
                    ``(B) to obligate a minimum capital investment in 
                any health care entity that is owned by or affiliated 
                with such covered firm; or
                    ``(C) to carry out such other activities as the 
                Secretary determines appropriate to ensure that such 
                covered firm provides a financial contribution 
                sufficient to mitigate the impact of a potential 
                closure, reduction of essential services, workforce 
                shortage, or reduction in quality or safety of care or 
                health care access.
    ``(b) Limitation on the Use of Real Estate Investment Trusts in 
Health Care.--
            ``(1) Prohibition.--No health care entity or covered firm 
        may enter into agreement to sell to, or lease from, a real 
        estate investment trust (as defined in section 856 of the 
        Internal Revenue Code of 1986) an interest in real property if 
        the terms of such sale or lease would lead to long-term 
        weakened financial status of the health care entity or place 
        the public health at risk.
            ``(2) Review of sale or lease terms.--
                    ``(A) In general.--The Secretary shall require each 
                health care entity, or the covered firm that owns such 
                health care entity, seeking to enter into an agreement 
                described in paragraph (1) to submit to the Secretary 
                for review the terms of the sale or lease, as 
                applicable.
                    ``(B) Standard.--In conducting a review of a sale 
                or lease under subparagraph (A), the Secretary shall 
                determine whether the terms of such sale or lease would 
                lead to long-term weakened financial status of the 
                health care entity or place the public health at risk.
                    ``(C) Consultation.--The Secretary may consult with 
                the relevant State attorney general in conducting a 
                review under subparagraph (A).
            ``(3) Litigation authority.--Except as provided in section 
        518 of title 28, United States Code (relating to litigation 
        before the Supreme Court), attorneys designated by the 
        Secretary may appear for the Department of Health and Human 
        Services and represent the Department in any civil action 
        brought in connection with a violation of paragraph (1).
    ``(c) Licensure.--
            ``(1) Definition of private equity firm.--In this 
        subsection, the term `private equity firm' means a for-profit 
        corporation with respect to which there is a private equity 
        fund that is a control person of the corporation.
            ``(2) Licenses.--The Secretary shall issue licenses for 
        private equity firms to invest, directly or indirectly, in or 
        purchase a health care entity.
            ``(3) Fees.--The Secretary may charge a fee for 
        applications for licenses under paragraph (1), which shall be 
        deposited into a special account, the amounts in which shall 
        remain available to the Secretary, until expended and without 
        further appropriation, for funding for the National Health 
        Service Corps, the community health centers program under 
        section 330, teaching health centers that operate graduate 
        medical education programs under section 340H, and other health 
        workforce programs carried out by the Health Resources and 
        Services Administration, and hospitals that have received 
        disproportionate share hospital payments under section 1886 of 
        the Social Security Act or section 1923 of such Act.
            ``(4) Denial; revocation.--
                    ``(A) In general.--The Secretary may deny or revoke 
                a license under this subsection--
                            ``(i) in cases in which the Secretary 
                        determines that the private equity firm--
                                    ``(I) has failed to comply with any 
                                of the provisions of this title; or
                                    ``(II) has engaged in price 
                                gauging, understaffing, access 
                                barriers, or such other metrics as the 
                                Secretary determines appropriate, with 
                                respect to the private equity firm's 
                                ownership of health care entities; or
                            ``(ii) for such other reason involving 
                        actions or practices of the private equity firm 
                        that may impact or interfere with access to, or 
                        quality of, health care, as the Secretary 
                        determines appropriate.
                    ``(B) Divestment.--A private equity firm the 
                license of which is revoked under subparagraph (A) 
                shall be required to divest from any investments in any 
                health care entity.
            ``(5) Civil monetary penalties.--Any private equity firm 
        that violates a requirement of this subsection with respect to 
        a health care entity shall be liable for a civil monetary 
        penalty of not more than the amount that is equal to the amount 
        of Federal funding received by the health care entity, which 
        shall be deposited in the account described in paragraph (3).

``SEC. 3404. TASK FORCE REVIEW OF THE ROLE OF PRIVATE EQUITY AND 
              CONSOLIDATION IN HEALTH CARE.

