,,ii  #aah? ,,congress  #b;d ,session   
,s4 #dhjd  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #be1 #bjbd,mr4   
,m>key 7= himself1 ,ms4 ,baldw91 ,mr4   
,wel*1 ,mr4 ,m]kley1 ,ms4 ,w>r51 ,mr4   
,s&]s1 ,mr4 ,book]1 ,ms4 ,smi?1 & ,mr4  
,blum5?al7 introduc$ ! foll[+ bill2 :i* 
0 read twice & ref]r$ to ! ,committee on
 ,f9ance  ,a ,,bill  ,to am5d ! ,public 
,heal? ,s]vice ,act to require !        
,secret>y ( ,heal? & ,human ,s]vices to 
en=ce c]ta9 requirem5ts ) respect to    
=-pr(it corporations t own heal? c>e    
sy/ems1 & = o!r purposes4  #a4 ,%ort    
title ,?is ,act may be cit$ z ! ,heal?  
,ov] ,weal? ,act4  #b4 ,am5dm5t to !    
,public ,heal? ,s]vice ,act ,! ,public  
,heal? ,s]vice ,act 7#db ,u4,s4,c4 #bja 
et seq47 is am5d$ by add+ at ! end !    
foll[+3  ,,xxxiv ,requirem5ts relat+ to 
private own]%ip 9 heal? c>e  #cdja4     
,def9itions ,9 ?is title3 7#a7          
,affiliate ,! t]m affiliate means-- 7,a7
 a p]son t directly or indirectly owns1 
controls1 or holds ) p[] to vote1 #bj   

p]c5t or m ( ! out/&+ vot+ securities ( 
ano!r entity1 o!r ?an a p]son t holds   
su* securities-- 7i7 9 a fiduci>y or    
ag5cy capacity )\t sole discretion>y p[]
 to vote su* securities2 or  7ii7 solely
 to secure a debt1 if su* entity has n 9
 fact ex]cis$ su* p[] to vote2  7,b7 a  
corporation #bj p]c5t or m ( ^: out/&+  
vot+ securities are directly or         
indirectly own$1 controll$1 or held )   
p[] to vote1 by ano!r entity 7ref]r$ to 
9 ?is subp>agraph z a cov]$ entity71 or 
by an entity t directly or indirectly   
owns1 controls1 or holds ) p[] to vote1 
#bj p]c5t or m ( ! out/&+ vot+          
securities ( ! cov]$ entity1 o!r ?an an 
entity t holds su* securities-- 7i7 9 a 
fiduci>y or ag5cy capacity )\t sole     
discretion>y p[] to vote su* securities2
 or  7ii7 solely to secure a debt1 if   
su* entity has n 9 fact ex]cis$ su* p[] 
to vote2  7,c7 a p]son ^: bus9ess is    
op]at$ "u a lease or op]at+ agreem5t by 
ano!r entity1 or p]son sub/antially all 
( ^: prop]ty is op]at$ "u an op]at+     

agreem5t ) t o!r entity2 or  7,d7 an    
entity t op]ates ! bus9ess or           
sub/antially all ( ! prop]ty ( ano!r    
entity "u a lease or op]at+ agreem5t4   
7#b7 ,corporation ,! t]m corporation    
means-- 7,a7 a jo9t-/ock company2  7,b7 
a company or p>tn]%ip association       
organiz$ "u a law t makes only ! capital
 subscrib$ or callable up to a specifi$ 
am\nt responsible = ! debts ( !         
association1 includ+ a limit$ p>tn]%ip &
 a limit$ liability company2  7,c7 a    
tru/2 or  7,d7 an association hav+ a p[]
 or privilege t a private corporation1 b
 n an individual or a p>tn]%ip1         
possesses4  7#c7 ,cov]$ firm ,! t]m     
cov]$ firm means a =-pr(it corporation t
 owns or is an affiliate ( a heal? c>e  
entity4  7#d7 ,heal? c>e entity ,! t]m  
heal? c>e entity means an entity t      
consi/s ( #a or m ( ! foll[+ heal? c>e  
provid]s3 7,a7 ,a hospital4  7,b7 ,a    
physician practice4  7,c7 ,a skill$     
nurs+ facility4  7,d7 ,a hospice        
facility4  7,e7 ,a m5tal or behavioral  

heal? c>e provid]4  7,f7 ,an opioid     
treatm5t program4  7,g7 ,a provid] (    
s]vices 7z def9$ 9 section #ahfa7u7 ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7u77 or a suppli] 7z def9$ 9      
section #ahfa7;d7 ( su* ,act 7#db       
,u4,s4,c4 #acie7;d77 enroll$ 9 ! ,m$ic>e
 program4  7,h7 ,any o!r entity !       
,secret>y det]m9es appropriate4  7#e7   
,private equity fund ,! t]m private     
equity fund means-- 7,a7 7i7 a p]son t  
w\ld be consid]$ an inve/m5t company "u 
section #c ( ! ,inve/m5t ,company ,act (
 #aidj 7#ae ,u4,s4,c4 #hj;a-#c7 b = !   
application ( p>agraph 7#a7 or 7#g7 (   
subsection 7c7 ( su* section #c2  7ii7 a
 v5ture capital fund1 z def9$ 9 section 
#bge4bjc7l7-#a ( title #ag1 ,code (     
,f$]al ,regulations 7or successor       
regulations72 or  7iii7 a sov]eign weal?
 fund2 &  7,b7 directly1 or ?r\gh an    
affiliate1 acts z a control p]son4      
#cdjb4 ,heal? c>e own]%ip transp>5cy    
7a7 ,requir$ report+  7#a7 ,9 g5]al ,!  
,secret>y %all require ea* cov]$ firm to

 submit to ! ,secret>y1 at su* times z !
 ,secret>y det]m9es appropriate1 ?r\gh !
 infra/ructure e/abli%$ "u p>agraph     
7#b71 a report conta9+-- 7,a7 = a cov]$ 
firm ) respect to :i* !re is a private  
equity fund t is a control p]son ( !    
cov]$ firm1 ! in=mation describ$ 9      
subsection 7b72 &  7,b7 = a cov]$ firm n
 describ$ 9 subp>agraph 7,a71 !         
in=mation describ$ 9 subsection 7c74    
7#b7 ,report+ infra/ructure ,!          
,secret>y1 9 consultation ) ! ,secret>y 
( ! ,treasury & ! ,f$]al ,trade         
,commission1 %all e/abli% infra/ructure 
to collect ! data submitt$ "u p>agraph  
7#a74  7#c7 ,public availability ,!     
,secret>y %all make ! data submitt$ "u  
p>agraph 7#a7 publicly available4  7#d7 
,audit+ ,! ,secret>y %all p]iodically   
conduct audits to v]ify ! data submitt$ 
"u p>agraph 7#a74  7#e7 ,annual reports 
,! ,secret>y %all submit to ,congress   
annual reports describ+ tr5ds id5tifi$  
?r\gh analysis ( ! data submitt$ "u     
p>agraph 7#a7 relat+ to-- 7,a7 !        

