PRINTER'S NO. 135
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
158
Session of
2023
INTRODUCED BY PASHINSKI, O'MARA, CIRESI, D. WILLIAMS, DELLOSO,
MADDEN, NEILSON, FREEMAN, OTTEN, SAPPEY, BURGOS, MALAGARI,
SHUSTERMAN, KINKEAD, DONAHUE, KHAN, KAZEEM AND HOHENSTEIN,
MARCH 8, 2023
REFERRED TO COMMITTEE ON HEALTH, MARCH 8, 2023
AN ACT
Providing for hospital closure procedure requirements, for
notice of proposed general hospital closure or significant
impact closure, for health equity impact assessments, for
closure plans and for enforcement actions.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Hospital
Closure Procedure and Notification Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Closure plan." A detailed plan for a general hospital
closure or a significant impact unit closure as required under
this act.
"Department." The Department of Health of the Commonwealth.
"General hospital closure." The closure of all or a majority
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of the units or departments of a hospital.
"Health equity impact assessment." A report that provides
data metrics on a hospital as required under section 7.
"Hospital." As defined in 28 Pa. Code § 101.4 (relating to
definitions).
"Hospital authority." A hospital's parent company or
governing body or a similar authority that oversees the
hospital's operations and a closure plan.
"Significant impact closure." The closure of an emergency
treatment unit or department of a hospital, a labor and delivery
unit or department of a hospital or any other type of unit or
department of a hospital, which the department determines, by
regulation under section 10, significantly impacts the health
and welfare of an affected community.
Section 3. Hospital closure procedure requirements.
(a) Prohibition.--A hospital authority may not engage in a
general hospital closure or significant impact closure unless
the hospital has adopted a closure plan that has been approved
by the Office of Attorney General and either the department or
the health department of the county or municipality where the
hospital is located.
(b) Approval process.--The Office of Attorney General and
either the department or the health department of the county or
municipality where the hospital is located may not approve a
closure plan unless the Office of Attorney General and either
the department or the health department of the county or
municipality where the hospital is located determine that
continuity of patient care and the health and safety needs of
the affected community have been adequately addressed in the
closure plan. The Office of Attorney General and either the
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department or the health department of the county or
municipality where the hospital is located may provide a
conditional approval of the closure plan based on the hospital
authority entering into an agreement with the Office of Attorney
General and either the department or the health department of
the county or municipality where the hospital is located to meet
the requirements under this act.
Section 4. Notice of proposed general hospital closure or
significant impact closure.
No later than 180 days before engaging in a general hospital
closure or significant impact closure, a hospital authority
shall submit a notice of the closure plan to the Office of
Attorney General and either the department or the health
department of the county or municipality where the hospital is
located.
Section 5. Public hearings.
(a) Hearings.--Before engaging in a general hospital closure
or significant impact closure, a hospital authority shall hold a
minimum of two public hearings in the affected community. The
hospital authority shall hold one public hearing no later than
60 days after submitting the notice under section 4. The
hospital authority shall hold a second public hearing no later
than 120 days after submitting the notice under section 4.
(b) Advertisements.--A hospital authority shall provide a
notice of each public hearing under subsection (a) by
advertising each public hearing in a newspaper of general
circulation within the impacted county, including the time and
place of each public hearing and other relevant information. The
hospital authority shall advertise each public hearing no
earlier than 60 days before the date of the public hearing and
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no later than 10 days before the date of the public hearing.
(c) Hearing information.--No later than 10 days before the
date of each public hearing under subsection (a), a hospital
authority shall make any relevant information, including
handouts, about each public hearing available via a publicly
accessible Internet website.
(d) Attendance.--The Office of Attorney General and either
the department or the health department of the county or
municipality where the hospital is located may require hospital
executive staff and administrators to attend a public hearing
under subsection (a) and engage in discussions at the public
hearing, including discussions regarding relevant information
and documents, the closure plan and compliance with the closure
plan.
Section 6. Public comment period.
(a) Comments.--In each advertisement under section 5(b), a
hospital authority shall include contact information for the
solicitation of public comments on the closure plan, including
all of the following:
(1) A toll-free telephone number for sharing public
comments.
(2) A publicly accessible Internet website for sharing
public comments.
(b) Review.--A hospital authority shall collect and
transcribe the public comments received under subsection (a),
make the public comments available on the publicly accessible
Internet website under subsection (a)(2) and provide a
transcript of the public comments to the Office of Attorney
General and either the department or the health department of
the county or municipality where the hospital is located no
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later than 30 days before engaging a general hospital closure or
significant impact closure.
(c) Comment period.--A hospital authority shall provide a
public comment period on the closure plan of no less than 60
days before engaging in a general hospital closure or
significant impact closure.
Section 7. Health equity impact assessments.
