Requires public notice and public engagement when a general hospital seeks to close entirely or a unit that provides maternity, mental health or substance use care.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1633A
SPONSOR: Simon (MS) TITLE OF BILL:
An act to amend the public health law, in relation to providing public
notice and public engagement when a general hospital seeks to close
entirely or a unit that provides maternity, mental health or substance
use care
PURPOSE OR GENERAL OF BILL:
To allow for improved public notice and public engagement when hospital
and certain unit closures are threatened, and to strengthen state review
of such closings.
SUMMARY OF SPECIFIC PROVISIONS:
Section one names the act as the "Local Input in Community Healthcare
Act."
Section two amends section 2801-g of the public health law (PHL) as it
relates to a community forum on hospital closure, to have community
notice and engagement on hospital closures and require general hospitals
to provide written notification of proposed closure of a general hospi-
tal or unit that offers emergency, maternity, mental health, or
substance use services to the Department of Health (DOH) no later than
270 days before the proposed closure date, if the proposed closure will
result in the reduction or unavailability of such services in the the
hospital's service area or county.
Subdivision two is amended to require a general hospital that seeks to
close entirely or seeks to close one or more units must submit an appli-
cation that requires review and approval by the Public Health and Health
Planning Council, or successor entity. The application would be submit-
ted at least 210 days before the proposed closure. No cessation, trans-
fer, pause, or limitation of service may be carried out without prior
written approval by the Commissioner of Health (COH).
A new subdivision three is added to extend the period that the COH is
required to hold a public community forum to obtain public input
concerning the anticipated impact of the hospital or unit's closure from
no later than 30 days after to 150 days before the proposed closure.
Subdivision four, is amended to require the commissioner to make public-
ly available no later than 30 days prior to a community forum the
proposed closure plan submitted by the health facility, the impact on
access to health care services to the surrounding community and informa-
tion on specific measures DOH will take and any other recommendations to
address the impact of the closure on health care services, including but
not limited to ensuring services being eliminated are still accessible
to medicaid, or individuals insured by publicly subsidized plans, and
uninsured residents in the surrounding facilities.
Subdivision 3, now re-numbered to five, amends the announcement of the
community forum on the proposed closure of a hospital or unit to 14 days
prior, instead of 10 days prior, to the date that the community forum
will be held and ensures the forum is held at a proper time and accessi-
ble to the impacted community virtually and physically. Subdivision 4
is re-numbered to subsection 6.
Adds a new subdivision 7 to require hospitals to notify health care
providers, labor unions, local, state, and federal legislative represen-
tatives, the office of the attorney general, their county executive,
mayor, town supervisor, and in NYC, the borough president and community
board for every district that the hospital is located in, no later than
thirty days prior to the community forum.
Adds a new subdivision 8 to require a hospital to submit a revised
closure plan to DOH addressing concerns raised during.the community
forum no later than 30 days after the forum and ensure DOH makes the
revised plan publicly available on their website no later than 45 days
after the community forum.
Adds a new subdivision 9 requiring an annual report to the legislature
by the department on a list of general hospitals or units of general
hospitals that notify the department of their intent to close.
Section three provides an effective date.
JUSTIFICATION:
The proposed closure of Long Island College Hospital (LICH), formerly
operated by the State University of New York-Downstate, ended up in
court for nearly two years, during which a court said that the current
regulation governing hospital closures is "unconstitutionally vague."
The court proceeding made clear that there was no process for determin-
ing the healthcare impact of the hospital's closure on Cobble Hill and
surrounding communities or Brooklyn. In addition, there was no role for
real community input or transparency. Throughout the multi-year fight to
save a full-service hospital in Cobble Hill, the community's needs were
repeatedly ignored.
This is happening across New York State. There have been several inci-
dents when hospitals summarily announce planned closures of maternity
services, emergency departments, mental health and substance use
services, and even entire hospitals without any prior communication or
meaningful engagement with the local communities they serve.
Over the last decade, 10 hospitals in New York State closed their mater-
nity services (in Columbia, Franklin, Lewis, New York, Niagara, Ontario,
Otsego, St. Lawrence and Wyoming counties). So far in 2024, two more
maternity service closures are pending in Rensselaer and Suffolk coun-
ties. Two major closings of entire hospitals are moving forward in lower
Manhattan and in Central Brooklyn, after last year's closures of another
Brooklyn hospital and a hospital in Eastern Niagara County. More
closures are likely; a recent study by the Center for Healthcare Quality
and Payment Reform found that there are 27 rural hospitals in New York
State at risk of closing, amounting to 53 percent of all rural hospitals
in the state.