f9ancial /atus ( cov]$ firms2 &  7,b7 h[
 ! type ( own]%ip ( heal? c>e entities  
impacts access to heal? c>e1 heal? c>e  
quality1 & pati5t safety4  7b7 ,reports 
submitt$ by cov]$ firms own$ by or      
affiliat$ ) private equity ,= purposes (
 subsection 7a71 & ) respect to a cov]$ 
firm describ$ 9 subsection 7a77#a77;,a7 
& ea* private equity fund t is a control
 p]son ( ! cov]$ firm1 ! in=mation      
describ$ 9 ?is subsection is ! foll[+   
in=mation ) respect to ea* ye> ( !      
previ\s #aj-ye> p]iod3 7#a7 ,! p]c5tage 
( ! equity ( ! private equity fund      
contribut$ by-- 7,a7 ! g5]al p>tn]s ( ! 
fund2 &  7,b7 ! limit$ p>tn]s ( ! fund4 
7#b7 ,! level ( debt ( ! cov]$ firm at !
 end ( ! applicable ye>4  7#c7          
,in=mation on ! debt held by ! private  
equity fund1 includ+-- 7,a7 ! doll>     
am\nt ( total debt2  7,b7 ! p]c5tage (  
debt = :i* ! cr$itor is a f9ancial      
in/itution 9 ! ,unit$ ,/ates2  7,c7 !   
p]c5tage ( debt = :i* ! cr$itor is a    
f9ancial in/itution outside ( ! ,unit$  

,/ates2  7,d7 ! p]c5tage ( debt = :i* ! 
cr$itor is an entity t is locat$ 9 !    
,unit$ ,/ates & is n a f9ancial         
in/itution2 &  7,e7 ! p]c5tage ( debt = 
:i* ! cr$itor is an entity t is locat$  
outside ( ! ,unit$ ,/ates & is n a      
f9ancial in/itution4  7#d7 ,! total     
am\nt ( debt held by ! cov]$ firm t is  
categoriz$ z-- 7,a7 liabilities2  7,b7  
long-t]m liabilities2 &  7,c7 paym5t 9  
k9d or z]o c\pon debt4  7#e7 ,! av]age  
debt-to-equity ratio (-- 7,a7 ea* cov]$ 
firm ) respect to ! private equity fund2
 &  7,b7 ! private equity fund4  7#f7 ,!
 av]age debt-to-,,ebitda 7,e>n+s ,be=e  
,int]e/1 ,taxes1 ,depreciation1 &       
,amortization7 ( ea* cov]$ firm )       
respect to ! private equity fund4  7#g7 
,! total numb] ( cov]$ firms ) respect  
to ! private equity fund t exp]i5c$ a   
default dur+ ! applicable ye>1 & ! "n ( 
any su* cov]$ firm4  7#h7 ,! total gross
 asset value ( ea* cov]$ firm ) respect 
to ! private equity fund4  7#i7 ,! gross
 p]=mance ( ! private equity fund dur+ !

 applicable ye>4  7#aj7 ,! total doll>  
am\nt ( aggregate fees & exp5ses        
collect$ by ! private equity fund1 !    
manag] ( ! fund1 or relat$ p>ties f     
cov]$ firms ) respect to ! private      
equity fund1 :i* %all-- 7,a7 be         
categoriz$ by ! type ( fee2 &  7,b7     
include a description ( ! purpose ( !   
fees4  7#aa7 ,any transaction1 monitor+1
 managem5t1 p]=mance1 or o!r fees       
collect$ by ! private equity fund f !   
cov]$ firm4  7#ab7 ,9 doll>s1 ! total   
am\nt ( regulatory assets "u managem5t  
by ! private equity fund4  7#ac7 ,9     
doll>s1 ! total am\nt ( net assets "u   
managem5t by ! private equity fund4     
7#ad7 ,) respect to ! applicable ye>1 ! 
diff]5ce obta9$ by subtract+ ! f9ancial 
ga9s ( ! private equity fund by ! fees t
 ! g5]al p>tn]s ( ! fund *>g$ to !      
limit$ p>tn]s ( ! fund 7commonly ref]r$ 
to z ! p]=mance net ( fees74  7#ae7 ,any
 managem5t s]vices agreem5ts betwe5 !   
cov]$ firm & ! private equity fund1     
includ+ a disclosure ( fees paid ?r\gh  

managem5t s]vices agreem5ts4  7#af7 ,any
 o!r s]vices procur$ by ! cov]$ firm f !
 private equity fund or any o!r company 
own$ by ! private equity fund4  7#ag7   
,divid5ds paid by ! cov]$ firm to !     
private equity fund4  7#ah7 ,! names (--
 7,a7 ! limit$ p>tn]s ( ! private equity
 fund2  7,b7 ! bo>d memb]s ( ! private  
equity fund2 &  7,c7 ! lead]%ip ( !     
cov]$ firm4  7#ai7 ,all political sp5d+ 
by ! cov]$ firm1 includ+ contributions1 
lobby+ sp5d+1 & contributions to gr\ps t
 d n %>e _! donor li/4  7#bj7 ,all      
political sp5d+ by ! private equity     
fund1 an affiliate ( ! fund1 or an      
inve/m5t pr(essional at ! fund1 )       
respect to-- 7,a7 heal? c>e relat$      
issues2 or  7,b7 memb]s ( congressional 
committees ) ov]sight ( heal? c>e4      
7#ba7 ,in=mation on ! ext5t to :i* !    
cov]$ firm ent]$ into any sale lease    
back transactions ) ! private equity    
fund4  7#bb7 ,e asset pur*as$ by ! cov]$
 firm dur+ ! applicable ye>4  7#bc7     
,in=mation t is simil> to ! in=mation   

