II 

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. 

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 ‘‘Health Over Wealth 

5 Act’’. 


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1 SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

2 ACT. 

3 The Public Health Service Act (42 U.S.C. 201 et 

4 seq.) is amended by adding at the end the following: 

5 ‘‘TITLE XXXIV—REQUIREMENTS 

6 RELATING TO PRIVATE OWN7 ERSHIP IN HEALTH CARE 

8 ‘‘SEC. 3401. DEFINITIONS. 

9 ‘‘In this title: 

10 ‘‘(1) AFFILIATE.—The term ‘affiliate’ means— 

11 ‘‘(A) a person that directly or indirectly 

12 owns, controls, or holds with power to vote, 20 

13 percent or more of the outstanding voting secu14 rities of another entity, other than a person 

15 that holds such securities— 

16 ‘‘(i) in a fiduciary or agency capacity 

17 without sole discretionary power to vote 

18 such securities; or 

19 ‘‘(ii) solely to secure a debt, if such 

20 entity has not in fact exercised such power 

21 to vote; 

22 ‘‘(B) a corporation 20 percent or more of 

23 whose outstanding voting securities are directly 

24 or indirectly owned, controlled, or held with 

25 power to vote, by another entity (referred to in 

26 this subparagraph as a ‘covered entity’), or by 


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1 an entity that directly or indirectly owns, con2 trols, or holds with power to vote, 20 percent or 

3 more of the outstanding voting securities of the 

4 covered entity, other than an entity that holds 

5 such securities— 

6 ‘‘(i) in a fiduciary or agency capacity 

7 without sole discretionary power to vote 

8 such securities; or 

9 ‘‘(ii) solely to secure a debt, if such 

10 entity has not in fact exercised such power 

11 to vote; 

12 ‘‘(C) a person whose business is operated 

13 under a lease or operating agreement by an14 other entity, or person substantially all of whose 

15 property is operated under an operating agree16 ment with that other entity; or 

17 ‘‘(D) an entity that operates the business 

18 or substantially all of the property of another 

19 entity under a lease or operating agreement. 

20 ‘‘(2) CORPORATION.—The term ‘corporation’ 

21 means— 

22 ‘‘(A) a joint-stock company; 

23 ‘‘(B) a company or partnership association 

24 organized under a law that makes only the cap25 ital subscribed or callable up to a specified 


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1 amount responsible for the debts of the associa2 tion, including a limited partnership and a lim3 ited liability company; 

4 ‘‘(C) a trust; or 

5 ‘‘(D) an association having a power or 

6 privilege that a private corporation, but not an 

7 individual or a partnership, possesses. 

8 ‘‘(3) COVERED FIRM.—The term ‘covered firm’ 

9 means a for-profit corporation that owns or is an af10 filiate of a health care entity. 

11 ‘‘(4) HEALTH CARE ENTITY.—The term ‘health 

12 care entity’ means an entity that consists of 1 or 

13 more of the following health care providers: 

14 ‘‘(A) A hospital. 

15 ‘‘(B) A physician practice. 

16 ‘‘(C) A skilled nursing facility. 

17 ‘‘(D) A hospice facility. 

18 ‘‘(E) A mental or behavioral health care 

19 provider. 

20 ‘‘(F) An opioid treatment program. 

21 ‘‘(G) A provider of services (as defined in 

22 section 1861(u) of the Social Security Act (42 

23 U.S.C. 1395x(u)) or a supplier (as defined in 

24 section 1861(d) of such Act (42 U.S.C. 

25 1395(d)) enrolled in the Medicare program. 


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1 ‘‘(H) Any other entity the Secretary deter2 mines appropriate. 

3 ‘‘(5) PRIVATE EQUITY FUND.—The term ‘pri4 vate equity fund’ means— 

5 ‘‘(A)(i) a person that would be considered 

6 an investment company under section 3 of the 

7 Investment Company Act of 1940 (15 U.S.C. 

8 80a–3) but for the application of paragraph (1) 

9 or (7) of subsection (c) of such section 3; 

10 ‘‘(ii) a venture capital fund, as defined in 

11 section 275.203(l)–1 of title 17, Code of Fed12 eral Regulations (or successor regulations); or 

13 ‘‘(iii) a sovereign wealth fund; and 

14 ‘‘(B) directly, or through an affiliate, acts 

15 as a control person. 

16 ‘‘SEC. 3402. HEALTH CARE OWNERSHIP TRANSPARENCY. 

17 ‘‘(a) REQUIRED REPORTING.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall require 

19 each covered firm to submit to the Secretary, at 

20 such times as the Secretary determines appropriate, 

21 through the infrastructure established under para22 graph (2), a report containing— 

23 ‘‘(A) for a covered firm with respect to 

24 which there is a private equity fund that is a 


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1 control person of the covered firm, the informa2 tion described in subsection (b); and 

3 ‘‘(B) for a covered firm not described in 

4 subparagraph (A), the information described in 

5 subsection (c). 

6 ‘‘(2) REPORTING INFRASTRUCTURE.—The Sec7 retary, in consultation with the Secretary of the 

8 Treasury and the Federal Trade Commission, shall 

9 establish infrastructure to collect the data submitted 

10 under paragraph (1). 

11 ‘‘(3) PUBLIC AVAILABILITY.—The Secretary 

12 shall make the data submitted under paragraph (1) 

13 publicly available. 

14 ‘‘(4) AUDITING.—The Secretary shall periodi15 cally conduct audits to verify the data submitted 

16 under paragraph (1). 

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

18 submit to Congress annual reports describing trends 

19 identified through analysis of the data submitted 

20 under paragraph (1) relating to— 

21 ‘‘(A) the financial status of covered firms; 

22 and 

23 ‘‘(B) how the type of ownership of health 

24 care entities impacts access to health care, 

25 health care quality, and patient safety. 


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1 ‘‘(b) REPORTS SUBMITTED BY COVERED FIRMS

2 OWNED BY OR AFFILIATED WITH PRIVATE EQUITY.— 

3 For purposes of subsection (a), and with respect to a cov4 ered firm described in subsection (a)(1)(A) and each pri5 vate equity fund that is a control person of the covered 

6 firm, the information described in this subsection is the 

7 following information with respect to each year of the pre8 vious 10-year period: 

9 ‘‘(1) The percentage of the equity of the private 

10 equity fund contributed by— 

11 ‘‘(A) the general partners of the fund; and 

12 ‘‘(B) the limited partners of the fund. 

13 ‘‘(2) The level of debt of the covered firm at the 

14 end of the applicable year. 

15 ‘‘(3) Information on the debt held by the pri16 vate equity fund, including— 

17 ‘‘(A) the dollar amount of total debt; 

18 ‘‘(B) the percentage of debt for which the 

19 creditor is a financial institution in the United 

20 States; 

21 ‘‘(C) the percentage of debt for which the 

22 creditor is a financial institution outside of the 

23 United States; 

24 ‘‘(D) the percentage of debt for which the 

25 creditor is an entity that is located in the 


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1 United States and is not a financial institution; 

2 and 

3 ‘‘(E) the percentage of debt for which the 

4 creditor is an entity that is located outside of 

5 the United States and is not a financial institu6 tion. 