(a) Submission.--No later than 80 days before engaging in a
general hospital closure or significant impact closure, a
hospital authority shall submit a health equity impact
assessment to the Office of Attorney General and either the
department or the health department of the county or
municipality where the hospital is located. The hospital
authority shall include all of the following information in the
health equity impact assessment:
(1) The estimated number of patients gaining or losing
access to health care services at the hospital due to the
general hospital closure or significant impact closure.
(2) The estimated number of low-income, senior, minority
and Medicare and medical assistance eligible patients gaining
or losing access to health care services due to the general
hospital closure or significant impact closure.
(3) The names and addresses of the three nearest
hospitals that provide comparable services, including whether
or not each hospital is a medical assistance provider.
(4) A summary of the public and private transit options
to the hospitals specified under paragraph (3), including
estimated drive times.
(5) The number of hospital beds gained or eliminated due
to the general hospital closure or significant impact
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closure.
(6) A summary of the gained or eliminated health care
services due to the general hospital closure or significant
impact closure.
(7) The number of jobs that will be created or lost due
to the general hospital closure or significant impact
closure.
(8) The estimated fiscal impact on the affected
community due to the general hospital closure or significant
impact closure.
(9) The estimated fiscal impact on the hospital
authority due to the general hospital closure or significant
impact closure.
(b) Forms.--The department shall develop a default form for
use by a hospital authority to submit on a health equity impact
assessment under subsection (a) and make the form available on
the department's publicly accessible Internet website.
Section 8. Closure plans.
(a) Initial plan.--No later than 120 days before engaging in
a general hospital closure or significant impact closure, a
hospital authority shall submit an initial closure plan to the
Office of Attorney General and either the department or the
health department of the county or municipality where the
hospital is located.
(b) Updates.--After submitting the initial closure plan
under subsection (a), a hospital authority shall provide updates
on the implementation of the closure plan to the Office of
Attorney General and either the department or the health
department of the county or municipality where the hospital is
located every 14 days until the date when the general hospital
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closure or significant impact closure is completed.
(c) Contents.--A hospital authority shall include all of the
following information in a closure plan:
(1) The reason for the general hospital closure or
significant impact closure.
(2) Strategies regarding the continuity of patient care
in each department and unit of the hospital and the transfer
of patients to other health care facilities.
(3) Strategies regarding specialized programs or groups
of patients particularly vulnerable to interruptions in
medical care, including cancer chemotherapy or prenatal care.
(4) Strategies for the closure of the emergency
department of the hospital, including diversion to other
hospital emergency departments and the interface with
emergency medical services.
(5) Written agreements with other health care providers
to accept responsibility for continuing the care of patients
receiving ongoing care at the hospital.
(6) Strategies for how all medical records, including
paper and electronic records, will be maintained throughout
and after the general hospital closure or significant impact
closure, and how the medical records will be made available
to former patients and the physicians who provide care for
the patients.
(7) Strategies for the maintenance, transfer and
disposal of pharmaceuticals, chemicals, hazardous substances
and other similar materials located at the hospital.
(8) The anticipated timeline for the closing of each
department or unit of the hospital.
(9) A communications and engagement plan regarding the
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affected community, including holding public meetings in the
affected community.
(10) Any changes to the administration and medical staff
of the hospital authority during the implementation of the
closure plan.
(11) Strategies regarding the hospital authority's
efforts to assist affected employees and students with
finding suitable employment and educational opportunities.
(12) Strategies regarding the hospital authority's
efforts to assist affected employees with maintaining health
insurance and to address the impact of collective bargaining
for represented employees.
(13) Strategies for maintaining hospital security.
(14) Strategies for supervising compliance with the
closure plan, including updates to the closure plan under
subsection (b).
Section 9. Enforcement actions.
(a) Actions.--If the Office of Attorney General or either
the department or the health department of the county or
municipality where the hospital is located determines that a
hospital has violated the provisions of this act, the Attorney
General or a district attorney may initiate a civil action to
enforce the provisions of this act.
(b) Remedies.--If a court of competent jurisdiction finds
that a hospital has failed to comply with any of the provisions
of this act, the court may:
(1) enjoin the hospital authority from taking any
measure to engage a general hospital closure or significant
impact closure until the hospital authority complies with the
provisions of this act;
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(2) appoint a special master or temporary manager to
ensure that the hospital authority complies with the
provisions of this act; or
(3) grant any other remedy as the court deems just,
proper and equitable under the circumstances.
Section 10. Regulations.
The Office of Attorney General and the department shall
jointly promulgate regulations necessary to effectuate this act.
Section 11. Construction.
Nothing in this act shall be construed to require the
Commonwealth or a municipality, including an official or
employee of the Commonwealth or municipality, to relieve,
discharge, perform, indemnify or assume liability for any
obligation or duty belonging to a hospital or the hospital's
officers, directors or affiliates.
Section 12. Effective date.
This act shall take effect in 30 days.
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