requir$ to be conta9$ 9 a notification  
fil$ pursuant to ! rules "u subsection  
#g;,a7d77#a7 ( ! ,clayton ,act 7#ae     
,u4,s4,c4 #ah;a7d77#a774  7#bd7 ,data   
relat$ to real e/ate1 mortgage1 & lease 
paym5ts4  7#be7 ,int]e/ exp5ses &       
paym5ts made by ! private equity fund & 
ea* cov]$ firm ) respect to ! private   
equity fund to comply ) tax receivable  
agreem5ts4  7#bf7 ,av]age int]e/ rate   
paid on secur$ & unsecur$ l9es ( cr$it  
by ! private equity fund & ea* cov]$    
firm ) respect to ! private equity fund4
  7#bg7 ,= ! private equity fund & ea*  
cov]$ firm ) respect to ! private equity
 fund1 a li/ (-- 7,a7 all transactions )
 ! #aj l>ge/ v5dors or s]vice provid]s2 
&  7,b7 any new v5dors or s]vice        
provid]s4  7#bh7 ,= ! private equity    
fund & ea* cov]$ firm ) respect to !    
private equity fund1 ! numb] ( paym5ts  
to /aff+ firms4  7#bi7 ,= ! cov]$ firm1 
! /aff+ ( ea* heal? c>e provid] own$ by 
su* cov]$ firm1 disaggregat$ by position
 & ratio ( /aff to pati5ts4  7#cj7 ,= ! 

cov]$ firm1 ! /aff ret5tion rates1 numb]
 ( job po/+s1 & vacancy rates1          
disaggregat$ by position1 ) respect to  
ea* heal? c>e provid] own$ by su* cov]$ 
firm4  7#ca7 ,= a cov]$ firm t owns #a  
or m hospitals1 ! numb] ( b$s 9 use & ! 
capacity ( ea* su* hospital4  7#cb7 ,= !
 cov]$ firm1 ! numb] ( heal? c>e        
facilities or provid]s own$ by su* cov]$
 firm t h clos$ dur+ su* ye>4  7#cc7 ,= 
! cov]$ firm1 heal? c>e co/s *>g$ to    
pati5ts & public & private heal? plans4 
7#cd7 ,= ! cov]$ firm1 ! p]c5tage &     
numb] ( non-pati5t c>e areas 9 heal? c>e
 facilities own$ by su* cov]$ firm t h  
be5 conv]t$ into pati5t c>e areas4      
7#ce7 ,= ! cov]$ firm1 r$uctions 9 !    
wages or b5efits ( heal? work]s employ$ 
by heal? c>e provid]s own$ by su* cov]$ 
firm4  7#cf7 ,= ! private equity fund & 
ea* cov]$ firm ) respect to ! private   
equity fund1 compla9ts (1 or citations =
 violations (1 ,/ate or ,f$]al work]    
protection laws1 includ+ *>ges ( unfair 
labor practices1 compla9ts ( violations 

( ,/ate or ,f$]al antidiscrim9ation     
laws1 compla9ts ( violations ( wage &   
h\r laws1 & :i/lebl[] compla9ts4  7#cg7 
,= ! private equity fund & ea* cov]$    
firm ) respect to ! private equity fund1
 disclosure ( any agreem5t or arrangem5t
 ) a labor relations consultant or o!r  
indep5d5t contractor or organization =  
:i* a report is requir$ to be fil$ "u   
section #bjc7;a77#d7 ( !                
,labor-,managem5t ,report+ & ,disclosure
 ,act ( #aiei 7#bi ,u4,s4,c4            
#dcc7;a77#d774  7#ch7 ,any o!r in=mation
 t ! ,secret>y det]m9es relevant =      
evaluat+ ! impact ( private equity      
own]%ip ( heal? c>e entities on !       
provision ( heal? c>e1 heal? c>e        
quality1 & safety4  7c7 ,in=mation      
submitt$ by cov]$ firms n own$ by       
private equity ,= purposes ( subsection 
7a7 & ) respect to a cov]$ firm describ$
 9 subsection 7a77#a77;,b71 ! in=mation 
describ$ 9 ?is subsection is ! foll[+   
in=mation ) respect to ea* ye> ( !      
previ\s #aj-ye> p]iod3 7#a7 ,! level (  

debt ( ! cov]$ firm at ! end ( !        
applicable ye>4  7#b7 ,! total am\nt (  
debt held by ! cov]$ firm t is          
categoriz$ z-- 7,a7 liabilities2  7,b7  
long-t]m liabilities2 &  7,c7 paym5t 9  
k9d or z]o c\pon debt4  7#c7 ,! av]age  
debt-to-equity ratio ( ! cov]$ firm4    
7#d7 ,! av]age debt-to-,,ebitda 7,e>n+s 
,be=e ,int]e/1 ,taxes1 ,depreciation1 & 
,amortization7 ( ! cov]$ firm4  7#e7    
,:e!r ! cov]$ firm exp]i5c$ a default   
dur+ ! applicable ye>4  7#f7 ,! total   
gross asset value ( ! cov]$ firm4  7#g7 
,divid5ds paid by ! cov]$ firm4  7#h7 ,!
 names ( ! lead]%ip ( ! cov]$ firm4     
7#i7 ,all political sp5d+ by ! cov]$    
firm1 includ+ contributions1 lobby+     
sp5d+1 & contributions to gr\ps t d n   
%>e _! donor li/4  7#aj7 ,e asset       
pur*as$ by ! cov]$ firm dur+ !          
applicable ye>4  7#aa7 ,in=mation t is  
simil> to ! in=mation requir$ to be     
includ$ 9 a notification fil$ pursuant  
to ! rules "u subsection #g;,a7d77#a7 ( 
! ,clayton ,act 7#ae ,u4,s4,c4          

#ah;a7d77#a774  7#ab7 ,data relat$ to   
real e/ate1 mortgage1 & lease paym5ts4  
7#ac7 ,int]e/ exp5ses & paym5ts made to 
comply ) tax receivable agreem5ts4      
7#ad7 ,av]age int]e/ rate paid on secur$
 & unsecur$ l9es ( cr$it4  7#ae7 ,a li/ 
(-- 7,a7 all transactions ) ! #aj l>ge/ 
v5dors or s]vice provid]s2 &  7,b7 any  
new v5dors or s]vic] provid]s4  7#af7 ,!
 numb] ( paym5ts to /aff+ firms4  7#ag7 
,! sal>ies ( ! executives ( ! cov]$ firm
 & ea* heal? c>e entity own$ by su*     
cov]$ firm4  7#ah7 ,! bo>d memb]%ip ( ! 
cov]$ firm & ea* heal? c>e entity own$  
by su* cov]$ firm4  7#ai7 ,! /aff       
ret5tion rates1 numb] ( job po/+s1 &    
vacancy rates1 disaggregat$ by position1
 ) respect to ea* heal? c>e provid] own$
 by ! cov]$ firm4  7#bj7 ,! p]c5tage &  
numb] ( non-pati5t c>e areas 9 heal? c>e
 facilities own$ by ! cov]$ firm t h be5
 conv]t$ into pati5t c>e areas4  7#ba7  
,r$uctions 9 ! wages or b5efits ( heal? 
work]s employ$ by heal? c>e provid]s    
own$ by ! cov]$ firm4  7#bb7 ,compla9ts 