7 ‘‘(4) The total amount of debt held by the cov8 ered firm that is categorized as— 

9 ‘‘(A) liabilities; 

10 ‘‘(B) long-term liabilities; and 

11 ‘‘(C) payment in kind or zero coupon debt. 

12 ‘‘(5) The average debt-to-equity ratio of— 

13 ‘‘(A) each covered firm with respect to the 

14 private equity fund; and 

15 ‘‘(B) the private equity fund. 

16 ‘‘(6) The average debt-to-EBITDA (Earnings 

17 Before Interest, Taxes, Depreciation, and Amortiza18 tion) of each covered firm with respect to the private 

19 equity fund. 

20 ‘‘(7) The total number of covered firms with re21 spect to the private equity fund that experienced a 

22 default during the applicable year, and the name of 

23 any such covered firm. 

24 ‘‘(8) The total gross asset value of each covered 

25 firm with respect to the private equity fund. 


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1 ‘‘(9) The gross performance of the private eq2 uity fund during the applicable year. 

3 ‘‘(10) The total dollar amount of aggregate fees 

4 and expenses collected by the private equity fund, 

5 the manager of the fund, or related parties from 

6 covered firms with respect to the private equity 

7 fund, which shall— 

8 ‘‘(A) be categorized by the type of fee; and 

9 ‘‘(B) include a description of the purpose 

10 of the fees. 

11 ‘‘(11) Any transaction, monitoring, manage12 ment, performance, or other fees collected by the 

13 private equity fund from the covered firm. 

14 ‘‘(12) In dollars, the total amount of regulatory 

15 assets under management by the private equity 

16 fund. 

17 ‘‘(13) In dollars, the total amount of net assets 

18 under management by the private equity fund. 

19 ‘‘(14) With respect to the applicable year, the 

20 difference obtained by subtracting the financial 

21 gains of the private equity fund by the fees that the 

22 general partners of the fund charged to the limited 

23 partners of the fund (commonly referred to as the 

24 ‘performance net of fees’). 


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1 ‘‘(15) Any management services agreements be2 tween the covered firm and the private equity fund, 

3 including a disclosure of fees paid through manage4 ment services agreements. 

5 ‘‘(16) Any other services procured by the cov6 ered firm from the private equity fund or any other 

7 company owned by the private equity fund. 

8 ‘‘(17) Dividends paid by the covered firm to the 

9 private equity fund. 

10 ‘‘(18) The names of— 

11 ‘‘(A) the limited partners of the private eq12 uity fund; 

13 ‘‘(B) the board members of the private eq14 uity fund; and 

15 ‘‘(C) the leadership of the covered firm. 

16 ‘‘(19) All political spending by the covered firm, 

17 including contributions, lobbying spending, and con18 tributions to groups that do not share their donor 

19 list. 

20 ‘‘(20) All political spending by the private eq21 uity fund, an affiliate of the fund, or an investment 

22 professional at the fund, with respect to— 

23 ‘‘(A) health care related issues; or 

24 ‘‘(B) members of congressional committees 

25 with oversight of health care. 


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1 ‘‘(21) Information on the extent to which the 

2 covered firm entered into any sale lease back trans3 actions with the private equity fund. 

4 ‘‘(22) Every asset purchased by the covered 

5 firm during the applicable year. 

6 ‘‘(23) Information that is similar to the infor7 mation required to be contained in a notification 

8 filed pursuant to the rules under subsection 

9 7A(d)(1) of the Clayton Act (15 U.S.C. 18a(d)(1)). 

10 ‘‘(24) Data related to real estate, mortgage, 

11 and lease payments. 

12 ‘‘(25) Interest expenses and payments made by 

13 the private equity fund and each covered firm with 

14 respect to the private equity fund to comply with tax 

15 receivable agreements. 

16 ‘‘(26) Average interest rate paid on secured and 

17 unsecured lines of credit by the private equity fund 

18 and each covered firm with respect to the private eq19 uity fund. 

20 ‘‘(27) For the private equity fund and each cov21 ered firm with respect to the private equity fund, a 

22 list of— 

23 ‘‘(A) all transactions with the 10 largest 

24 vendors or service providers; and 

25 ‘‘(B) any new vendors or service providers. 


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1 ‘‘(28) For the private equity fund and each cov2 ered firm with respect to the private equity fund, the 

3 number of payments to staffing firms. 

4 ‘‘(29) For the covered firm, the staffing of each 

5 health care provider owned by such covered firm, 

6 disaggregated by position and ratio of staff to pa7 tients. 

8 ‘‘(30) For the covered firm, the staff retention 

9 rates, number of job postings, and vacancy rates, 

10 disaggregated by position, with respect to each 

11 health care provider owned by such covered firm. 

12 ‘‘(31) For a covered firm that owns 1 or more 

13 hospitals, the number of beds in use and the capac14 ity of each such hospital. 

15 ‘‘(32) For the covered firm, the number of 

16 health care facilities or providers owned by such cov17 ered firm that have closed during such year. 

18 ‘‘(33) For the covered firm, health care costs 

19 charged to patients and public and private health 

20 plans. 

21 ‘‘(34) For the covered firm, the percentage and 

22 number of non-patient care areas in health care fa23 cilities owned by such covered firm that have been 

24 converted into patient care areas. 


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1 ‘‘(35) For the covered firm, reductions in the 

2 wages or benefits of health workers employed by 

3 health care providers owned by such covered firm. 

4 ‘‘(36) For the private equity fund and each cov5 ered firm with respect to the private equity fund, 

6 complaints of, or citations for violations of, State or 

7 Federal worker protection laws, including charges of 

8 unfair labor practices, complaints of violations of 

9 State or Federal antidiscrimination laws, complaints 

10 of violations of wage and hour laws, and whistle11 blower complaints. 

12 ‘‘(37) For the private equity fund and each cov13 ered firm with respect to the private equity fund, 

14 disclosure of any agreement or arrangement with a 

15 labor relations consultant or other independent con16 tractor or organization for which a report is required 

17 to be filed under section 203(a)(4) of the Labor18 Management Reporting and Disclosure Act of 1959 

19 (29 U.S.C. 433(a)(4)). 

20 ‘‘(38) Any other information that the Secretary 

21 determines relevant for evaluating the impact of pri22 vate equity ownership of health care entities on the 

23 provision of health care, health care quality, and 

24 safety. 


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1 ‘‘(c) INFORMATION SUBMITTED BY COVERED FIRMS

2 NOT OWNED BY PRIVATE EQUITY.—For purposes of sub3 section (a) and with respect to a covered firm described 

4 in subsection (a)(1)(B), the information described in this 

5 subsection is the following information with respect to 

6 each year of the previous 10-year period: 

7 ‘‘(1) The level of debt of the covered firm at the 

8 end of the applicable year. 

9 ‘‘(2) The total amount of debt held by the cov10 ered firm that is categorized as— 

11 ‘‘(A) liabilities; 

12 ‘‘(B) long-term liabilities; and 

13 ‘‘(C) payment in kind or zero coupon debt. 

14 ‘‘(3) The average debt-to-equity ratio of the 

15 covered firm. 

