,,ii  #aah? ,,congress  #b;d ,session   
,s4 #dggg  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #be1 #bjbd,ms4   
,baldw9 7= h]self & ,mr4 ,m>key7        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
require hospitals to fulfill c]ta9      
obligations relat+ to discont9uation (  
s]vices or closure4  #a4 ,%ort title    
,?is ,act may be cit$ z ! ,hospital     
,/ability & ,heal? ,s]vices ,act (      
#bjbd4  #b4 ,ma9t5ance ( heal? c>e      
access relat+ to hospital discont9uation
 ( s]vices or closure ,section #ahff ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie;cc7 is am5d$-- 7#a7 9 subsection  
7a77#a7-- 7,a7 9 subp>agraph 7,x71 by   
/rik+ & at ! end2  7,b7 9 subp>agraph   
7,y77ii77,v71 by /rik+ ! p]iod & ins]t+ 
1 &2 &  7,c7 by ins]t+ aft] subp>agraph 
7,y7 ! foll[+ new subp>agraph3  7,z7    
beg9n+ #fj days aft] ! date ( ! enactm5t
 ( ?is subp>agraph1 9 ! case ( a        

hospital1 to comply ) ! requirem5ts (   
subsection 7l7 7relat+ to discont9uation
 ( s]vices or closure74  2 &  7#b7 by   
add+ at ! end ! foll[+ new subsection3  
7l7 ,requirem5ts = hospitals relat+ to  
discont9uation ( s]vices or closure     
7#a7 ,requirem5ts  7,a7 ,9 g5]al ,=     
purposes ( subsection 7a77#a77,z71      
except z provid$ 9 subp>agraph 7,b71 !  
requirem5ts describ$ 9 ?is subsection   
are t a hospital-- 7i7 notify !         
,secret>y1 9 accordance ) p>agraph 7#b71
 n less ?an #ij days prior to !         
discont9uation ( s]vices or full        
hospital closure2  7ii7 prohibit !      
discont9uation ( ess5tial s]vices 7z    
def9$ 9 p>agraph 7#f77 dur+ !           
notification p]iod 7z def9$ 9 su*       
p>agraph7 unless !re is a cle> h>m pos$ 
to pati5t or employee heal? or safety 9 
! hospital cont9u+ to furni% su*        
s]vices2  7iii7 respond to any inquiries
 by ! ,secret>y relat+ to !             
implem5tation ( ?is subsection1 includ+ 
! det]m9ation ( ess5tial s]vices "u     

p>agraph 7#f77;,c72 &  7iv7 if          
applicable-- 7,i7 submit a mitigation   
plan & relat$ in=mation z describ$ 9    
p>agraph 7#c72 &  7,,ii7 p>ticipate 9 ! 
public comm5t & review process 7includ+1
 if applicable1 ! alt]native mitigation 
plan7 describ$ 9 p>agraph 7#d74  7,b7   
,application 9 case ( cata/rophic ev5ts 
,9 ! case :]e a discont9uation ( s]vices
 or closure ( a hospital is due to an   
un=ese5 cata/rophic ev5t 7z def9$ by !  
,secret>y71 ! requirem5ts describ$ 9    
subp>agraph 7,a7 %all apply1 except--   
7i7 ! hospital %all provide !           
notification "u clause 7i7 ( su*        
subp>agraph n lat] ?an #cj days aft] !  
cata/rophic ev5t or z soon z feasible z 
det]m9$ by ! ,secret>y2 &  7ii7 clause  
7ii7 ( su* subp>agraph 7relat+ to       
prohibit+ ! discont9uation ( s]vices7   
%all n apply4  7#b7 ,notification       
in=mation ,= purposes ( p>agraph        
7#a77;,a77i71 ! notification "u su*     
p>agraph %all include ! foll[+ in=mation
 ) respect to a hospital3 7,a7          