    ``(a) Establishment.--The Secretary shall establish and operate a 
task force to monitor changes in the health care marketplace, to 
address and limit the role of private equity and consolidation in 
health care, and to address changes to the health care marketplace and 
private equity or market consolidation patterns that may create, 
continue, or exacerbate health care disparities or disparate health 
outcomes based on sex, sexuality, race, nationality, ethnicity, age, 
disability, immigration status, socioeconomic status, or location of 
residence (referred to in this section as the `Task Force').
    ``(b) Composition.--
            ``(1) Chair.--The Secretary shall chair the Task Force.
            ``(2) Co-chair.--The Secretary shall select from among the 
        members appointed under paragraph (3) a co-chair of the Task 
        Force, who shall be a practicing health care provider.
            ``(3) Members.--The Secretary shall appoint the members of 
        the Task Force from among the following:
                    ``(A) Academic experts and researchers with 
                expertise on--
                            ``(i) the role of private equity in 
                        healthcare; and
                            ``(ii) the impact of mergers and 
                        acquisitions in healthcare on costs and 
                        patients.
                    ``(B) Representatives from organizations focused on 
                consumer protection, antitrust, health care equity, 
                patient advocacy, and worker advocacy.
                    ``(C) Hospital and health care staff (and the labor 
                organizations representing such staff).
                    ``(D) Patients.
            ``(4) Advisory members.--In addition to the members 
        described in paragraph (3), the Chair of the Federal Trade 
        Commission and the Attorney General shall serve as advisory 
        members of the Task Force.
            ``(5) Member appointment.--Not later than 180 days after 
        the date of enactment of this Act, the Secretary shall appoint 
        the members of the Task Force--
                    ``(A) in accordance with paragraph (2); and
                    ``(B) using a competitive application process.
    ``(c) Recommendations.--The Task Force shall--
            ``(1) identify best practices and, for purposes of 
        subsection (d), develop recommendations, for limiting the role 
        of private equity in health care, taking into account the 
        implications on health outcomes and staff working conditions;
            ``(2) identify emerging trends within the health care 
        marketplace that may undermine access to health care, quality 
        of care, or patient safety or create financial instability and 
        risk for health providers; and
            ``(3) develop legislative recommendations for preserving 
        and expanding health care quality, safety, and access under 
        this title.
    ``(d) Report.--The Secretary shall submit to Congress annually a 
report--
            ``(1) on the recommendations developed subsection (c); and
            ``(2) that includes regulatory and legislative 
        recommendations to address any adverse effects of health care 
        consolidation, private equity's involvement in health care, or 
        any other change or emerging trend in the health care 
        marketplace.
    ``(e) Moratorium.--The Secretary may prohibit a private equity fund 
from purchasing voting securities of a covered firm, and may prohibit 
any merger or acquisition that would result in a private equity fund 
gaining control of voting securities of a covered firm, until the date 
on which the Secretary determines that the Task Force has had 
sufficient time to study and identify whether abuses are taking place 
in specific health care sectors or by health care entities related to 
price gauging, understaffing, access barriers, or such other metrics as 
the Secretary determines appropriate.

``SEC. 3405. CORPORATE ACCOUNTABILITY.

    ``The Secretary shall--
            ``(1) maintain a corporate accountability data collection 
        program for the reporting of any person subject to the 
        requirements of this title for failure to comply with this 
        title; and
            ``(2) furnish the information collected under paragraph (1) 
        to the National Practitioner Data Bank established pursuant to 
        the Health Care Quality Improvement Act of 1986.

``SEC. 3406. ENFORCEMENT.

    ``(a) State Enforcement.--
            ``(1) State authority.--Each State may require a person 
        subject to the requirements of this title to satisfy such 
        requirements applicable to the person.
            ``(2) Failure to implement requirements.--In the case of a 
        State that fails to substantially enforce the requirements of 
        this title with respect to applicable persons in the State, the 
        Secretary shall enforce the requirements of this title under 
        subsection (b) to the extent that such requirements relate to 
        actions prohibited under this title occurring in such State.
    ``(b) Secretarial Enforcement Authority.--
            ``(1) In general.--If a person is found by the Secretary to 
        be in violation of this title, the Secretary may apply a civil 
        monetary penalty with respect to such person in an amount not 
        to exceed $10,000 per violation.
            ``(2) Licensure penalties.--A civil monetary penalty under 
        paragraph (1) shall be in addition to any civil monetary 
        penalty assessed under section 3403(c)(4).
    ``(c) Continued Applicability of State Law.--This title shall not 
be construed to supersede any provision of State law that establishes, 
implements, or continues in effect any requirement or prohibition 
except to the extent that such requirement or prohibition prevents the 
application of a requirement or prohibition of this title.