(1 or citations = violations (1 ,/ate or
 ,f$]al work] protection laws1 includ+  
*>ges ( unfair labor practices1         
compla9ts ( violations ( ,/ate or ,f$]al
 antidiscrim9ation laws1 compla9ts (    
violations ( wage & h\r laws1 &         
:i/lebl[] compla9ts4  7#bc7 ,disclosure 
( any agreem5t or arrangem5t ) a labor  
relations consultant or o!r indep5d5t   
contractor or organization = :i* a      
report is requir$ to be fil$ "u section 
#bjc7;a77#d7 ( ! ,labor-,managem5t      
,report+ & ,disclosure ,act ( #aiei 7#bi
 ,u4,s4,c4 #dcc7;a77#d774  7#bd7 ,any   
o!r in=mation t ! ,secret>y det]m9es    
relevant = evaluat+ ! impact ( =-pr(it  
own]%ip ( heal? c>e entities on !       
provision ( heal? c>e1 heal? c>e        
quality1 & safety4  7d7 ,nonduplication2
 r$uction ( adm9i/rative burd5 ,to !    
maximum ext5t practicable1 ! ,secret>y  
%all-- 7#a7 ensure t ! report+          
requirem5ts "u ?is section are n        
duplicative ( o!r report+ requirem5ts "u
 ,f$]al law2 &  7#b7 r$uce !            

adm9i/rative burd5 on cov]$ firms (     
comply+ ) su* requirem5ts4  #cdjc4 ,risk
 mitigation & acc\ntability  7a7 ,risk  
mitigation  7#a7 ,def9ition ( ess5tial  
s]vices ,9 ?is subsection1 ! t]m        
ess5tial s]vices1 ) respect to a heal?  
c>e provid] ( a heal? c>e entity own$ by
 or affiliat$ ) a cov]$ firm1 means     
s]vices t are necess>y = pres]v+ heal?  
c>e access1 heal? c>e quality1 & pati5t 
safety1 z det]m9$ by ! ,secret>y1       
includ+ s]vices = :i* ! ,secret>y       
det]m9es-- 7,a7 !re are no equival5t    
s]vices available )9 ! same travel "t2  
7,b7 t loss ( ! s]vices w\ld result 9   
mean+ful r$uctions 9 surge capacity t w 
negatively impact access to s]vices1    
heal? c>e quality1 & pati5t safety2     
7,c7 t loss ( ! s]vices w\ld limit heal?
 c>e access1 heal? c>e quality1 & pati5t
 safety = specific demographics (       
individuals bas$ on sex1 sexuality1     
race1 nationality1 age1 or disability   
/atus2 or  7,d7 t loss ( ! s]vices w\ld 
h a mean+ful impact on ! ability ( heal?

 c>e entities to provide c>e 9 !        
surr\nd+ geographical area ( ! heal? c>e
 provid]4  7#b7 ,me*anism to ensure risk
 mitigation ,! ,secret>y %all e/abli% a 
me*anism to ensure t ! risks ( cov]$    
firms ) respect to :i* !re is a private 
equity fund t is a control p]son ( !    
cov]$ firm are mitigat$4 ,su* me*anism  
may require ea* su* cov]$ firm-- 7,a7 to
 e/abli% an escr[ acc\nt ) suffici5t    
fund+ to cov] op]at+ & capital          
exp5ditures = n less ?an #e ye>s1       
includ+1 9 ! case ( ! closure ( a heal? 
c>e provid] ( a heal? c>e entity own$ by
 or affiliat$ ) su* cov]$ firm or if !re
 are r$uctions ( ess5tial heal? s]vices 
at su* a heal? c>e provid]1 suffici5t   
fund+-- 7i7 to pay out contract         
obligations to heal? c>e provid]s & o!r 
/aff ( su* heal? c>e entity2 &  7ii7 to 
provide supplem5tal fund+ to community  
heal? c>e or non-pr(it heal? c>e        
provid]s 9 ! surr\nd+ geographical area 
impact$ by su* closure or s]vice        
r$uctions2  7,b7 to obligate a m9imum   

capital inve/m5t 9 any heal? c>e entity 
t is own$ by or affiliat$ ) su* cov]$   
firm2 or  7,c7 to c>ry out su* o!r      
activities z ! ,secret>y det]m9es       
appropriate to ensure t su* cov]$ firm  
provides a f9ancial contribution        
suffici5t to mitigate ! impact ( a      
pot5tial closure1 r$uction ( ess5tial   
s]vices1 work=ce %ortage1 or r$uction 9 
quality or safety ( c>e or heal? c>e    
access4  7b7 ,limitation on ! use ( real
 e/ate inve/m5t tru/s 9 heal? c>e  7#a7 
,prohibition ,no heal? c>e entity or    
cov]$ firm may ent] into agreem5t to    
sell to1 or lease f1 a real e/ate       
inve/m5t tru/ 7z def9$ 9 section #hef ( 
! ,int]nal ,rev5ue ,code ( #aihf7 an    
int]e/ 9 real prop]ty if ! t]ms ( su*   
sale or lease w\ld lead to long-t]m     
weak5$ f9ancial /atus ( ! heal? c>e     
entity or place ! public heal? at risk4 
7#b7 ,review ( sale or lease t]ms  7,a7 
,9 g5]al ,! ,secret>y %all require ea*  
heal? c>e entity1 or ! cov]$ firm t owns
 su* heal? c>e entity1 seek+ to ent]    