,discont9uation ( s]vices ,9 ! case :]e 
! hospital is discont9u+ s]vices 7)\t   
full hospital closure73 7i7 ,! s]vices t
 w be discont9u$ & numb] ( hospital b$s 
impact$4  7ii7 ,! numb] ( individuals   
furni%$ su* s]vices annually & a        
breakd[n ( ! type ( insurance us$ by su*
 individuals = su* s]vices4  7iii7 ,!   
numb] ( impact$ employees & :at labor   
organization repres5ts !m 7& ! contact  
in=mation = su* organization74  7iv7 ,! 
names & addresses ( any organiz$ heal?  
c>e coalitions & community gr\ps t      
repres5t ! communities impact$ by !     
discont9uation ( su* s]vices4  7v7      
,alt]native provid]s ( su* s]vices1     
includ+ provid] type1 contact in=mation1
 & di/ance & transportation "t by c> &  
public transit f ! hospital4  7,b7 ,full
 hospital closure ,9 ! case ( full      
hospital closure3 7i7 ,hospital own]%ip 
entities4  7ii7 ,! full ext5t ( s]vices 
t w no long] be furni%$ by ! hospital4  
7iii7 ,! numb] ( individuals furni%$    
s]vices annually by ! hospital1 a       

description ( ! s]vices furni%$1 & a    
breakd[n ( ! type ( insurance us$ by su*
 individuals = su* s]vices4  7iv7 ,!    
numb] ( impact$ employees &1 if         
applicable1 :at labor organizations     
repres5t !m 7& ! contact in=mation = ea*
 su* organization74  7v7 ,! names &     
addresses ( any organiz$ heal? c>e      
coalitions & community gr\ps t repres5t 
! communities impact$ by ! closure4     
7vi7 ,alt]native provid]s1 includ+      
provid] type1 contact in=mation1 &      
di/ance & transportation "t by c> &     
public transit f ! hospital4  7vii7     
,/eps tak5 prior to ! decision to close 
9 ord] to avoid closure4  7viii7        
,di/ribution ( liquidation proce$s 7ca% 
or assets7 or any paym5ts 7ca% or       
assets7 made to employees1 own]s1 or    
contractors relat$ to ! closure4  7#c7  
,submission ( mitigation plan & relat$  
in=mation = ess5tial s]vices  7,a7      
,notification by secret>y ,if !         
,secret>y det]m9es t ! discont9uation ( 
s]vices or closure ( an applicable      

hospital w\ld negatively impact access  
to ess5tial s]vices1 ! ,secret>y %all   
notify ! applicable hospital ( su*      
det]m9ation4  7,b7 ,submission (        
mitigation plan & relat$ in=mation ,if  
an applicable hospital receives a       
notification "u subp>agraph 7,a71 !     
applicable hospital %all1 n lat] ?an #ae
 days aft] receiv+ su* notification1    
submit to ! ,secret>y1 ! ,/ate heal?    
dep>tm5t1 & ! local dep>tm5t ( public   
heal?-- 7i7 a plan to-- 7,i7 pres]ve    
access to ess5tial s]vices = impact$    
communities ?r\gh p>tn]%ips1 commitm5ts 
f surr\nd+ facilities1 transportation   
plan access1 & prep>ation = surge       
response2 &  7,,ii7 support employees 9 
transition+ to new positions )9 heal?   
c>e2  7ii7 in=mation on work=ce & public
 engagem5t to ensure aw>5ess ( !        
discont9uation ( s]vices or closure2    
7iii7 a description ( pot5tial          
alt]natives to ! discont9uation (       
s]vices or closure t ! hospital consid]$
 & an explanation ( :y ^? alt]natives   

are n a viable option2 &  7iv7 a local  
m>ket /udy to asc]ta9 regional b$       
supply1 payor mix di/ribution among all 
provid]s1 demographic tr5ds1 & rema9+   
heal? sy/ems 9 ! area4  7,c7 ,public    
availability ,! ,secret>y %all make a   
mitigation plan & relat$ in=mation      
submitt$ by an applicable hospital "u   
?is p>agraph available to ! public on ! 
int]net website ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices4  7#d7 ,public comm5t 
& review process2 alt]native mitigation 
plan  7,a7 ,public comm5t p]iod  7i7 ,9 
g5]al ,! ,secret>y %all provide a public
 comm5t p]iod ( n less ?an #de days ) ! 
opportunity to submit writt5 comm5ts    
reg>d+ ! impact ( ! pot5tial            
discont9uation ( s]vices or closure ( an
 applicable hospital4  7ii7 ,notice     
,notice ( ! opportunity to submit       
comm5ts %all be publi%$ 9 ! ,f$]al      
,regi/] & di/ribut$ to-- 7,i7 provid]s (
 s]vices & suppli]s t may be impact$ by 
! discont9uation ( s]vices or closure ( 
! applicable hospital2  7,,ii7 any labor

