```

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4777 Introduced in Senate (IS)]

<DOC>

118th CONGRESS
  2d Session
                                S. 4777

To amend title XVIII of the Social Security Act to require hospitals to 
fulfill certain obligations relating to discontinuation of services or 
                                closure.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 25, 2024

Ms. Baldwin (for herself and Mr. Markey) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL

 
To amend title XVIII of the Social Security Act to require hospitals to 
fulfill certain obligations relating to discontinuation of services or 
                                closure.

    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 ``Hospital Stability and Health 
Services Act of 2024''.

SEC. 2. 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);
                    ``(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.''.
                                 <all>
```