II 118th CONGRESS 2d Session S. 4777 IN THE SENATE OF THE UNITED STATES July 25, 2024 Ms. Baldwin (for herself and Mr. Markey ) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to require hospitals to fulfill certain obligations relating to discontinuation of services or closure.

1. Short title This Act may be cited as the Hospital Stability and Health Services Act of 2024 . 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. .