into an agreem5t describ$ 9 p>agraph    
7#a7 to submit to ! ,secret>y = review !
 t]ms ( ! sale or lease1 z applicable4  
7,b7 ,/&>d ,9 conduct+ a review ( a sale
 or lease "u subp>agraph 7,a71 !        
,secret>y %all det]m9e :e!r ! t]ms ( su*
 sale or lease w\ld lead to long-t]m    
weak5$ f9ancial /atus ( ! heal? c>e     
entity or place ! public heal? at risk4 
7,c7 ,consultation ,! ,secret>y may     
consult ) ! relevant ,/ate attorney     
g5]al 9 conduct+ a review "u subp>agraph
 7,a74  7#c7 ,litigation au?ority       
,except z provid$ 9 section #eah ( title
 #bh1 ,unit$ ,/ates ,code 7relat+ to    
litigation be=e ! ,supreme ,c\rt71      
attorneys designat$ by ! ,secret>y may  
appe> = ! ,dep>tm5t ( ,heal? & ,human   
,s]vices & repres5t ! ,dep>tm5t 9 any   
civil action br\ght 9 connection ) a    
violation ( p>agraph 7#a74  7c7         
,lic5sure  7#a7 ,def9ition ( private    
equity firm ,9 ?is subsection1 ! t]m    
private equity firm means a =-pr(it     
corporation ) respect to :i* !re is a   

private equity fund t is a control p]son
 ( ! corporation4  7#b7 ,lic5ses ,!     
,secret>y %all issue lic5ses = private  
equity firms to inve/1 directly or      
indirectly1 9 or pur*ase a heal? c>e    
entity4  7#c7 ,fees ,! ,secret>y may    
*>ge a fee = applications = lic5ses "u  
p>agraph 7#a71 :i* %all be deposit$ into
 a special acc\nt1 ! am\nts 9 :i* %all  
rema9 available to ! ,secret>y1 until   
exp5d$ & )\t fur!r appropriation1 =     
fund+ = ! ,national ,heal? ,s]vice      
,corps1 ! community heal? c5t]s program 
"u section #ccj1 tea*+ heal? c5t]s t    
op]ate graduate m$ical education        
programs "u section #cdj;,h1 & o!r heal?
 work=ce programs c>ri$ out by ! ,heal? 
,res\rces & ,s]vices ,adm9i/ration1 &   
hospitals t h receiv$ disproportionate  
%>e hospital paym5ts "u section #ahhf ( 
! ,social ,security ,act or section     
#aibc ( su* ,act4  7#d7 ,d5ial2         
revocation  7,a7 ,9 g5]al ,! ,secret>y  
may d5y or revoke a lic5se "u ?is       
subsection-- 7i7 9 cases 9 :i* !        

,secret>y det]m9es t ! private equity   
firm-- 7,i7 has fail$ to comply ) any ( 
! provisions ( ?is title2 or  7,,ii7 has
 engag$ 9 price gaug+1 und]/aff+1 access
 b>ri]s1 or su* o!r metrics z !         
,secret>y det]m9es appropriate1 )       
respect to ! private equity firm's      
own]%ip ( heal? c>e entities2 or  7ii7 =
 su* o!r reason involv+ actions or      
practices ( ! private equity firm t may 
impact or int]f]e ) access to1 or       
quality (1 heal? c>e1 z ! ,secret>y     
det]m9es appropriate4  7,b7 ,dive/m5t ,a
 private equity firm ! lic5se ( :i* is  
revok$ "u subp>agraph 7,a7 %all be      
requir$ to dive/ f any inve/m5ts 9 any  
heal? c>e entity4  7#e7 ,civil monet>y  
p5alties ,any private equity firm t     
violates a requirem5t ( ?is subsection )
 respect to a heal? c>e entity %all be  
liable = a civil monet>y p5alty ( n m   
?an ! am\nt t is equal to ! am\nt (     
,f$]al fund+ receiv$ by ! heal? c>e     
entity1 :i* %all be deposit$ 9 ! acc\nt 
describ$ 9 p>agraph 7#c74  #cdjd4 ,task 

,=ce review ( ! role ( private equity & 
consolidation 9 heal? c>e  7a7          
,e/abli%m5t ,! ,secret>y %all e/abli% & 
op]ate a task =ce to monitor *anges 9 ! 
heal? c>e m>ketplace1 to address & limit
 ! role ( private equity & consolidation
 9 heal? c>e1 & to address *anges to !  
heal? c>e m>ketplace & private equity or
 m>ket consolidation patt]ns t may      
create1 cont9ue1 or exac]bate heal? c>e 
disp>ities or disp>ate heal? outcomes   
bas$ on sex1 sexuality1 race1           
nationality1 e?nicity1 age1 disability1 
immigration /atus1 socioeconomic /atus1 
or location ( resid5ce 7ref]r$ to 9 ?is 
section z ! ,task ,=ce74  7b7           
,composition  7#a7 ,*air ,! ,secret>y   
%all *air ! ,task ,=ce4  7#b7 ,co-*air  
,! ,secret>y %all select f among !      
memb]s appo9t$ "u p>agraph 7#c7 a       
co-*air ( ! ,task ,=ce1 :o %all be a    
practic+ heal? c>e provid]4  7#c7       
,memb]s ,! ,secret>y %all appo9t !      
memb]s ( ! ,task ,=ce f among ! foll[+3 
7,a7 ,academic exp]ts & rese>*]s )      

exp]tise on-- 7i7 ! role ( private      
equity 9 heal?c>e2 &  7ii7 ! impact (   
m]g]s & acquisitions 9 heal?c>e on co/s 
& pati5ts4  7,b7 ,repres5tatives f      
organizations focus$ on consum]         
protection1 antitru/1 heal? c>e equity1 
pati5t advocacy1 & work] advocacy4  7,c7
 ,hospital & heal? c>e /aff 7& ! labor  
organizations repres5t+ su* /aff74  7,d7
 ,pati5ts4  7#d7 ,advisory memb]s ,9    
addition to ! memb]s describ$ 9 p>agraph
 7#c71 ! ,*air ( ! ,f$]al ,trade        
,commission & ! ,attorney ,g5]al %all   
s]ve z advisory memb]s ( ! ,task ,=ce4  
7#e7 ,memb] appo9tm5t ,n lat] ?an #ahj  
days aft] ! date ( enactm5t ( ?is ,act1 
! ,secret>y %all appo9t ! memb]s ( !    
,task ,=ce-- 7,a7 9 accordance )        
p>agraph 7#b72 &  7,b7 us+ a competitive
 application process4  7c7              
,recomm5dations ,! ,task ,=ce %all--    
7#a7 id5tify be/ practices &1 = purposes
 ( subsection 7d71 develop              
recomm5dations1 = limit+ ! role (       
private equity 9 heal? c>e1 tak+ into   