 organization t repres5ts any           
subdivision ( employees ( ! applicable  
hospital2  7,,iii7 organiz$ heal? c>e   
coalitions & community gr\ps t repres5t 
! communities impact$ by !              
discont9uation ( s]vices or closure2    
7,,iv7 ! ,/ate heal? ag5cy2 &  7,v7 !   
local dep>tm5t ( public heal?4  7iii7   
,recomm5dations ( ,/ate heal? ag5cy &   
local dep>tm5ts ( public heal? ,9       
review+ a mitigation plan submitt$ by an
 applicable hospital "u p>agraph 7#c71 !
 ,secret>y %all take into consid]ation  
any recomm5dations submitt$ by ! ,/ate  
heal? ag5cy & local dep>tm5ts ( public  
heal?1 z applicable1 reg>d+ :e!r su*    
plan %\ld be approv$4  7,b7 ,alt]native 
mitigation plan  7i7 ,9 g5]al ,if1 aft] 
review+ ! mitigation plan submitt$ by an
 applicable hospital "u p>agraph 7#c7 & 
! comm5ts submitt$ dur+ ! public comm5t 
p]iod "u subp>agraph 7,a7 ) respect to !
 discont9uation ( s]vices or closure ( !
 applicable hospital1 ! ,secret>y f9ds t
 ! discont9uation ( s]vices or closure (

 ! applicable hospital w\ld h a         
significant impact on access to ess5tial
 s]vices1 ! ,secret>y %all "w ) !       
applicable hospital or o!r provid]s (   
s]vices & suppli]s 9 ! area1 z          
appropriate1 to develop & implem5t an   
alt]native plan to ! plan submitt$ by ! 
applicable hospital "u p>agraph 7#c7    
7ref]r$ to 9 ?is subsection z !         
alt]native mitigation plan7 9 ord] to   
ensure cont9u$ access to ess5tial       
s]vices1 :i* may include an agreem5t to 
delay ! discont9uation ( s]vices or     
closure ( ! applicable hospital until ! 
alt]native mitigation plan is complete4 
7ii7 ,te*nical assi/ance ,an alt]native 
mitigation plan "u clause 7i7 may       
include te*nical assi/ance or in=mation 
on available fund+ me*anisms to support 
! furni%+ ( ess5tial s]vices4  7iii7    
,collaboration ,! ,secret>y %\ld1 to !  
ext5t practicable1 collaborate ) ,/ate &
 municipal gov]nm5t (ficials 9 !        
developm5t ( an alt]native mitigation   
plan "u clause 7i74  7iv7 ,public       

availability ,! ,secret>y %all make any 
in=mation submitt$ & ! alt]native       
mitigation plan develop$ "u ?is p>agraph
 available to ! public on ! int]net     
website ( ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices4  7,c7 ,implem5tation ,!       
,secret>y %all promulgate regulations to
 detail ! requir$ response "t by an     
applicable hospital & ! spe$ ( ! review 
process "u ?is p>agraph 9 ord] to ensure
 t su* process c be complet$ ) respect  
to an applicable hospital prior to !    
propos$ s]vice discont9uation date or   
closure date ( ! applicable hospital4   
7,d7 ,prohibition ,9 ! case :]e !       
,secret>y f9ds t a hospital has violat$ 
! requirem5ts ( ?is subsection1 !       
,secret>y may prohibit ! hospital & any 
hospital "u ! same hospital own]%ip     
entity f be+ eligible to enroll or      
re5roll "u ! program "u ?is title "u    
section #ahff7;j7 until ! e>li] (-- 7i7 
! date t is #c ye>s aft] ! date on :i* !
 hospital discont9ues s]vices or closes2
  7ii7 ! date on :i* ! ,secret>y        