``SEC. 3407. RESEARCH.

    ``The Secretary shall conduct or support research on--
            ``(1) the impact of transitioning to a ban on for-profit 
        corporations owning or investing in health care entities;
            ``(2) the impact of private equity investment in health 
        care entities on--
                    ``(A) health care costs;
                    ``(B) access to health care;
                    ``(C) clinical decision making;
                    ``(D) health care entity recruitment and retention;
                    ``(E) labor organization membership rates and 
                collective bargaining power of health worker labor 
                organizations;
                    ``(F) health care worker pay, pensions, and other 
                benefits;
                    ``(G) health outcomes; and
                    ``(H) health disparities;
            ``(3) the effectiveness of State law (including 
        regulations) and State enforcement on ensuring acquisition of 
        health care entities by covered firms does not place access to 
        health care, health care quality, or patient safety at risk; 
        and
            ``(4) compliance the CMS-855A Medicare Enrollment 
        Application and other Federal ownership transparency 
        requirements.''.

SEC. 3. PROHIBITED ACTS BY INVESTMENT COMPANIES WITH RESPECT TO HEALTH 
              CARE.

    Section 12 of the Investment Company Act of 1940 (15 U.S.C. 80a-12) 
is amended by adding at the end the following:
    ``(h)(1) In this subsection, the term `health care entity' has the 
meaning given the term in section 3401 of the Public Health Service 
Act.
    ``(2) It shall be unlawful for any registered investment company to 
engage in any act, practice, or course of business that would strip an 
asset from a health care entity or otherwise undermine the quality or 
safety of, or access to, health care.
    ``(3) The Commission, in consultation with the Secretary of Health 
and Human Services, shall, for the purposes of this subsection, by 
rules and regulations define, and prescribe means reasonably designed 
to prevent, actions, practices, and courses of business described in 
paragraph (2).''.

SEC. 4. AMENDMENTS TO TITLE 11, UNITED STATES CODE.

