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