acc\nt ! implications on heal? outcomes 
& /aff work+ conditions2  7#b7 id5tify  
em]g+ tr5ds )9 ! heal? c>e m>ketplace t 
may und]m9e access to heal? c>e1 quality
 ( c>e1 or pati5t safety or create      
f9ancial in/ability & risk = heal?      
provid]s2 &  7#c7 develop legislative   
recomm5dations = pres]v+ & exp&+ heal?  
c>e quality1 safety1 & access "u ?is    
title4  7d7 ,report ,! ,secret>y %all   
submit to ,congress annually a report-- 
7#a7 on ! recomm5dations develop$       
subsection 7c72 &  7#b7 t includes      
regulatory & legislative recomm5dations 
to address any adv]se effects ( heal?   
c>e consolidation1 private equity's     
involvem5t 9 heal? c>e1 or any o!r *ange
 or em]g+ tr5d 9 ! heal? c>e m>ketplace4
  7e7 ,moratorium ,! ,secret>y may      
prohibit a private equity fund f pur*as+
 vot+ securities ( a cov]$ firm1 & may  
prohibit any m]g] or acquisition t w\ld 
result 9 a private equity fund ga9+     
control ( vot+ securities ( a cov]$     
firm1 until ! date on :i* ! ,secret>y   

det]m9es t ! ,task ,=ce has _h suffici5t
 "t to /udy & id5tify :e!r abuses are   
tak+ place 9 specific heal? c>e sectors 
or by heal? c>e entities relat$ to price
 gaug+1 und]/aff+1 access b>ri]s1 or su*
 o!r metrics z ! ,secret>y det]m9es     
appropriate4  #cdje4 ,corporate         
acc\ntability ,! ,secret>y %all-- 7#a7  
ma9ta9 a corporate acc\ntability data   
collection program = ! report+ ( any    
p]son subject to ! requirem5ts ( ?is    
title = failure to comply ) ?is title2 &
  7#b7 furni% ! in=mation collect$ "u   
p>agraph 7#a7 to ! ,national            
,practition] ,data ,bank e/abli%$       
pursuant to ! ,heal? ,c>e ,quality      
,improvem5t ,act ( #aihf4  #cdjf4       
,en=cem5t  7a7 ,/ate en=cem5t  7#a7     
,/ate au?ority ,ea* ,/ate may require a 
p]son subject to ! requirem5ts ( ?is    
title to satisfy su* requirem5ts        
applicable to ! p]son4  7#b7 ,failure to
 implem5t requirem5ts ,9 ! case ( a     
,/ate t fails to sub/antially en=ce !   
requirem5ts ( ?is title ) respect to    

applicable p]sons 9 ! ,/ate1 ! ,secret>y
 %all en=ce ! requirem5ts ( ?is title "u
 subsection 7b7 to ! ext5t t su*        
requirem5ts relate to actions prohibit$ 
"u ?is title occurr+ 9 su* ,/ate4  7b7  
,secret>ial en=cem5t au?ority  7#a7 ,9  
g5]al ,if a p]son is f\nd by ! ,secret>y
 to be 9 violation ( ?is title1 !       
,secret>y may apply a civil monet>y     
p5alty ) respect to su* p]son 9 an am\nt
 n to exce$ #aj1jjj p] violation4  7#b7 
,lic5sure p5alties ,a civil monet>y     
p5alty "u p>agraph 7#a7 %all be 9       
addition to any civil monet>y p5alty    
assess$ "u section #cdjc7;c77#d74  7c7  
,cont9u$ applicability ( /ate law ,?is  
title %all n be con/ru$ to sup]s$e any  
provision ( ,/ate law t e/abli%es1      
implem5ts1 or cont9ues 9 effect any     
requirem5t or prohibition except to !   
ext5t t su* requirem5t or prohibition   
prev5ts ! application ( a requirem5t or 
prohibition ( ?is title4  #cdjg4 ,rese>*
 ,! ,secret>y %all conduct or support   
rese>* on-- 7#a7 ! impact ( transition+ 

to a ban on =-pr(it corporations own+ or
 inve/+ 9 heal? c>e entities2  7#b7 !   
impact ( private equity inve/m5t 9 heal?
 c>e entities on-- 7,a7 heal? c>e co/s2 
7,b7 access to heal? c>e2  7,c7 cl9ical 
decision mak+2  7,d7 heal? c>e entity   
recruitm5t & ret5tion2  7,e7 labor      
organization memb]%ip rates & collective
 b>ga9+ p[] ( heal? work] labor         
organizations2  7,f7 heal? c>e work]    
pay1 p5sions1 & o!r b5efits2  7,g7 heal?
 outcomes2 &  7,h7 heal? disp>ities2    
7#c7 ! effectiv5ess ( ,/ate law 7includ+
 regulations7 & ,/ate en=cem5t on ensur+
 acquisition ( heal? c>e entities by    
cov]$ firms does n place access to heal?
 c>e1 heal? c>e quality1 or pati5t      
safety at risk2 &  7#d7 compliance !    
,,cms-#hee;,a ,m$ic>e ,enrollm5t        
,application & o!r ,f$]al own]%ip       
transp>5cy requirem5ts4  4  #c4         
,prohibit$ acts by inve/m5t companies ) 
respect to heal? c>e ,section #ab ( !   
,inve/m5t ,company ,act ( #aidj 7#ae    
,u4,s4,c4 #hj;a-#ab7 is am5d$ by add+ at

 ! end ! foll[+3  7h7 7#a7 ,9 ?is       
subsection1 ! t]m heal? c>e entity has !
 mean+ giv5 ! t]m 9 section #cdja ( !   
,public ,heal? ,s]vice ,act4  7#b7 ,x   
%all be unlawful = any regi/]$ inve/m5t 
company to engage 9 any act1 practice1  
or c\rse ( bus9ess t w\ld /rip an asset 
f a heal? c>e entity or o!rwise und]m9e 
! quality or safety (1 or access to1    
heal? c>e4  7#c7 ,! ,commission1 9      
consultation ) ! ,secret>y ( ,heal? &   
,human ,s]vices1 %all1 = ! purposes (   
?is subsection1 by rules & regulations  
def9e1 & prescribe means reasonably     
design$ to prev5t1 actions1 practices1 &
 c\rses ( bus9ess describ$ 9 p>agraph   
7#b74  4  #d4 ,am5dm5ts to title #aa1   
,unit$ ,/ates ,code  7a7 ,priorities (  
claims 9 bankruptcy  7#a7 ,9 g5]al      
,section #ejg7;a7 ( title #aa1 ,unit$   
,/ates ,code1 is am5d$-- 7,a7 by        
r$esignat+ p>agraphs 7#a7 ?r\gh #aj z   
p>agraphs 7#b7 ?r\gh 7#aa71             
respectively2  7,b7 by ins]t+ be=e      
p>agraph 7#b71 z s r$esignat$1 ! foll[+3