    (a) Priorities of Claims in Bankruptcy.--
            (1) In general.--Section 507(a) of title 11, United States 
        Code, is amended--
                    (A) by redesignating paragraphs (1) through 10 as 
                paragraphs (2) through (11), respectively;
                    (B) by inserting before paragraph (2), as so 
                redesignated, the following:
                    ``(A) First, withdrawal liability determined under 
                part 1 of subtitle E of title IV of the Employee 
                Retirement Income Security Act of 1974 (29 U.S.C. 1381 
                et seq.).'';
                    (C) in the matter preceding subparagraph (A) of 
                paragraph (2), as so redesignated, by striking 
                ``First:'' and inserting ``Second:'';
                    (D) in paragraph (3), as so redesignated, by 
                striking ``Second,'' and inserting ``Third,'';
                    (E) in paragraph (4), as so redesignated, by 
                striking ``Third,'' and inserting ``Fourth,'';
                    (F) in the matter preceding subparagraph (A) of 
                paragraph (5), as so redesignated, by striking 
                ``Fourth,'' and inserting ``Fifth,'';
                    (G) in the matter preceding subparagraph (A) of 
                paragraph (6), as so redesignated, by striking 
                ``Fifth,'' and inserting ``Sixth,'';
                    (H) in the matter preceding subparagraph (A) of 
                paragraph (7), as so redesignated, by striking 
                ``Sixth,'' and inserting ``Seventh,'';
                    (I) in paragraph (8), as so redesignated, by 
                striking ``Seventh,'' and inserting ``Eighth,'';
                    (J) in the matter preceding subparagraph (A) of 
                paragraph (9), as so redesignated, by striking 
                ``Eighth,'' and inserting ``Ninth,'';
                    (K) in paragraph (10), as so redesignated, by 
                striking ``Ninth,'' and inserting ``Tenth,''; and
                    (L) in paragraph (11), as so redesignated, by 
                striking ``Tenth,'' and inserting ``Eleventh,''.
            (2) Technical and conforming amendments.--
                    (A) Section 502(i) of title 11, United States Code, 
                is amended by striking ``section 507(a)(8)'' and 
                inserting ``section 507(a)(9)''.
                    (B) Section 503(b)(1)(B)(i) of title 11, United 
                States Code, is amended by striking ``section 
                507(a)(8)'' and inserting ``section 507(a)(9)''.
                    (C) Section 507(d) of title 11, United States Code, 
                is amended by striking ``(a)(1), (a)(4), (a)(5), 
                (a)(6), (a)(7), (a)(8) excluding subparagraph (F), or 
                (a)(9)'' and inserting ``(a)(2), (a)(5), (a)(6), 
                (a)(7), (a)(8), (a)(9) excluding subparagraph (F), or 
                (a)(10)''.
                    (D) Section 523(a)(1)(A) of title 11, United States 
                Code, is amended by striking ``section 507(a)(3) or 
                507(a)(8)'' and inserting ``section 507(a)(4) or 
                507(a)(9)''.
                    (E) Section 724 of title 11, United States Code, is 
                amended--
                            (i) in subsection (b)(2)--
                                    (I) by striking ``section 
                                507(a)(1)(C) or 507(a)(2)'' and 
                                inserting ``section 507(a)(2)(C) or 
                                507(a)(3)''; and
                                    (II) by striking ``507(a)(1)(A), 
                                507(a)(1)(B), 507(a)(3), 507(a)(4), 
                                507(a)(5), 507(a)(6), or 507(a)(7)'' 
                                and inserting ``507(a)(2)(A), 
                                507(a)(2)(B), 507(a)(4), 507(a)(5), 
                                507(a)(6), 507(a)(7), or 507(a)(8)''; 
                                and
                            (ii) in subsection (f)--
                                    (I) in paragraph (1), by striking 
                                ``section 507(a)(4)'' and inserting 
                                ``section 507(a)(5)''; and
                                    (II) in paragraph (2), by striking 
                                ``section 507(a)(5)'' and inserting 
                                ``section 507(a)(6)''.
                    (F) Section 726(b) of title 11, United States Code, 
                is amended by striking ``paragraph (1), (2), (3), (4), 
                (5), (6), (7), (8), (9), or (10) of section 507(a)'' 
                and inserting ``paragraphs (2) through (11) of section 
                507(a)''.
                    (G) Section 752(a) of title 11, United States Code, 
                is amended by striking ``section 507(a)(2)'' and 
                inserting ``section 507(a)(3)''.
                    (H) Section 766 of title 11, United States Code, is 
                amended--
                            (i) in subsection (h), by striking 
                        ``section 507(a)(2)'' and inserting ``section 
                        507(a)(3)''; and
                            (ii) in subsection (i)--
                                    (I) in paragraph (1), by striking 
                                ``section 507(a)(2)'' and inserting 
                                ``section 507(a)(3)''; and
                                    (II) in paragraph (2), by striking 
                                ``section 507(a)(2)'' and inserting 
                                ``section 507(a)(3)''.
                    (I) Section 901 of title 11, United States Code, is 
                amended by striking ``507(a)(2)'' and inserting 
                ``507(a)(3)''.
                    (J) Section 943(b)(5) of title 11, United States 
                Code, is amended by striking ``section 507(a)(2)'' and 
                inserting ``section 507(a)(3)''.
                    (K) Section 1123(a)(1) of title 11, United States 
                Code, is amended by striking ``section 507(a)(2), 
                507(a)(3), or 507(a)(8)'' and inserting ``section 
                507(a)(3), 507(a)(4), or 507(a)(9)''.
                    (L) Section 1129(a)(9) of title 11, United States 
                Code, is amended--
                            (i) in subparagraph (A), by striking 
                        ``section 507(a)(2) or 507(a)(3)'' and 
                        inserting ``section 507(a)(3) or 507(a)(4)'';
                            (ii) in the matter preceding clause (i) of 
                        subparagraph (B), by striking ``section 
                        507(a)(1), 507(a)(4), 507(a)(5), 507(a)(6), or 
                        507(a)(7)'' and inserting ``section 507(a)(2), 
                        507(a)(5), 507(a)(6), 507(a)(7), or 
                        507(a)(8)'';
                            (iii) in the matter preceding clause (i) of 
                        subparagraph (C), by striking ``section 
                        507(a)(8)'' and inserting ``section 
                        507(a)(9)''; and
                            (iv) in subparagraph (D), by striking 
                        ``section 507(a)(8)'' and inserting ``section 
                        507(a)(9)''.
                    (M) Section 1191(e) of title 11, United States 
                Code, is amended by striking ``paragraph (2) or (3)'' 
                and inserting ``paragraph (3) or (4)''.
                    (N) Section 1222(a)(4) of title 11, United States 
                Code, is amended by striking ``section 507(a)(1)(B)'' 
                and inserting ``507(a)(2)(B)''.
                    (O) Section 1226(b)(1) of title 11, United States 
                Code, is amended by striking ``section 507(a)(2)'' and 
                inserting ``section 507(a)(3)''.
                    (P) Section 1322(a)(4) of title 11, United States 
                Code, is amended by striking ``section 507(a)(1)(B)'' 
                and inserting ``section 507(a)(2)(B)''.
                    (Q) Section 1326(b)(1) of title 11, United States 
                Code, is amended by striking ``section 507(a)(2)'' and 
                inserting ``section 507(a)(3)''.
                    (R) Section 1328(a)(2) of title 11, United States 
                Code, is amended by striking ``section 507(a)(8)(C)'' 
                and inserting ``section 507(a)(9)(C)''.
                    (S) Section 6(e) of the Securities Investor 
                Protection Act of 1970 (15 U.S.C. 78fff(e)) is amended, 
                in the last sentence, by striking ``section 507(a)(2)'' 
                and inserting ``section 507(a)(3)''.
    (b) Confirmation of Plan.--Section 1129 of title 11, United States 
Code, is amended by adding at the end the following:
    ``(f) Notwithstanding any other provision of this section, if the 
debtor is a health care business, the court, in confirming a plan, 
shall give substantial weight to the extent to which the plan would 
allow for maintenance of regional health care access, quality and 
safety of health care provided regionally, and health care provider and 
staff retention regionally.''.