16 ‘‘(4) The average debt-to-EBITDA (Earnings 

17 Before Interest, Taxes, Depreciation, and Amortiza18 tion) of the covered firm. 

19 ‘‘(5) Whether the covered firm experienced a 

20 default during the applicable year. 

21 ‘‘(6) The total gross asset value of the covered 

22 firm. 

23 ‘‘(7) Dividends paid by the covered firm. 

24 ‘‘(8) The names of the leadership of the covered 

25 firm. 


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1 ‘‘(9) All political spending by the covered firm, 

2 including contributions, lobbying spending, and con3 tributions to groups that do not share their donor 

4 list. 

5 ‘‘(10) Every asset purchased by the covered 

6 firm during the applicable year. 

7 ‘‘(11) Information that is similar to the infor8 mation required to be included in a notification filed 

9 pursuant to the rules under subsection 7A(d)(1) of 

10 the Clayton Act (15 U.S.C. 18a(d)(1)). 

11 ‘‘(12) Data related to real estate, mortgage, 

12 and lease payments. 

13 ‘‘(13) Interest expenses and payments made to 

14 comply with tax receivable agreements. 

15 ‘‘(14) Average interest rate paid on secured and 

16 unsecured lines of credit. 

17 ‘‘(15) A list of— 

18 ‘‘(A) all transactions with the 10 largest 

19 vendors or service providers; and 

20 ‘‘(B) any new vendors or servicer pro21 viders. 

22 ‘‘(16) The number of payments to staffing 

23 firms. 


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1 ‘‘(17) The salaries of the executives of the cov2 ered firm and each health care entity owned by such 

3 covered firm. 

4 ‘‘(18) The board membership of the covered 

5 firm and each health care entity owned by such cov6 ered firm. 

7 ‘‘(19) The staff retention rates, number of job 

8 postings, and vacancy rates, disaggregated by posi9 tion, with respect to each health care provider owned 

10 by the covered firm. 

11 ‘‘(20) The percentage and number of non-pa12 tient care areas in health care facilities owned by the 

13 covered firm that have been converted into patient 

14 care areas. 

15 ‘‘(21) Reductions in the wages or benefits of 

16 health workers employed by health care providers 

17 owned by the covered firm. 

18 ‘‘(22) Complaints of, or citations for violations 

19 of, State or Federal worker protection laws, includ20 ing charges of unfair labor practices, complaints of 

21 violations of State or Federal antidiscrimination 

22 laws, complaints of violations of wage and hour laws, 

23 and whistleblower complaints. 

24 ‘‘(23) Disclosure of any agreement or arrange25 ment with a labor relations consultant or other indeVerDate Sep 11 2014 23:06 Aug 22, 2024 Jkt 049200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S4804.IS S4804

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1 pendent contractor or organization for which a re2 port is required to be filed under section 203(a)(4) 

3 of the Labor-Management Reporting and Disclosure 

4 Act of 1959 (29 U.S.C. 433(a)(4)). 

5 ‘‘(24) Any other information that the Secretary 

6 determines relevant for evaluating the impact of for7 profit ownership of health care entities on the provi8 sion of health care, health care quality, and safety. 

9 ‘‘(d) NONDUPLICATION; REDUCTION OF ADMINIS10 TRATIVE BURDEN.—To the maximum extent practicable, 

11 the Secretary shall— 

12 ‘‘(1) ensure that the reporting requirements 

13 under this section are not duplicative of other re14 porting requirements under Federal law; and 

15 ‘‘(2) reduce the administrative burden on cov16 ered firms of complying with such requirements. 

17 ‘‘SEC. 3403. RISK MITIGATION AND ACCOUNTABILITY. 

18 ‘‘(a) RISK MITIGATION.— 

19 ‘‘(1) DEFINITION OF ESSENTIAL SERVICES.—In 

20 this subsection, the term ‘essential services’, with re21 spect to a health care provider of a health care enti22 ty owned by or affiliated with a covered firm, means 

23 services that are necessary for preserving health care 

24 access, health care quality, and patient safety, as deVerDate Sep 11 2014 23:06 Aug 22, 2024 Jkt 049200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S4804.IS S4804

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1 termined by the Secretary, including services for 

2 which the Secretary determines— 

3 ‘‘(A) there are no equivalent services avail4 able within the same travel time; 

5 ‘‘(B) that loss of the services would result 

6 in meaningful reductions in surge capacity that 

7 will negatively impact access to services, health 

8 care quality, and patient safety; 

9 ‘‘(C) that loss of the services would limit 

10 health care access, health care quality, and pa11 tient safety for specific demographics of individ12 uals based on sex, sexuality, race, nationality, 

13 age, or disability status; or 

14 ‘‘(D) that loss of the services would have 

15 a meaningful impact on the ability of health 

16 care entities to provide care in the surrounding 

17 geographical area of the health care provider. 

18 ‘‘(2) MECHANISM TO ENSURE RISK MITIGA19 TION.—The Secretary shall establish a mechanism 

20 to ensure that the risks of covered firms with respect 

21 to which there is a private equity fund that is a con22 trol person of the covered firm are mitigated. Such 

23 mechanism may require each such covered firm— 

24 ‘‘(A) to establish an escrow account with 

25 sufficient funding to cover operating and capital 


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1 expenditures for not less than 5 years, includ2 ing, in the case of the closure of a health care 

3 provider of a health care entity owned by or af4 filiated with such covered firm or if there are 

5 reductions of essential health services at such a 

6 health care provider, sufficient funding— 

7 ‘‘(i) to pay out contract obligations to 

8 health care providers and other staff of 

9 such health care entity; and 

10 ‘‘(ii) to provide supplemental funding 

11 to community health care or non-profit 

12 health care providers in the surrounding 

13 geographical area impacted by such closure 

14 or service reductions; 

15 ‘‘(B) to obligate a minimum capital invest16 ment in any health care entity that is owned by 

17 or affiliated with such covered firm; or 

18 ‘‘(C) to carry out such other activities as 

19 the Secretary determines appropriate to ensure 

20 that such covered firm provides a financial con21 tribution sufficient to mitigate the impact of a 

22 potential closure, reduction of essential services, 

23 workforce shortage, or reduction in quality or 

24 safety of care or health care access. 


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1 ‘‘(b) LIMITATION ON THE USE OF REAL ESTATE IN2 VESTMENT TRUSTS IN HEALTH CARE.— 

3 ‘‘(1) PROHIBITION.—No health care entity or 

4 covered firm may enter into agreement to sell to, or 

5 lease from, a real estate investment trust (as defined 

6 in section 856 of the Internal Revenue Code of 

7 1986) an interest in real property if the terms of 

8 such sale or lease would lead to long-term weakened 

9 financial status of the health care entity or place the 

10 public health at risk. 

11 ‘‘(2) REVIEW OF SALE OR LEASE TERMS.— 

12 ‘‘(A) IN GENERAL.—The Secretary shall 

13 require each health care entity, or the covered 

14 firm that owns such health care entity, seeking 

15 to enter into an agreement described in para16 graph (1) to submit to the Secretary for review 

17 the terms of the sale or lease, as applicable. 