det]m9es ess5tial heal? s]vices t 7     
negatively impact$ by ! discont9uation  
or closure h be5 re/or$2 or  7iii7 su*  
"t z ! ,secret>y is satisfi$ ) !        
mitigation plan submitt$ by ! hospital  
"u p>agraph 7#c7 or ! alt]native        
mitigation plan "u p>agraph 7#d74  7#e7 
,annual reports ,! ,secret>y %all submit
 an annual report to ,congress on !     
discont9uation ( s]vices & full closure 
( hospitals4 ,ea* report submitt$ "u !  
prec$+ s5t5ce %all include-- 7,a7 a     
description ( tr5ds 9 ! discont9uation (
 s]vices & closures ( hospitals1 includ+
 hospital own]%ip type1 geographic      
location1 types ( s]vices furni%$1      
demographic s]v$1 & insurance type2     
7,b7 an analysis ( ! impact ( !         
discont9uation ( s]vices & closures on  
heal? c>e access & ability to meet surge
 dem& due to em]g5cy 7su* z a p&emic or 
climate disa/]72  7,c7 recomm5dations = 
su* adm9i/rative or legislative *anges z
 ! ,secret>y det]m9es appropriate to    
pres]ve access to ess5tial s]vices      

nationwide4  7#f7 ,def9itions ,9 ?is    
subsection3 7,a7 ,applicable hospital ,!
 t]m applicable hospital means a        
hospital t submits a notification "u    
p>agraph 7#a77;,a77i7 ( a discont9uation
 ( s]vices or full hospital closure4    
7,b7 ,discont9uation ,! t]m             
discont9uation may include any r$uction 
or discont9uation ( s]vices furni%$ by  
an applicable hospital1 includ+ ^? t    
occur z "p ( a m]g] or acquisition      
agreem5t4  7,c7 ,ess5tial s]vices ,! t]m
 ess5tial s]vices means1 ) respect to an
 applicable hospital1 s]vices t are     
necess>y = pres]v+ heal? c>e access 7z  
det]m9$ by ! ,secret>y71 includ+ s]vices
 = :i* ! ,secret>y det]m9es-- 7i7 !re   
are no equival5t s]vices available )9 ! 
same travel "t2  7ii7 t loss ( ! s]vices
 w\ld result 9 mean+ful r$uctions 9     
surge capacity t w negatively impact    
access to s]vices2  7iii7 t loss ( !    
s]vices w\ld limit heal? c>e access =   
specific demographics ( individuals bas$
 on sex1 sexuality1 race1 nationality1  

age1 or disability /atus2  7iv7 t loss (
 ! s]vices w\ld h a mean+ful impact on !
 ability ( heal? sy/ems to respond to   
impacts ( climate *ange2 or  7v7 !re is 
a heal? or heal? c>e-relat$ em]g5cy     
decl>ation /atus applicable to !        
surr\nd+ geographical area ( ! hospital 
on ! date on :i* ! hospital submits     
notification "u p>agraph 7#a77;,a77i7 ( 
a discont9uation ( s]vices or full      
hospital closure4  7,d7 ,notification   
p]iod ,! t]m notification p]iod means1 )
 respect to an applicable hospital1 !   
p]iod beg9n+ on ! date on :i* ! hospital
 submits notification "u p>agraph       
7#a77;,a77i7 ( a discont9uation (       
s]vices or full hospital closure & end+ 
on ! date ( su* discont9uation ( s]vices
 or closure4  7#g7 ,no preemption ( /ate
 law ,no?+ 9 subsection 7a77#a77,z7 or  
?is subsection %all be con/ru$ to limit 
any rights or rem$ies "u ,/ate or local 
law relat+ to protect+ access to        
ess5tial s]vices or review+ propos$     
hospital closures or r$uction ( s]vices4

  4