,,ii  #aahth ,,congress  #b;d ,session  
,s4 #dggg  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,july #be1     
#bjbd,ms4 ,baldwin 7for herself and ,mr4
 ,markey7 introduced the following bill2
 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 closure4 
#a4 ,short title ,this ,act may be cited
 as the ,hospital ,stability and ,health
 ,services ,act of #bjbd4  #b4          
,maintenance of health care access      
relating to hospital discontinuation of 
services or closure ,section #ahff of   
the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;cc7 is amended-- 7#a7 in
 subsection 7a77#a7-- 7,a7 in           
subparagraph 7,x71 by striking and at   
the end2  7,b7 in subparagraph          
7,y77ii77,v71 by striking the period and
 inserting 1 and2 and  7,c7 by inserting
 after subparagraph 7,y7 the following  

new subparagraph3  7,z7 beginning #fj   
days after the date of the enactment of 
this subparagraph1 in the case of a     
hospital1 to comply with the            
requirements of subsection 7l7 7relating
 to discontinuation of services or      
closure74  2 and  7#b7 by adding at the 
end the following new subsection3  7l7  
,requirements for hospitals relating to 
discontinuation of services or closure  
7#a7 ,requirements  7,a7 ,in general    
,for purposes of subsection 7a77#a77,z71
 except as provided in subparagraph     
7,b71 the requirements described in this
 subsection are that a hospital-- 7i7   
notify the ,secretary1 in accordance    
with paragraph 7#b71 not less than #ij  
days prior to the discontinuation of    
services or full hospital closure2  7ii7
 prohibit the discontinuation of        
essential services 7as defined in       
paragraph 7#f77 during the notification 
period 7as defined in such paragraph7   
unless there is a clear harm posed to   
patient or employee health or safety in 

the hospital continuing to furnish such 
services2  7iii7 respond to any         
inquiries by the ,secretary relating to 
the implementation of this subsection1  
including the determination of essential
 services under paragraph 7#f77;,c72 and
  7iv7 if applicable-- 7,i7 submit a    
mitigation plan and related information 
as described in paragraph 7#c72 and     
7,,ii7 participate in the public comment
 and review process 7including1 if      
applicable1 the alternative mitigation  
plan7 described in paragraph 7#d74  7,b7
 ,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 7as defined by the   
,secretary71 the requirements described 
in subparagraph 7,a7 shall apply1       
except-- 7i7 the hospital shall provide 
the notification under clause 7i7 of    
such subparagraph not later than #cj    
days after the catastrophic event or as 
soon as feasible as determined by the   

,secretary2 and  7ii7 clause 7ii7 of    
such subparagraph 7relating to          
prohibiting the discontinuation of      
services7 shall not apply4  7#b7        
,notification information ,for purposes 
of paragraph 7#a77;,a77i71 the          
notification under such paragraph shall 
include the following information with  
respect to a hospital3 7,a7             
,discontinuation of services ,in the    
case where the hospital is discontinuing
 services 7without full hospital        
closure73 7i7 ,the services that will be
 discontinued and number of hospital    
beds impacted4  7ii7 ,the number of     
individuals furnished such services     
annually and a breakdown of the type of 
insurance used by such individuals for  
such services4  7iii7 ,the number of    
impacted employees and what labor       
organization represents them 7and the   
contact information for such            
organization74  7iv7 ,the names and     
addresses of any organized health care  
coalitions and community groups that    

represent the communities impacted by   
the discontinuation of such services4   
7v7 ,alternative providers of such      
services1 including provider type1      
contact information1 and distance and   
transportation time by car and public   
transit from the hospital4  7,b7 ,full  
hospital closure ,in the case of full   
hospital closure3 7i7 ,hospital         
ownership entities4  7ii7 ,the full     
extent of services that will no longer  
be furnished by the hospital4  7iii7    
,the number of individuals furnished    
services annually by the hospital1 a    
description of the services furnished1  
and a breakdown of the type of insurance
 used by such individuals for such      
services4  7iv7 ,the number of impacted 
employees and1 if applicable1 what labor
 organizations represent them 7and the  
contact information for each such       
organization74  7v7 ,the names and      
addresses of any organized health care  
coalitions and community groups that    
represent the communities impacted by   

the closure4  7vi7 ,alternative         
providers1 including provider type1     
contact information1 and distance and   
transportation time by car and public   
transit from the hospital4  7vii7 ,steps
 taken prior to the decision to close in
 order to avoid closure4  7viii7        
,distribution of liquidation proceeds   
7cash or assets7 or any payments 7cash  
or assets7 made to employees1 owners1 or
 contractors related to the closure4    
7#c7 ,submission of mitigation plan and 
related information for essential       
services  7,a7 ,notification by         
secretary ,if the ,secretary determines 
that the discontinuation of services or 
closure of an applicable hospital would 
negatively impact access to essential   
services1 the ,secretary shall notify   
the applicable hospital of such         
determination4  7,b7 ,submission of     
mitigation plan and related information 
,if an applicable hospital receives a   
notification under subparagraph 7,a71   
the applicable hospital shall1 not later

 than #ae days after receiving such     
notification1 submit to the ,secretary1 
the ,state health department1 and the   
local department of public health-- 7i7 
a plan to-- 7,i7 preserve access to     
essential services for impacted         
communities through partnerships1       
commitments from surrounding facilities1
 transportation plan access1 and        
preparation for surge response2 and     
7,,ii7 support employees in             
transitioning to new positions within   
health care2  7ii7 information on       
workforce and public engagement to      
ensure awareness of the discontinuation 
of services or closure2  7iii7 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 option2   
and  7iv7 a local market study to       
ascertain regional bed supply1 payor mix
 distribution among all providers1      
demographic trends1 and remaining health