18 ‘‘(B) STANDARD.—In conducting a review 

19 of a sale or lease under subparagraph (A), the 

20 Secretary shall determine whether the terms of 

21 such sale or lease would lead to long-term 

22 weakened financial status of the health care en23 tity or place the public health at risk. 


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1 ‘‘(C) CONSULTATION.—The Secretary may 

2 consult with the relevant State attorney general 

3 in conducting a review under subparagraph (A). 

4 ‘‘(3) LITIGATION AUTHORITY.—Except as pro5 vided in section 518 of title 28, United States Code 

6 (relating to litigation before the Supreme Court), at7 torneys designated by the Secretary may appear for 

8 the Department of Health and Human Services and 

9 represent the Department in any civil action brought 

10 in connection with a violation of paragraph (1). 

11 ‘‘(c) LICENSURE.— 

12 ‘‘(1) DEFINITION OF PRIVATE EQUITY FIRM.— 

13 In this subsection, the term ‘private equity firm’ 

14 means a for-profit corporation with respect to which 

15 there is a private equity fund that is a control per16 son of the corporation. 

17 ‘‘(2) LICENSES.—The Secretary shall issue li18 censes for private equity firms to invest, directly or 

19 indirectly, in or purchase a health care entity. 

20 ‘‘(3) FEES.—The Secretary may charge a fee 

21 for applications for licenses under paragraph (1), 

22 which shall be deposited into a special account, the 

23 amounts in which shall remain available to the Sec24 retary, until expended and without further appro25 priation, for funding for the National Health Service 


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1 Corps, the community health centers program under 

2 section 330, teaching health centers that operate 

3 graduate medical education programs under section 

4 340H, and other health workforce programs carried 

5 out by the Health Resources and Services Adminis6 tration, and hospitals that have received dispropor7 tionate share hospital payments under section 1886 

8 of the Social Security Act or section 1923 of such 

9 Act. 

10 ‘‘(4) DENIAL; REVOCATION.— 

11 ‘‘(A) IN GENERAL.—The Secretary may 

12 deny or revoke a license under this subsection— 

13 ‘‘(i) in cases in which the Secretary 

14 determines that the private equity firm— 

15 ‘‘(I) has failed to comply with 

16 any of the provisions of this title; or 

17 ‘‘(II) has engaged in price gaug18 ing, understaffing, access barriers, or 

19 such other metrics as the Secretary 

20 determines appropriate, with respect 

21 to the private equity firm’s ownership 

22 of health care entities; or 

23 ‘‘(ii) for such other reason involving 

24 actions or practices of the private equity 

25 firm that may impact or interfere with acVerDate Sep 11 2014 23:06 Aug 22, 2024 Jkt 049200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S4804.IS S4804

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1 cess to, or quality of, health care, as the 

2 Secretary determines appropriate. 

3 ‘‘(B) DIVESTMENT.—A private equity firm 

4 the license of which is revoked under subpara5 graph (A) shall be required to divest from any 

6 investments in any health care entity. 

7 ‘‘(5) CIVIL MONETARY PENALTIES.—Any pri8 vate equity firm that violates a requirement of this 

9 subsection with respect to a health care entity shall 

10 be liable for a civil monetary penalty of not more 

11 than the amount that is equal to the amount of Fed12 eral funding received by the health care entity, 

13 which shall be deposited in the account described in 

14 paragraph (3). 

15 ‘‘SEC. 3404. TASK FORCE REVIEW OF THE ROLE OF PRIVATE 

16 EQUITY AND CONSOLIDATION IN HEALTH 

17 CARE. 

18 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab19 lish and operate a task force to monitor changes in the 

20 health care marketplace, to address and limit the role of 

21 private equity and consolidation in health care, and to ad22 dress changes to the health care marketplace and private 

23 equity or market consolidation patterns that may create, 

24 continue, or exacerbate health care disparities or disparate 

25 health outcomes based on sex, sexuality, race, nationality, 


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1 ethnicity, age, disability, immigration status, socio2 economic status, or location of residence (referred to in 

3 this section as the ‘Task Force’). 

4 ‘‘(b) COMPOSITION.— 

5 ‘‘(1) CHAIR.—The Secretary shall chair the 

6 Task Force. 

7 ‘‘(2) CO-CHAIR.—The Secretary shall select 

8 from among the members appointed under para9 graph (3) a co-chair of the Task Force, who shall 

10 be a practicing health care provider. 

11 ‘‘(3) MEMBERS.—The Secretary shall appoint 

12 the members of the Task Force from among the fol13 lowing: 

14 ‘‘(A) Academic experts and researchers 

15 with expertise on— 

16 ‘‘(i) the role of private equity in 

17 healthcare; and 

18 ‘‘(ii) the impact of mergers and acqui19 sitions in healthcare on costs and patients. 

20 ‘‘(B) Representatives from organizations 

21 focused on consumer protection, antitrust, 

22 health care equity, patient advocacy, and work23 er advocacy. 

24 ‘‘(C) Hospital and health care staff (and 

25 the labor organizations representing such staff). 


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1 ‘‘(D) Patients. 

2 ‘‘(4) ADVISORY MEMBERS.—In addition to the 

3 members described in paragraph (3), the Chair of 

4 the Federal Trade Commission and the Attorney 

5 General shall serve as advisory members of the Task 

6 Force. 

7 ‘‘(5) MEMBER APPOINTMENT.—Not later than 

8 180 days after the date of enactment of this Act, the 

9 Secretary shall appoint the members of the Task 

10 Force— 

11 ‘‘(A) in accordance with paragraph (2); 

12 and 

13 ‘‘(B) using a competitive application proc14 ess. 

15 ‘‘(c) RECOMMENDATIONS.—The Task Force shall— 

16 ‘‘(1) identify best practices and, for purposes of 

17 subsection (d), develop recommendations, for lim18 iting the role of private equity in health care, taking 

19 into account the implications on health outcomes 

20 and staff working conditions; 

21 ‘‘(2) identify emerging trends within the health 

22 care marketplace that may undermine access to 

23 health care, quality of care, or patient safety or cre24 ate financial instability and risk for health providers; 

25 and 


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1 ‘‘(3) develop legislative recommendations for 

2 preserving and expanding health care quality, safety, 

3 and access under this title. 

4 ‘‘(d) REPORT.—The Secretary shall submit to Con5 gress annually a report— 

6 ‘‘(1) on the recommendations developed sub7 section (c); and 

8 ‘‘(2) that includes regulatory and legislative rec9 ommendations to address any adverse effects of 

10 health care consolidation, private equity’s involve11 ment in health care, or any other change or emerg12 ing trend in the health care marketplace. 

13 ‘‘(e) MORATORIUM.—The Secretary may prohibit a 

14 private equity fund from purchasing voting securities of 

15 a covered firm, and may prohibit any merger or acquisi16 tion that would result in a private equity fund gaining con17 trol of voting securities of a covered firm, until the date 

18 on which the Secretary determines that the Task Force 

19 has had sufficient time to study and identify whether 

20 abuses are taking place in specific health care sectors or 

21 by health care entities related to price gauging, under22 staffing, access barriers, or such other metrics as the Sec23 retary determines appropriate. 