SEC. 5. MAINTENANCE OF HEALTH CARE ACCESS RELATING TO HOSPITAL 
              DISCONTINUATION OF SERVICES OR CLOSURE.

    Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is 
amended--
            (1) in subsection (a)(1)--
                    (A) in subparagraph (X), by striking ``and'' at the 
                end;
                    (B) in subparagraph (Y)(ii)(V), by striking the 
                period and inserting ``, and''; and
                    (C) by inserting after subparagraph (Y) the 
                following new subparagraph:
            ``(Z) beginning 60 days after the date of the enactment of 
        this subparagraph, in the case of a hospital, to comply with 
        the requirements of subsection (l) (relating to discontinuation 
        of services or closure).''; and
            (2) by adding at the end the following new subsection:
    ``(l) Requirements for Hospitals Relating to Discontinuation of 
Services or Closure.--
            ``(1) Requirements.--
                    ``(A) In general.--For purposes of subsection 
                (a)(1)(Z), except as provided in subparagraph (B), the 
                requirements described in this subsection are that a 
                hospital--
                            ``(i) notify the Secretary, in accordance 
                        with paragraph (2), not less than 90 days prior 
                        to the discontinuation of services or full 
                        hospital closure;
                            ``(ii) prohibit the discontinuation of 
                        essential services (as defined in paragraph 
                        (6)) during the notification period (as defined 
                        in such paragraph) unless there is a clear harm 
                        posed to patient or employee health or safety 
                        in the hospital continuing to furnish such 
                        services;
                            ``(iii) respond to any inquiries by the 
                        Secretary relating to the implementation of 
                        this subsection, including the determination of 
                        essential services under paragraph (6)(C); and
                            ``(iv) if applicable--
                                    ``(I) submit a mitigation plan and 
                                related information as described in 
                                paragraph (3); and
                                    ``(II) participate in the public 
                                comment and review process (including, 
                                if applicable, the alternative 
                                mitigation plan) described in paragraph 
                                (4).
                    ``(B) Application in case of catastrophic events.--
                In the case where a discontinuation of services or 
                closure of a hospital is due to an unforeseen 
                catastrophic event (as defined by the Secretary), the 
                requirements described in subparagraph (A) shall apply, 
                except--
                            ``(i) the hospital shall provide the 
                        notification under clause (i) of such 
                        subparagraph not later than 30 days after the 
                        catastrophic event or as soon as feasible as 
                        determined by the Secretary; and
                            ``(ii) clause (ii) of such subparagraph 
                        (relating to prohibiting the discontinuation of 
                        services) shall not apply.
            ``(2) Notification information.--For purposes of paragraph 
        (1)(A)(i), the notification under such paragraph shall include 
        the following information with respect to a hospital:
                    ``(A) Discontinuation of services.--In the case 
                where the hospital is discontinuing services (without 
                full hospital closure):
                            ``(i) The services that will be 
                        discontinued and number of hospital beds 
                        impacted.
                            ``(ii) The number of individuals furnished 
                        such services annually and a breakdown of the 
                        type of insurance used by such individuals for 
                        such services.
                            ``(iii) The number of impacted employees 
                        and what labor organization represents them 
                        (and the contact information for such 
                        organization).
                            ``(iv) The names and addresses of any 
                        organized health care coalitions and community 
                        groups that represent the communities impacted 
                        by the discontinuation of such services.
                            ``(v) Alternative providers of such 
                        services, including provider type, contact 
                        information, and distance and transportation 
                        time by car and public transit from the 
                        hospital.
                    ``(B) Full hospital closure.--In the case of full 
                hospital closure:
                            ``(i) Hospital ownership entities.
                            ``(ii) The full extent of services that 
                        will no longer be furnished by the hospital.
                            ``(iii) The number of individuals furnished 
                        services annually by the hospital, a 
                        description of the services furnished, and a 
                        breakdown of the type of insurance used by such 
                        individuals for such services.
                            ``(iv) The number of impacted employees 
                        and, if applicable, what labor organizations 
                        represent them (and the contact information for 
                        each such organization).
                            ``(v) The names and addresses of any 
                        organized health care coalitions and community 
                        groups that represent the communities impacted 
                        by the closure.
                            ``(vi) Alternative providers, including 
                        provider type, contact information, and 
                        distance and transportation time by car and 
                        public transit from the hospital.
                            ``(vii) Steps taken prior to the decision 
                        to close in order to avoid closure.
                            ``(viii) Distribution of liquidation 