 systems in the area4  7,c7 ,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  
,services4  7#d7 ,public comment and    
review process2 alternative mitigation  
plan  7,a7 ,public comment period  7i7  
,in general ,the ,secretary shall       
provide a public comment period of not  
less than #de days with the opportunity 
to submit written comments regarding the
 impact of the potential discontinuation
 of services or closure of an applicable
 hospital4  7ii7 ,notice ,notice of the 
opportunity to submit comments shall be 
published in the ,federal ,register and 
distributed to-- 7,i7 providers of      
services and suppliers that may be      
impacted by the discontinuation of      
services or closure of the applicable   
hospital2  7,,ii7 any labor organization
 that represents any subdivision of     

employees of the applicable hospital2   
7,,iii7 organized health care coalitions
 and community groups that represent the
 communities impacted by the            
discontinuation of services or closure2 
7,,iv7 the ,state health agency2 and    
7,v7 the local department of public     
health4  7iii7 ,recommendations of      
,state health agency and local          
departments of public health ,in        
reviewing a mitigation plan submitted by
 an applicable hospital under paragraph 
7#c71 the ,secretary shall take into    
consideration any recommendations       
submitted by the ,state health agency   
and local departments of public health1 
as applicable1 regarding whether such   
plan should be approved4  7,b7          
,alternative mitigation plan  7i7 ,in   
general ,if1 after reviewing the        
mitigation plan submitted by an         
applicable hospital under paragraph 7#c7
 and the comments submitted during the  
public comment period under subparagraph
 7,a7 with respect to the               

discontinuation of services or closure  
of the applicable hospital1 the         
,secretary finds that the               
discontinuation of services or closure  
of the applicable hospital would have a 
significant impact on access to         
essential services1 the ,secretary shall
 work with the applicable hospital or   
other providers of services and         
suppliers in the area1 as appropriate1  
to develop and implement an alternative 
plan to the plan submitted by the       
applicable hospital under paragraph 7#c7
 7referred to in this subsection as the 
alternative mitigation plan7 in order to
 ensure continued access to essential   
services1 which may include an agreement
 to delay the discontinuation of        
services or closure of the applicable   
hospital until the alternative          
mitigation plan is complete4  7ii7      
,technical assistance ,an alternative   
mitigation plan under clause 7i7 may    
include technical assistance or         
information on available funding        

mechanisms to support the furnishing of 
essential services4  7iii7              
,collaboration ,the ,secretary should1  
to the extent practicable1 collaborate  
with ,state and municipal government    
officials in the development of an      
alternative mitigation plan under clause
 7i74  7iv7 ,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 ,services4  7,c7              
,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 hospital4  7,d7          
,prohibition ,in the case where the     

,secretary finds that a hospital has    
violated the requirements of this       
subsection1 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 #ahff7;j7 until the earlier    
of-- 7i7 the date that is #c years after
 the date on which the hospital         
discontinues services or closes2  7ii7  
the date on which the ,secretary        
determines essential health services    
that were negatively impacted by the    
discontinuation or closure have been    
restored2 or  7iii7 such time as the    
,secretary is satisfied with the        
mitigation plan submitted by the        
hospital under paragraph 7#c7 or the    
alternative mitigation plan under       
paragraph 7#d74  7#e7 ,annual reports   
,the ,secretary shall submit an annual  
report to ,congress on the              
discontinuation of services and full    
closure of hospitals4 ,each report      

submitted under the preceding sentence  
shall include-- 7,a7 a description of   
trends in the discontinuation of        
services and closures of hospitals1     
including hospital ownership type1      
geographic location1 types of services  
furnished1 demographic served1 and      
insurance type2  7,b7 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 7such as a pandemic or 
climate disaster72  7,c7 recommendations
 for such administrative or legislative 
changes as the ,secretary determines    
appropriate to preserve access to       
essential services nationwide4  7#f7    
,definitions ,in this subsection3 7,a7  
,applicable hospital ,the term          
applicable hospital means a hospital    
that submits a notification under       
paragraph 7#a77;,a77i7 of a             
discontinuation of services or full     
hospital closure4  7,b7 ,discontinuation
 ,the term discontinuation may include  

any reduction or discontinuation of     
services furnished by an applicable     
hospital1 including those that occur as 
part of a merger or acquisition         
agreement4  7,c7 ,essential services    
,the term essential services means1 with
 respect to an applicable hospital1     
services that are necessary for         
preserving health care access 7as       
determined by the ,secretary71 including
 services for which the ,secretary      
determines-- 7i7 there are no equivalent
 services available within the same     
travel time2  7ii7 that loss of the     
services would result in meaningful     
reductions in surge capacity that will  
negatively impact access to services2   
7iii7 that loss of the services would   
limit health care access for specific   
demographics of individuals based on    
sex1 sexuality1 race1 nationality1 age1 
or disability status2  7iv7 that loss of
 the services would have a meaningful   
impact on the ability of health systems 
to respond to impacts of climate change2

 or  7v7 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            
7#a77;,a77i7 of a discontinuation of    
services or full hospital closure4  7,d7
 ,notification period ,the term         
notification period means1 with respect 
to an applicable hospital1 the period   
beginning on the date on which the      
hospital submits notification under     
paragraph 7#a77;,a77i7 of a             
discontinuation of services or full     
hospital closure and ending on the date 
of such discontinuation of services or  
closure4  7#g7 ,no preemption of state  
law ,nothing in subsection 7a77#a77,z7  
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 services4  4