24 ‘‘SEC. 3405. CORPORATE ACCOUNTABILITY. 

25 ‘‘The Secretary shall— 


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1 ‘‘(1) maintain a corporate accountability data 

2 collection program for the reporting of any person 

3 subject to the requirements of this title for failure 

4 to comply with this title; and 

5 ‘‘(2) furnish the information collected under 

6 paragraph (1) to the National Practitioner Data 

7 Bank established pursuant to the Health Care Qual8 ity Improvement Act of 1986. 

9 ‘‘SEC. 3406. ENFORCEMENT. 

10 ‘‘(a) STATE ENFORCEMENT.— 

11 ‘‘(1) STATE AUTHORITY.—Each State may re12 quire a person subject to the requirements of this 

13 title to satisfy such requirements applicable to the 

14 person. 

15 ‘‘(2) FAILURE TO IMPLEMENT REQUIRE16 MENTS.—In the case of a State that fails to sub17 stantially enforce the requirements of this title with 

18 respect to applicable persons in the State, the Sec19 retary shall enforce the requirements of this title 

20 under subsection (b) to the extent that such require21 ments relate to actions prohibited under this title oc22 curring in such State. 

23 ‘‘(b) SECRETARIAL ENFORCEMENT AUTHORITY.— 

24 ‘‘(1) IN GENERAL.—If a person is found by the 

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1 retary may apply a civil monetary penalty with re2 spect to such person in an amount not to exceed 

3 $10,000 per violation. 

4 ‘‘(2) LICENSURE PENALTIES.—A civil monetary 

5 penalty under paragraph (1) shall be in addition to 

6 any civil monetary penalty assessed under section 

7 3403(c)(4). 

8 ‘‘(c) CONTINUED APPLICABILITY OF STATE LAW.— 

9 This title shall not be construed to supersede any provision 

10 of State law that establishes, implements, or continues in 

11 effect any requirement or prohibition except to the extent 

12 that such requirement or prohibition prevents the applica13 tion of a requirement or prohibition of this title. 

14 ‘‘SEC. 3407. RESEARCH. 

15 ‘‘The Secretary shall conduct or support research 

16 on— 

17 ‘‘(1) the impact of transitioning to a ban on 

18 for-profit corporations owning or investing in health 

19 care entities; 

20 ‘‘(2) the impact of private equity investment in 

21 health care entities on— 

22 ‘‘(A) health care costs; 

23 ‘‘(B) access to health care; 

24 ‘‘(C) clinical decision making; 


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1 ‘‘(D) health care entity recruitment and re2 tention; 

3 ‘‘(E) labor organization membership rates 

4 and collective bargaining power of health work5 er labor organizations; 

6 ‘‘(F) health care worker pay, pensions, and 

7 other benefits; 

8 ‘‘(G) health outcomes; and 

9 ‘‘(H) health disparities; 

10 ‘‘(3) the effectiveness of State law (including 

11 regulations) and State enforcement on ensuring ac12 quisition of health care entities by covered firms 

13 does not place access to health care, health care 

14 quality, or patient safety at risk; and 

15 ‘‘(4) compliance the CMS–855A Medicare En16 rollment Application and other Federal ownership 

17 transparency requirements.’’. 

18 SEC. 3. PROHIBITED ACTS BY INVESTMENT COMPANIES 

19 WITH RESPECT TO HEALTH CARE. 

20 Section 12 of the Investment Company Act of 1940 

21 (15 U.S.C. 80a–12) is amended by adding at the end the 

22 following: 

23 ‘‘(h)(1) In this subsection, the term ‘health care enti24 ty’ has the meaning given the term in section 3401 of the 

25 Public Health Service Act. 


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1 ‘‘(2) It shall be unlawful for any registered invest2 ment company to engage in any act, practice, or course 

3 of business that would strip an asset from a health care 

4 entity or otherwise undermine the quality or safety of, or 

5 access to, health care. 

6 ‘‘(3) The Commission, in consultation with the Sec7 retary of Health and Human Services, shall, for the pur8 poses of this subsection, by rules and regulations define, 

9 and prescribe means reasonably designed to prevent, ac10 tions, practices, and courses of business described in para11 graph (2).’’. 

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

13 (a) PRIORITIES OF CLAIMS IN BANKRUPTCY.— 

14 (1) IN GENERAL.—Section 507(a) of title 11, 

15 United States Code, is amended— 

16 (A) by redesignating paragraphs (1) 

17 through 10 as paragraphs (2) through (11), re18 spectively; 

19 (B) by inserting before paragraph (2), as 

20 so redesignated, the following: 

21 ‘‘(A) First, withdrawal liability determined 

22 under part 1 of subtitle E of title IV of the 

23 Employee Retirement Income Security Act of 

24 1974 (29 U.S.C. 1381 et seq.).’’; 


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1 (C) in the matter preceding subparagraph 

2 (A) of paragraph (2), as so redesignated, by 

3 striking ‘‘First:’’ and inserting ‘‘Second:’’; 

4 (D) in paragraph (3), as so redesignated, 

5 by striking ‘‘Second,’’ and inserting ‘‘Third,’’; 

6 (E) in paragraph (4), as so redesignated, 

7 by striking ‘‘Third,’’ and inserting ‘‘Fourth,’’; 

8 (F) in the matter preceding subparagraph 

9 (A) of paragraph (5), as so redesignated, by 

10 striking ‘‘Fourth,’’ and inserting ‘‘Fifth,’’; 

11 (G) in the matter preceding subparagraph 

12 (A) of paragraph (6), as so redesignated, by 

13 striking ‘‘Fifth,’’ and inserting ‘‘Sixth,’’; 

14 (H) in the matter preceding subparagraph 

15 (A) of paragraph (7), as so redesignated, by 

16 striking ‘‘Sixth,’’ and inserting ‘‘Seventh,’’; 

17 (I) in paragraph (8), as so redesignated, 

18 by striking ‘‘Seventh,’’ and inserting ‘‘Eighth,’’; 

19 (J) in the matter preceding subparagraph 

20 (A) of paragraph (9), as so redesignated, by 

21 striking ‘‘Eighth,’’ and inserting ‘‘Ninth,’’; 

22 (K) in paragraph (10), as so redesignated, 

23 by striking ‘‘Ninth,’’ and inserting ‘‘Tenth,’’; 

24 and 


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1 (L) in paragraph (11), as so redesignated, 

2 by striking ‘‘Tenth,’’ and inserting ‘‘Eleventh,’’. 

3 (2) TECHNICAL AND CONFORMING AMEND4 MENTS.— 

5 (A) Section 502(i) of title 11, United 

6 States Code, is amended by striking ‘‘section 

7 507(a)(8)’’ and inserting ‘‘section 507(a)(9)’’. 

8 (B) Section 503(b)(1)(B)(i) of title 11, 

9 United States Code, is amended by striking 

10 ‘‘section 507(a)(8)’’ and inserting ‘‘section 

11 507(a)(9)’’. 