  7,a7 ,fir/1 )drawal liability det]m9$ 
"u "p #a ( subtitle ,e ( title ,,iv ( ! 
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #acha et    
seq474  2  7,c7 9 ! matt] prec$+        
subp>agraph 7,a7 ( p>agraph 7#b71 z s   
r$esignat$1 by /rik+ ,fir/3 & ins]t+    
,second32  7,d7 9 p>agraph 7#c71 z s    
r$esignat$1 by /rik+ ,second1 & ins]t+  
,?ird12  7,e7 9 p>agraph 7#d71 z s      
r$esignat$1 by /rik+ ,?ird1 & ins]t+    
,f\r?12  7,f7 9 ! matt] prec$+          
subp>agraph 7,a7 ( p>agraph 7#e71 z s   
r$esignat$1 by /rik+ ,f\r?1 & ins]t+    
,fif?12  7,g7 9 ! matt] prec$+          
subp>agraph 7,a7 ( p>agraph 7#f71 z s   
r$esignat$1 by /rik+ ,fif?1 & ins]t+    
,six?12  7,h7 9 ! matt] prec$+          
subp>agraph 7,a7 ( p>agraph 7#g71 z s   
r$esignat$1 by /rik+ ,six?1 & ins]t+    
,sev5?12  7,i7 9 p>agraph 7#h71 z s     
r$esignat$1 by /rik+ ,sev5?1 & ins]t+   
,eigh?12  7,j7 9 ! matt] prec$+         
subp>agraph 7,a7 ( p>agraph 7#i71 z s   
r$esignat$1 by /rik+ ,eigh?1 & ins]t+   

,n9?12  7,k7 9 p>agraph 7#aj71 z s      
r$esignat$1 by /rik+ ,n9?1 & ins]t+     
,t5?12 &  7,l7 9 p>agraph 7#aa71 z s    
r$esignat$1 by /rik+ ,t5?1 & ins]t+     
,elev5?14  7#b7 ,te*nical & con=m+      
am5dm5ts  7,a7 ,section #ejb7;i7 ( title
 #aa1 ,unit$ ,/ates ,code1 is am5d$ by  
/rik+ section #ejg7;a77#h7 & ins]t+     
section #ejg7;a77#i74  7,b7 ,section    
#ejc7;b77#a77;,b77i7 ( title #aa1 ,unit$
 ,/ates ,code1 is am5d$ by /rik+ section
 #ejg7;a77#h7 & ins]t+ section          
#ejg7;a77#i74  7,c7 ,section #ejg7;d7 ( 
title #aa1 ,unit$ ,/ates ,code1 is am5d$
 by /rik+ 7a77#a71 7a77#d71 7a77#e71    
7a77#f71 7a77#g71 7a77#h7 exclud+       
subp>agraph 7,f71 or 7a77#i7 & ins]t+   
7a77#b71 7a77#e71 7a77#f71 7a77#g71     
7a77#h71 7a77#i7 exclud+ subp>agraph    
7,f71 or 7a77#aj74  7,d7 ,section       
#ebc7;a77#a77;,a7 ( title #aa1 ,unit$   
,/ates ,code1 is am5d$ by /rik+ section 
#ejg7;a77#c7 or #ejg7;a77#h7 & ins]t+   
section #ejg7;a77#d7 or #ejg7;a77#i74   
7,e7 ,section #gbd ( title #aa1 ,unit$  

,/ates ,code1 is am5d$-- 7i7 9          
subsection 7b77#b7-- 7,i7 by /rik+      
section #ejg7;a77#a77;,c7 or            
#ejg7;a77#b7 & ins]t+ section           
#ejg7;a77#b77;,c7 or #ejg7;a77#c72 &    
7,,ii7 by /rik+ #ejg7;a77#a77;,a71      
#ejg7;a77#a77;,b71 #ejg7;a77#c71        
#ejg7;a77#d71 #ejg7;a77#e71             
#ejg7;a77#f71 or #ejg7;a77#g7 & ins]t+  
#ejg7;a77#b77;,a71 #ejg7;a77#b77;,b71   
#ejg7;a77#d71 #ejg7;a77#e71             
#ejg7;a77#f71 #ejg7;a77#g71 or          
#ejg7;a77#h72 &  7ii7 9 subsection 7f7--
 7,i7 9 p>agraph 7#a71 by /rik+ section 
#ejg7;a77#d7 & ins]t+ section           
#ejg7;a77#e72 &  7,,ii7 9 p>agraph 7#b71
 by /rik+ section #ejg7;a77#e7 & ins]t+ 
section #ejg7;a77#f74  7,f7 ,section    
#gbf7;b7 ( title #aa1 ,unit$ ,/ates     
,code1 is am5d$ by /rik+ p>agraph 7#a71 
7#b71 7#c71 7#d71 7#e71 7#f71 7#g71     
7#h71 7#i71 or 7#aj7 ( section #ejg7;a7 
& ins]t+ p>agraphs 7#b7 ?r\gh 7#aa7 (   
section #ejg7;a74  7,g7 ,section        
#geb7;a7 ( title #aa1 ,unit$ ,/ates     