                        proceeds (cash or assets) or any payments (cash 
                        or assets) made to employees, owners, or 
                        contractors related to the closure.
            ``(3) Submission of mitigation plan and related information 
        for essential services.--
                    ``(A) Notification by secretary.--If the Secretary 
                determines that the discontinuation of services or 
                closure of an applicable hospital would negatively 
                impact access to essential services, the Secretary 
                shall notify the applicable hospital of such 
                determination.
                    ``(B) Submission of mitigation plan and related 
                information.--If an applicable hospital receives a 
                notification under subparagraph (A), the applicable 
                hospital shall, not later than 15 days after receiving 
                such notification, submit to the Secretary, the State 
                health department, and the local department of public 
                health--
                            ``(i) a plan to--
                                    ``(I) preserve access to essential 
                                services for impacted communities 
                                through partnerships, commitments from 
                                surrounding facilities, transportation 
                                plan access, and preparation for surge 
                                response; and
                                    ``(II) support employees in 
                                transitioning to new positions within 
                                health care;
                            ``(ii) information on workforce and public 
                        engagement to ensure awareness of the 
                        discontinuation of services or closure;
                            ``(iii) a description of potential 
                        alternatives to the discontinuation of services 
                        or closure that the hospital considered and an 
                        explanation of why those alternatives are not a 
                        viable option; and
                            ``(iv) a local market study to ascertain 
                        regional bed supply, payor mix distribution 
                        among all providers, demographic trends, and 
                        remaining health systems in the area.
                    ``(C) Public availability.--The Secretary shall 
                make a mitigation plan and related information 
                submitted by an applicable hospital under this 
                paragraph available to the public on the internet 
                website of the Centers for Medicare & Medicaid 
                Services.
            ``(4) Public comment and review process; alternative 
        mitigation plan.--
                    ``(A) Public comment period.--
                            ``(i) In general.--The Secretary shall 
                        provide a public comment period of not less 
                        than 45 days with the opportunity to submit 
                        written comments regarding the impact of the 
                        potential discontinuation of services or 
                        closure of an applicable hospital.
                            ``(ii) Notice.--Notice of the opportunity 
                        to submit comments shall be published in the 
                        Federal Register and distributed to--
                                    ``(I) providers of services and 
                                suppliers that may be impacted by the 
                                discontinuation of services or closure 
                                of the applicable hospital;
                                    ``(II) any labor organization that 
                                represents any subdivision of employees 
                                of the applicable hospital;
                                    ``(III) organized health care 
                                coalitions and community groups that 
                                represent the communities impacted by 
                                the discontinuation of services or 
                                closure;
                                    ``(IV) the State health agency; and
                                    ``(V) the local department of 
                                public health.
                            ``(iii) Recommendations of state health 
                        agency and local departments of public 
                        health.--In reviewing a mitigation plan 
                        submitted by an applicable hospital under 
                        paragraph (3), the Secretary shall take into 
                        consideration any recommendations submitted by 
                        the State health agency and local departments 
                        of public health, as applicable, regarding 
                        whether such plan should be approved.
                    ``(B) Alternative mitigation plan.--
                            ``(i) In general.--If, after reviewing the 
                        mitigation plan submitted by an applicable 
                        hospital under paragraph (3) and the comments 
                        submitted during the public comment period 
                        under subparagraph (A) with respect to the 
                        discontinuation of services or closure of the 
                        applicable hospital, the Secretary finds that 
                        the discontinuation of services or closure of 
                        the applicable hospital would have a 
                        significant impact on access to essential 
                        services, the Secretary shall work with the 
                        applicable hospital or other providers of 
                        services and suppliers in the area, as 
                        appropriate, to develop and implement an 
                        alternative plan to the plan submitted by the 
                        applicable hospital under paragraph (3) 
                        (referred to in this subsection as the 
                        `alternative mitigation plan') in order to 
                        ensure continued access to essential services, 
                        which may include an agreement to delay the 
                        discontinuation of services or closure of the 
                        applicable hospital until the alternative 
                        mitigation plan is complete.
                            ``(ii) Technical assistance.--An 