12 (C) Section 507(d) of title 11, United 

13 States Code, is amended by striking ‘‘(a)(1), 

14 (a)(4), (a)(5), (a)(6), (a)(7), (a)(8) excluding 

15 subparagraph (F), or (a)(9)’’ and inserting 

16 ‘‘(a)(2), (a)(5), (a)(6), (a)(7), (a)(8), (a)(9) ex17 cluding subparagraph (F), or (a)(10)’’. 

18 (D) Section 523(a)(1)(A) of title 11, 

19 United States Code, is amended by striking 

20 ‘‘section 507(a)(3) or 507(a)(8)’’ and inserting 

21 ‘‘section 507(a)(4) or 507(a)(9)’’. 

22 (E) Section 724 of title 11, United States 

23 Code, is amended— 

24 (i) in subsection (b)(2)— 


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1 (I) by striking ‘‘section 

2 507(a)(1)(C) or 507(a)(2)’’ and in3 serting ‘‘section 507(a)(2)(C) or 

4 507(a)(3)’’; and 

5 (II) by striking ‘‘507(a)(1)(A), 

6 507(a)(1)(B), 507(a)(3), 507(a)(4), 

7 507(a)(5), 507(a)(6), or 507(a)(7)’’ 

8 and inserting ‘‘507(a)(2)(A), 

9 507(a)(2)(B), 507(a)(4), 507(a)(5), 

10 507(a)(6), 507(a)(7), or 507(a)(8)’’; 

11 and 

12 (ii) in subsection (f)— 

13 (I) in paragraph (1), by striking 

14 ‘‘section 507(a)(4)’’ and inserting 

15 ‘‘section 507(a)(5)’’; and 

16 (II) in paragraph (2), by striking 

17 ‘‘section 507(a)(5)’’ and inserting 

18 ‘‘section 507(a)(6)’’. 

19 (F) Section 726(b) of title 11, United 

20 States Code, is amended by striking ‘‘paragraph 

21 (1), (2), (3), (4), (5), (6), (7), (8), (9), or (10) 

22 of section 507(a)’’ and inserting ‘‘paragraphs 

23 (2) through (11) of section 507(a)’’. 


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1 (G) Section 752(a) of title 11, United 

2 States Code, is amended by striking ‘‘section 

3 507(a)(2)’’ and inserting ‘‘section 507(a)(3)’’. 

4 (H) Section 766 of title 11, United States 

5 Code, is amended— 

6 (i) in subsection (h), by striking ‘‘sec7 tion 507(a)(2)’’ and inserting ‘‘section 

8 507(a)(3)’’; and 

9 (ii) in subsection (i)— 

10 (I) in paragraph (1), by striking 

11 ‘‘section 507(a)(2)’’ and inserting 

12 ‘‘section 507(a)(3)’’; and 

13 (II) in paragraph (2), by striking 

14 ‘‘section 507(a)(2)’’ and inserting 

15 ‘‘section 507(a)(3)’’. 

16 (I) Section 901 of title 11, United States 

17 Code, is amended by striking ‘‘507(a)(2)’’ and 

18 inserting ‘‘507(a)(3)’’. 

19 (J) Section 943(b)(5) of title 11, United 

20 States Code, is amended by striking ‘‘section 

21 507(a)(2)’’ and inserting ‘‘section 507(a)(3)’’. 

22 (K) Section 1123(a)(1) of title 11, United 

23 States Code, is amended by striking ‘‘section 

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1 ing ‘‘section 507(a)(3), 507(a)(4), or 

2 507(a)(9)’’. 

3 (L) Section 1129(a)(9) of title 11, United 

4 States Code, is amended— 

5 (i) in subparagraph (A), by striking 

6 ‘‘section 507(a)(2) or 507(a)(3)’’ and in7 serting ‘‘section 507(a)(3) or 507(a)(4)’’; 

8 (ii) in the matter preceding clause (i) 

9 of subparagraph (B), by striking ‘‘section 

10 507(a)(1), 507(a)(4), 507(a)(5), 507(a)(6), 

11 or 507(a)(7)’’ and inserting ‘‘section 

12 507(a)(2), 507(a)(5), 507(a)(6), 507(a)(7), 

13 or 507(a)(8)’’; 

14 (iii) in the matter preceding clause (i) 

15 of subparagraph (C), by striking ‘‘section 

16 507(a)(8)’’ and inserting ‘‘section 

17 507(a)(9)’’; and 

18 (iv) in subparagraph (D), by striking 

19 ‘‘section 507(a)(8)’’ and inserting ‘‘section 

20 507(a)(9)’’. 

21 (M) Section 1191(e) of title 11, United 

22 States Code, is amended by striking ‘‘paragraph 

23 (2) or (3)’’ and inserting ‘‘paragraph (3) or 

24 (4)’’. 


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1 (N) Section 1222(a)(4) of title 11, United 

2 States Code, is amended by striking ‘‘section 

3 507(a)(1)(B)’’ and inserting ‘‘507(a)(2)(B)’’. 

4 (O) Section 1226(b)(1) of title 11, United 

5 States Code, is amended by striking ‘‘section 

6 507(a)(2)’’ and inserting ‘‘section 507(a)(3)’’. 

7 (P) Section 1322(a)(4) of title 11, United 

8 States Code, is amended by striking ‘‘section 

9 507(a)(1)(B)’’ and inserting ‘‘section 

10 507(a)(2)(B)’’. 

11 (Q) Section 1326(b)(1) of title 11, United 

12 States Code, is amended by striking ‘‘section 

13 507(a)(2)’’ and inserting ‘‘section 507(a)(3)’’. 

14 (R) Section 1328(a)(2) of title 11, United 

15 States Code, is amended by striking ‘‘section 

16 507(a)(8)(C)’’ and inserting ‘‘section 

17 507(a)(9)(C)’’. 

18 (S) Section 6(e) of the Securities Investor 

19 Protection Act of 1970 (15 U.S.C. 78fff(e)) is 

20 amended, in the last sentence, by striking ‘‘sec21 tion 507(a)(2)’’ and inserting ‘‘section 

22 507(a)(3)’’. 

23 (b) CONFIRMATION OF PLAN.—Section 1129 of title 

24 11, United States Code, is amended by adding at the end 

25 the following: 


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1 ‘‘(f) Notwithstanding any other provision of this sec2 tion, if the debtor is a health care business, the court, in 

3 confirming a plan, shall give substantial weight to the ex4 tent to which the plan would allow for maintenance of re5 gional health care access, quality and safety of health care 

6 provided regionally, and health care provider and staff re7 tention regionally.’’. 