,code1 is am5d$ by /rik+ section        
#ejg7;a77#b7 & ins]t+ section           
#ejg7;a77#c74  7,h7 ,section #gff (     
title #aa1 ,unit$ ,/ates ,code1 is      
am5d$-- 7i7 9 subsection 7h71 by /rik+  
section #ejg7;a77#b7 & ins]t+ section   
#ejg7;a77#c72 &  7ii7 9 subsection 7i7--
 7,i7 9 p>agraph 7#a71 by /rik+ section 
#ejg7;a77#b7 & ins]t+ section           
#ejg7;a77#c72 &  7,,ii7 9 p>agraph 7#b71
 by /rik+ section #ejg7;a77#b7 & ins]t+ 
section #ejg7;a77#c74  7,i7 ,section    
#ija ( title #aa1 ,unit$ ,/ates ,code1  
is am5d$ by /rik+ #ejg7;a77#b7 & ins]t+ 
#ejg7;a77#c74  7,j7 ,section            
#idc7;b77#e7 ( title #aa1 ,unit$ ,/ates 
,code1 is am5d$ by /rik+ section        
#ejg7;a77#b7 & ins]t+ section           
#ejg7;a77#c74  7,k7 ,section            
#aabc7;a77#a7 ( title #aa1 ,unit$ ,/ates
 ,code1 is am5d$ by /rik+ section       
#ejg7;a77#b71 #ejg7;a77#c71 or          
#ejg7;a77#h7 & ins]t+ section           
#ejg7;a77#c71 #ejg7;a77#d71 or          
#ejg7;a77#i74  7,l7 ,section            

#aabi7;a77#i7 ( title #aa1 ,unit$ ,/ates
 ,code1 is am5d$-- 7i7 9 subp>agraph    
7,a71 by /rik+ section #ejg7;a77#b7 or  
#ejg7;a77#c7 & ins]t+ section           
#ejg7;a77#c7 or #ejg7;a77#d72  7ii7 9 ! 
matt] prec$+ clause 7i7 ( subp>agraph   
7,b71 by /rik+ section #ejg7;a77#a71    
#ejg7;a77#d71 #ejg7;a77#e71             
#ejg7;a77#f71 or #ejg7;a77#g7 & ins]t+  
section #ejg7;a77#b71 #ejg7;a77#e71     
#ejg7;a77#f71 #ejg7;a77#g71 or          
#ejg7;a77#h72  7iii7 9 ! matt] prec$+   
clause 7i7 ( subp>agraph 7,c71 by /rik+ 
section #ejg7;a77#h7 & ins]t+ section   
#ejg7;a77#i72 &  7iv7 9 subp>agraph     
7,d71 by /rik+ section #ejg7;a77#h7 &   
ins]t+ section #ejg7;a77#i74  7,m7      
,section #aaia7;e7 ( title #aa1 ,unit$  
,/ates ,code1 is am5d$ by /rik+ p>agraph
 7#b7 or 7#c7 & ins]t+ p>agraph 7#c7 or 
7#d74  7,n7 ,section #abbb7;a77#d7 (    
title #aa1 ,unit$ ,/ates ,code1 is am5d$
 by /rik+ section #ejg7;a77#a77;,b7 &   
ins]t+ #ejg7;a77#b77;,b74  7,o7 ,section
 #abbf7;b77#a7 ( title #aa1 ,unit$      

,/ates ,code1 is am5d$ by /rik+ section 
#ejg7;a77#b7 & ins]t+ section           
#ejg7;a77#c74  7,p7 ,section            
#acbb7;a77#d7 ( title #aa1 ,unit$ ,/ates
 ,code1 is am5d$ by /rik+ section       
#ejg7;a77#a77;,b7 & ins]t+ section      
#ejg7;a77#b77;,b74  7,q7 ,section       
#acbf7;b77#a7 ( title #aa1 ,unit$ ,/ates
 ,code1 is am5d$ by /rik+ section       
#ejg7;a77#b7 & ins]t+ section           
#ejg7;a77#c74  7,r7 ,section            
#acbh7;a77#b7 ( title #aa1 ,unit$ ,/ates
 ,code1 is am5d$ by /rik+ section       
#ejg7;a77#h77;,c7 & ins]t+ section      
#ejg7;a77#i77;,c74  7,s7 ,section #f7;e7
 ( ! ,securities ,inve/or ,protection   
,act ( #aigj 7#ae ,u4,s4,c4 #gh;fff7e77 
is am5d$1 9 ! la/ s5t5ce1 by /rik+      
section #ejg7;a77#b7 & ins]t+ section   
#ejg7;a77#c74  7b7 ,confirmation ( plan 
,section #aabi ( title #aa1 ,unit$      
,/ates ,code1 is am5d$ by add+ at ! end 
! foll[+3  7f7 ,not)/&+ any o!r         
provision ( ?is section1 if ! debtor is 
a heal? c>e bus9ess1 ! c\rt1 9 confirm+ 

a plan1 %all give sub/antial weight to !
 ext5t to :i* ! plan w\ld all[ =        
ma9t5ance ( regional heal? c>e access1  
quality & safety ( heal? c>e provid$    
regionally1 & heal? c>e provid] & /aff  
ret5tion regionally4  4  #e4 ,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$uction ( s]vices4
  4  #f4 ,treatm5t ( r5ts f qualifi$    
heal? c>e prop]ty  7a7 ,9 g5]al ,section
 #hef7;d77#b7 ( ! ,int]nal ,rev5ue ,code
 ( #aihf is am5d$ by /rik+ & at ! end ( 
subp>agraph 7,b71 by /rik+ ! p]iod &    
ins]t+ 1 & at ! end ( subp>agraph 7,c71 
& by add+ at ! end ! foll[+ new         
subp>agraph3  7,d7 not)/&+ p>agraphs    

7#d71 7#f71 & 7#h71 any am\nt receiv$ or
 accru$ directly or indirectly f        
qualifi$ heal? c>e prop]ty 7z def9$ 9   
subsection 7e77#f77;,d77i774  4  7b7    
,con=m+ am5dm5ts  7#a7 ,section         
#hef7;d77#h77;,b7 ( ! ,int]nal ,rev5ue  
,code ( #aihf is am5d$-- 7,a7 by /rik+  
or a qualifi$ heal? c>e prop]ty 7z def9$
 9 subsection 7e77#f77;,d77i771 &  7,b7 
by /rik+ qualifi$ heal? c>e prop]ty or4 
7#b7 ,section #hef7;d77#i7 ( su* ,code  
is am5d$-- 7,a7 by /rik+ or a qualifi$  
heal? c>e prop]ty 7z def9$ 9 subsection 
7e77#f77;,d77i77 9 subp>agraph 7,a71    
7,b7 by /rik+ or qualifi$ heal? c>e     
prop]ty ea* place x appe>s 9 subp>agraph
 7,a7 & 7,b71 &  7,c7 by /rik+ or       
qualifi$ heal? c>e prop]ties 9          
subp>agraph 7,a74  7c7 ,effective date  
,! am5dm5ts made by ?is section %all    
apply to taxable ye>s beg9n+ aft] ! date
 ( ! enactm5t ( ?is ,act4