                        alternative mitigation plan under clause (i) 
                        may include technical assistance or information 
                        on available funding mechanisms to support the 
                        furnishing of essential services.
                            ``(iii) Collaboration.--The Secretary 
                        should, to the extent practicable, collaborate 
                        with State and municipal government officials 
                        in the development of an alternative mitigation 
                        plan under clause (i).
                            ``(iv) Public availability.--The Secretary 
                        shall make any information submitted and the 
                        alternative mitigation plan developed under 
                        this paragraph available to the public on the 
                        internet website of the Centers for Medicare & 
                        Medicaid Services.
                    ``(C) Implementation.--The Secretary shall 
                promulgate regulations to detail the required response 
                time by an applicable hospital and the speed of the 
                review process under this paragraph in order to ensure 
                that such process can be completed with respect to an 
                applicable hospital prior to the proposed service 
                discontinuation date or closure date of the applicable 
                hospital.
                    ``(D) Prohibition.--In the case where the Secretary 
                finds that a hospital has violated the requirements of 
                this subsection, the Secretary may prohibit the 
                hospital and any hospital under the same hospital 
                ownership entity from being eligible to enroll or 
                reenroll under the program under this title under 
                section 1866(j) until the earlier of--
                            ``(i) the date that is 3 years after the 
                        date on which the hospital discontinues 
                        services or closes;
                            ``(ii) the date on which the Secretary 
                        determines essential health services that were 
                        negatively impacted by the discontinuation or 
                        closure have been restored; or
                            ``(iii) such time as the Secretary is 
                        satisfied with the mitigation plan submitted by 
                        the hospital under paragraph (3) or the 
                        alternative mitigation plan under paragraph 
                        (4).
            ``(5) Annual reports.--The Secretary shall submit an annual 
        report to Congress on the discontinuation of services and full 
        closure of hospitals. Each report submitted under the preceding 
        sentence shall include--
                    ``(A) a description of trends in the 
                discontinuation of services and closures of hospitals, 
                including hospital ownership type, geographic location, 
                types of services furnished, demographic served, and 
                insurance type;
                    ``(B) an analysis of the impact of the 
                discontinuation of services and closures on health care 
                access and ability to meet surge demand due to 
                emergency (such as a pandemic or climate disaster); and
                    ``(C) recommendations for such administrative or 
                legislative changes as the Secretary determines 
                appropriate to preserve access to essential services 
                nationwide.
            ``(6) Definitions.--In this subsection:
                    ``(A) Applicable hospital.--The term `applicable 
                hospital' means a hospital that submits a notification 
                under paragraph (1)(A)(i) of a discontinuation of 
                services or full hospital closure.
                    ``(B) Discontinuation.--The term `discontinuation' 
                may include any reduction or discontinuation of 
                services furnished by an applicable hospital, including 
                those that occur as part of a merger or acquisition 
                agreement.
                    ``(C) Essential services.--The term `essential 
                services' means, with respect to an applicable 
                hospital, services that are necessary for preserving 
                health care access (as determined by the Secretary), 
                including services for which the Secretary determines--
                            ``(i) there are no equivalent services 
                        available within the same travel time;
                            ``(ii) that loss of the services would 
                        result in meaningful reductions in surge 
                        capacity that will negatively impact access to 
                        services;
                            ``(iii) that loss of the services would 
                        limit health care access for specific 
                        demographics of individuals based on sex, 
                        sexuality, race, nationality, age, or 
                        disability status;
                            ``(iv) that loss of the services would have 
                        a meaningful impact on the ability of health 
                        systems to respond to impacts of climate 
                        change; or
                            ``(v) there is a health or health care-
                        related emergency declaration status applicable 
                        to the surrounding geographical area of the 
                        hospital on the date on which the hospital 
                        submits notification under paragraph (1)(A)(i) 
                        of a discontinuation of services or full 
                        hospital closure.
                    ``(D) Notification period.--The term `notification 
                period' means, with respect to an applicable hospital, 
                the period beginning on the date on which the hospital 
                submits notification under paragraph (1)(A)(i) of a 
                discontinuation of services or full hospital closure 
                and ending on the date of such discontinuation of 
                services or closure.
            ``(7) No preemption of state law.--Nothing in subsection 
        (a)(1)(Z) or this subsection shall be construed to limit any 
        rights or remedies under State or local law relating to 
        protecting access to essential services or reviewing proposed 
        hospital closures or reduction of services.''.