8 SEC. 5. MAINTENANCE OF HEALTH CARE ACCESS RELAT9 ING TO HOSPITAL DISCONTINUATION OF 

10 SERVICES OR CLOSURE. 

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

12 1395cc) is amended— 

13 (1) in subsection (a)(1)— 

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

15 ‘‘and’’ at the end; 

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

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

18 (C) by inserting after subparagraph (Y) 

19 the following new subparagraph: 

20 ‘‘(Z) beginning 60 days after the date of the en21 actment of this subparagraph, in the case of a hos22 pital, to comply with the requirements of subsection 

23 (l) (relating to discontinuation of services or clo24 sure).’’; and 


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1 (2) by adding at the end the following new sub2 section: 

3 ‘‘(l) REQUIREMENTS FOR HOSPITALS RELATING TO

4 DISCONTINUATION OF SERVICES OR CLOSURE.— 

5 ‘‘(1) REQUIREMENTS.— 

6 ‘‘(A) IN GENERAL.—For purposes of sub7 section (a)(1)(Z), except as provided in sub8 paragraph (B), the requirements described in 

9 this subsection are that a hospital— 

10 ‘‘(i) notify the Secretary, in accord11 ance with paragraph (2), not less than 90 

12 days prior to the discontinuation of serv13 ices or full hospital closure; 

14 ‘‘(ii) prohibit the discontinuation of 

15 essential services (as defined in paragraph 

16 (6)) during the notification period (as de17 fined in such paragraph) unless there is a 

18 clear harm posed to patient or employee 

19 health or safety in the hospital continuing 

20 to furnish such services; 

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

22 Secretary relating to the implementation of 

23 this subsection, including the determina24 tion of essential services under paragraph 

25 (6)(C); and 


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1 ‘‘(iv) if applicable— 

2 ‘‘(I) submit a mitigation plan 

3 and related information as described 

4 in paragraph (3); and 

5 ‘‘(II) participate in the public 

6 comment and review process (includ7 ing, if applicable, the alternative miti8 gation plan) described in paragraph 

9 (4). 

10 ‘‘(B) APPLICATION IN CASE OF CATA11 STROPHIC EVENTS.—In the case where a dis12 continuation of services or closure of a hospital 

13 is due to an unforeseen catastrophic event (as 

14 defined by the Secretary), the requirements de15 scribed in subparagraph (A) shall apply, ex16 cept— 

17 ‘‘(i) the hospital shall provide the no18 tification under clause (i) of such subpara19 graph not later than 30 days after the cat20 astrophic event or as soon as feasible as 

21 determined by the Secretary; and 

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

23 (relating to prohibiting the discontinuation 

24 of services) shall not apply. 


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1 ‘‘(2) NOTIFICATION INFORMATION.—For pur2 poses of paragraph (1)(A)(i), the notification under 

3 such paragraph shall include the following informa4 tion with respect to a hospital: 

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

6 the case where the hospital is discontinuing 

7 services (without full hospital closure): 

8 ‘‘(i) The services that will be discon9 tinued and number of hospital beds im10 pacted. 

11 ‘‘(ii) The number of individuals fur12 nished such services annually and a break13 down of the type of insurance used by such 

14 individuals for such services. 

15 ‘‘(iii) The number of impacted em16 ployees and what labor organization rep17 resents them (and the contact information 

18 for such organization). 

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

20 organized health care coalitions and com21 munity groups that represent the commu22 nities impacted by the discontinuation of 

23 such services. 

24 ‘‘(v) Alternative providers of such 

25 services, including provider type, contact 


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1 information, and distance and transpor2 tation time by car and public transit from 

3 the hospital. 

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

5 case of full hospital closure: 

6 ‘‘(i) Hospital ownership entities. 

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

8 will no longer be furnished by the hospital. 

9 ‘‘(iii) The number of individuals fur10 nished services annually by the hospital, a 

11 description of the services furnished, and a 

12 breakdown of the type of insurance used 

13 by such individuals for such services. 

14 ‘‘(iv) The number of impacted employ15 ees and, if applicable, what labor organiza16 tions represent them (and the contact in17 formation for each such organization). 

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

19 organized health care coalitions and com20 munity groups that represent the commu21 nities impacted by the closure. 

22 ‘‘(vi) Alternative providers, including 

23 provider type, contact information, and 

24 distance and transportation time by car 

25 and public transit from the hospital. 


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1 ‘‘(vii) Steps taken prior to the deci2 sion to close in order to avoid closure. 

3 ‘‘(viii) Distribution of liquidation pro4 ceeds (cash or assets) or any payments 

5 (cash or assets) made to employees, own6 ers, or contractors related to the closure. 

7 ‘‘(3) SUBMISSION OF MITIGATION PLAN AND

8 RELATED INFORMATION FOR ESSENTIAL SERV9 ICES.— 

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

11 the Secretary determines that the discontinu12 ation of services or closure of an applicable hos13 pital would negatively impact access to essential 

14 services, the Secretary shall notify the applica15 ble hospital of such determination. 

16 ‘‘(B) SUBMISSION OF MITIGATION PLAN

17 AND RELATED INFORMATION.—If an applicable 

18 hospital receives a notification under subpara19 graph (A), the applicable hospital shall, not 

20 later than 15 days after receiving such notifica21 tion, submit to the Secretary, the State health 

22 department, and the local department of public 

23 health— 

24 ‘‘(i) a plan to— 


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1 ‘‘(I) preserve access to essential 

2 services for impacted communities 

3 through partnerships, commitments 

4 from surrounding facilities, transpor5 tation plan access, and preparation 

6 for surge response; and 

7 ‘‘(II) support employees in 

8 transitioning to new positions within 

9 health care; 

10 ‘‘(ii) information on workforce and 

11 public engagement to ensure awareness of 

12 the discontinuation of services or closure; 

13 ‘‘(iii) a description of potential alter14 natives to the discontinuation of services or 

15 closure that the hospital considered and an 

16 explanation of why those alternatives are 

17 not a viable option; and 

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

19 regional bed supply, payor mix distribution 

20 among all providers, demographic trends, 

21 and remaining health systems in the area. 

22 ‘‘(C) PUBLIC AVAILABILITY.—The Sec23 retary shall make a mitigation plan and related 

24 information submitted by an applicable hospital 

25 under this paragraph available to the public on 


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1 the internet website of the Centers for Medicare 

2 & Medicaid Services. 

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

4 ALTERNATIVE MITIGATION PLAN.— 

5 ‘‘(A) PUBLIC COMMENT PERIOD.— 

6 ‘‘(i) IN GENERAL.—The Secretary 

7 shall provide a public comment period of 

8 not less than 45 days with the opportunity 

9 to submit written comments regarding the 

10 impact of the potential discontinuation of 

11 services or closure of an applicable hos12 pital. 

13 ‘‘(ii) NOTICE.—Notice of the oppor14 tunity to submit comments shall be pub15 lished in the Federal Register and distrib16 uted to— 

17 ‘‘(I) providers of services and 

18 suppliers that may be impacted by the 

19 discontinuation of services or closure 

20 of the applicable hospital; 

21 ‘‘(II) any labor organization that 

22 represents any subdivision of employ23 ees of the applicable hospital; 

24 ‘‘(III) organized health care coa25 litions and community groups that 


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1 represent the communities impacted 

2 by the discontinuation of services or 

3 closure; 

4 ‘‘(IV) the State health agency; 

5 and 

6 ‘‘(V) the local department of pub7 lic health. 

8 ‘‘(iii) RECOMMENDATIONS OF STATE

9 HEALTH AGENCY AND LOCAL DEPART10 MENTS OF PUBLIC HEALTH.—In reviewing 

11 a mitigation plan submitted by an applica12 ble hospital under paragraph (3), the Sec13 retary shall take into consideration any 

14 recommendations submitted by the State 

15 health agency and local departments of 

16 public health, as applicable, regarding 

17 whether such plan should be approved. 

18 ‘‘(B) ALTERNATIVE MITIGATION PLAN.— 

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

20 the mitigation plan submitted by an appli21 cable hospital under paragraph (3) and the 

22 comments submitted during the public 

23 comment period under subparagraph (A) 

24 with respect to the discontinuation of serv25 ices or closure of the applicable hospital, 


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1 the Secretary finds that the discontinu2 ation of services or closure of the applica3 ble hospital would have a significant im4 pact on access to essential services, the 

5 Secretary shall work with the applicable 

6 hospital or other providers of services and 

7 suppliers in the area, as appropriate, to de8 velop and implement an alternative plan to 

9 the plan submitted by the applicable hos10 pital under paragraph (3) (referred to in 

11 this subsection as the ‘alternative mitiga12 tion plan’) in order to ensure continued ac13 cess to essential services, which may in14 clude an agreement to delay the dis15 continuation of services or closure of the 

16 applicable hospital until the alternative 

17 mitigation plan is complete. 

18 ‘‘(ii) TECHNICAL ASSISTANCE.—An 

19 alternative mitigation plan under clause (i) 

20 may include technical assistance or infor21 mation on available funding mechanisms to 

22 support the furnishing of essential services. 

23 ‘‘(iii) COLLABORATION.—The Sec24 retary should, to the extent practicable, 

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1 ernment officials in the development of an 

2 alternative mitigation plan under clause 

3 (i). 

4 ‘‘(iv) PUBLIC AVAILABILITY.—The 

5 Secretary shall make any information sub6 mitted and the alternative mitigation plan 

7 developed under this paragraph available 

8 to the public on the internet website of the 

9 Centers for Medicare & Medicaid Services. 

10 ‘‘(C) IMPLEMENTATION.—The Secretary 

11 shall promulgate regulations to detail the re12 quired response time by an applicable hospital 

13 and the speed of the review process under this 

14 paragraph in order to ensure that such process 

15 can be completed with respect to an applicable 

16 hospital prior to the proposed service dis17 continuation date or closure date of the applica18 ble hospital. 

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

20 the Secretary finds that a hospital has violated 

21 the requirements of this subsection, the Sec22 retary may prohibit the hospital and any hos23 pital under the same hospital ownership entity 

24 from being eligible to enroll or reenroll under 


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1 the program under this title under section 

2 1866(j) until the earlier of— 

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

4 date on which the hospital discontinues 

5 services or closes; 

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

7 determines essential health services that 

8 were negatively impacted by the dis9 continuation or closure have been restored; 

10 or 

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

12 satisfied with the mitigation plan sub13 mitted by the hospital under paragraph (3) 

14 or the alternative mitigation plan under 

15 paragraph (4). 

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

17 submit an annual report to Congress on the dis18 continuation of services and full closure of hospitals. 

19 Each report submitted under the preceding sentence 

20 shall include— 

21 ‘‘(A) a description of trends in the dis22 continuation of services and closures of hos23 pitals, including hospital ownership type, geo24 graphic location, types of services furnished, de25 mographic served, and insurance type; 


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1 ‘‘(B) an analysis of the impact of the dis2 continuation of services and closures on health 

3 care access and ability to meet surge demand 

4 due to emergency (such as a pandemic or cli5 mate disaster); and 

6 ‘‘(C) recommendations for such adminis7 trative or legislative changes as the Secretary 

8 determines appropriate to preserve access to es9 sential services nationwide. 

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

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

12 ‘applicable hospital’ means a hospital that sub13 mits a notification under paragraph (1)(A)(i) of 

14 a discontinuation of services or full hospital clo15 sure. 

16 ‘‘(B) DISCONTINUATION.—The term ‘dis17 continuation’ may include any reduction or dis18 continuation of services furnished by an appli19 cable hospital, including those that occur as 

20 part of a merger or acquisition agreement. 

21 ‘‘(C) ESSENTIAL SERVICES.—The term ‘es22 sential services’ means, with respect to an ap23 plicable hospital, services that are necessary for 

24 preserving health care access (as determined by 


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1 the Secretary), including services for which the 

2 Secretary determines— 

3 ‘‘(i) there are no equivalent services 

4 available within the same travel time; 

5 ‘‘(ii) that loss of the services would re6 sult in meaningful reductions in surge ca7 pacity that will negatively impact access to 

8 services; 

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

10 limit health care access for specific demo11 graphics of individuals based on sex, sexu12 ality, race, nationality, age, or disability 

13 status; 

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

15 have a meaningful impact on the ability of 

16 health systems to respond to impacts of 

17 climate change; or 

18 ‘‘(v) there is a health or health care19 related emergency declaration status appli20 cable to the surrounding geographical area 

21 of the hospital on the date on which the 

22 hospital submits notification under para23 graph (1)(A)(i) of a discontinuation of 

24 services or full hospital closure. 


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

2 ‘notification period’ means, with respect to an 

3 applicable hospital, the period beginning on the 

4 date on which the hospital submits notification 

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

6 of services or full hospital closure and ending 

7 on the date of such discontinuation of services 

8 or closure. 

9 ‘‘(7) NO PREEMPTION OF STATE LAW.—Noth10 ing in subsection (a)(1)(Z) or this subsection shall 

11 be construed to limit any rights or remedies under 

12 State or local law relating to protecting access to es13 sential services or reviewing proposed hospital clo14 sures or reduction of services.’’. 

15 SEC. 6. TREATMENT OF RENTS FROM QUALIFIED HEALTH 

16 CARE PROPERTY. 

17 (a) IN GENERAL.—Section 856(d)(2) of the Internal 

18 Revenue Code of 1986 is amended by striking ‘‘and’’ at 

19 the end of subparagraph (B), by striking the period and 

20 inserting ‘‘, and’’ at the end of subparagraph (C), and by 

21 adding at the end the following new subparagraph: 

22 ‘‘(D) notwithstanding paragraphs (4), (6), 

23 and (8), any amount received or accrued di24 rectly or indirectly from qualified health care 


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1 property (as defined in subsection 

2 (e)(6)(D)(i)).’’. 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) Section 856(d)(8)(B) of the Internal Rev5 enue Code of 1986 is amended— 

6 (A) by striking ‘‘or a qualified health care 

7 property (as defined in subsection 

8 (e)(6)(D)(i))’’, and 

9 (B) by striking ‘‘qualified health care prop10 erty or’’. 

11 (2) Section 856(d)(9) of such Code is amend12 ed— 

13 (A) by striking ‘‘or a qualified health care 

14 property (as defined in subsection 

15 (e)(6)(D)(i))’’ in subparagraph (A), 

16 (B) by striking ‘‘or qualified health care 

17 property’’ each place it appears in subpara18 graph (A) and (B), and 

19 (C) by striking ‘‘or qualified health care 

20 properties’’ in subparagraph (A). 

21 (c) EFFECTIVE DATE.—The amendments made by 

22 this section shall apply to taxable years beginning after 

23 the date of the enactment of this Act. 

Æ 


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