SEC. 6. TREATMENT OF RENTS FROM QUALIFIED HEALTH CARE PROPERTY.

    (a) In General.--Section 856(d)(2) of the Internal Revenue Code of 
1986 is amended by striking ``and'' at the end of subparagraph (B), by 
striking the period and inserting ``, and'' at the end of subparagraph 
(C), and by adding at the end the following new subparagraph:
                    ``(D) notwithstanding paragraphs (4), (6), and (8), 
                any amount received or accrued directly or indirectly 
                from qualified health care property (as defined in 
                subsection (e)(6)(D)(i)).''.
    (b) Conforming Amendments.--
            (1) Section 856(d)(8)(B) of the Internal Revenue Code of 
        1986 is amended--
                    (A) by striking ``or a qualified health care 
                property (as defined in subsection (e)(6)(D)(i))'', and
                    (B) by striking ``qualified health care property 
                or''.
            (2) Section 856(d)(9) of such Code is amended--
                    (A) by striking ``or a qualified health care 
                property (as defined in subsection (e)(6)(D)(i))'' in 
                subparagraph (A),
                    (B) by striking ``or qualified health care 
                property'' each place it appears in subparagraph (A) 
                and (B), and
                    (C) by striking ``or qualified health care 
                properties'' in subparagraph (A).
    (c) Effective Date.--The amendments made by this section shall 
apply to taxable years beginning after the date of the enactment of 
this Act.
                                 <all>
```