(Source:
HTTPS://WWW.BECKERSHOSPITALREVIEW.CORN/FINANCE/ 646-HOSPI-
TALS-AT-RISK-OF-CLOSURERANKED-BY-STATE.HTML)
Closures of any of these services, or of the entire hospital, can have a
devastating impact on the communities that have depended on these facil-
ities for care. When the COVID-19 pandemic hit New York City in early
2020, one of the boroughs most affected (Queens) was ill prepared
because of hospital closings in that borough. Elmhurst Hospital, a
public hospital, was forced to shoulder more than its fair share of
COVID-19 cases because of the closures of St. John's Queens Hospital,
Mary Immaculate Hospital and Parkway Hospital in 2009. (Source:
HTTPS://QNS.COM/2020/03/DEMISE-OF-THREE-QUEENS-HO SPITALS-11
-YEARS-AGO-ADDS-TO-PAIN-OFBOROUGHS- CORONAVIRUS-TRAGEDIES/)
Closures of hospital maternity services are leaving entire counties
without any nearby access to labor and delivery, causing pregnant
patients to have to travel long distances to the nearest hospital with
maternal health services. The proposed closure of the Burdett Birth
Center in Troy, for example, would leave Rensselaer County as the larg-
est county in the state without maternity care, and also affect pregnant
people in adjacent rural Washington and Columbia counties, which lack
their own maternity services. The March of Dimes warns that the further
a pregnant person has to travel to obtain maternity care, the greater
the chances that there will be a negative outcome. There is a higher
risk for complications and death for both mothers and babies in communi-
ties that do not have maternity care services, according to the Center
for Healthcare Quality and Payment Reform.
Closures of hospital psychiatric services were numerous during the
pandemic, with more than two dozen hospitals closing more than 500
psychiatric beds, and the Hochul administration has been working to
bring those back into service, citing a severe shortage of short-term
beds for patients suffering psychiatric crises.
(Source:
HTTPS://WWW.NYTIMES.COM/2023/10/12/NYREGION/ HOSPITALS-HO-
CHUL-MENTAL-HEALTH.HTML)
Despite the serious impact of such closures on communities, especially
those where people are already medically-underserved and not easily able
to travel elsewhere for care, New York State Public Health Law does not
adequately require hospitals to engage the public and work to address
their concerns. Too little (if any) advance notice is given to the
community and key stakeholders, and under the law, a public hearing is
not required until 30 days after a hospital closes (although recent
state Department of Health guidance to hospitals has required an advance
hearing).
While the state's new Health Equity Impact Assessment law is helping to
improve community engagement, it does not apply to closings of entire
hospitals because those are carried out through simple notice to the
Department and a closure plan, not a Certificate of Need application.
Moreover, none of these types of closures (the entire hospital, or
maternity, emergency or mental health services) requires a full review
Certificate of Need that would go before the state Public Health and
Health Planning Council for review in a public meeting at which communi-
ty members could make comments.
This proposed legislation will address these gaps in the state's review
of proposed hospital and hospital unit closures by ensuring adequate
advance notice to the public, public disclosure of hospital closing
plans, a community forum held well in advance of the closure date to
allow public comment on the proposed closure plan, and preparation of a
final closure plan that addresses concerns raised at the community
forum.
PRIOR LEGISLATIVE STORY:
2023: A.1633 Simon - passed assembly
2022: A.2251a Simon - passed assembly
2020-19: A.2986 Simon - referred to health
2018-17: A.1015 Simon - referred to health
FISCAL IMPLICATIONS:
None.
EFFECTIVE DATE:
Effective on the sixtieth day after it shall have become law, and shall
not apply to any matter subject to section 2801-g of the PHL that is
pending on the date it shall take effect.
STATE OF NEW YORK
________________________________________________________________________
1633--A
Cal. No. 47
2023-2024 Regular Sessions
IN ASSEMBLY
January 17, 2023
___________
Introduced by M. of A. SIMON, CRUZ, REYES, GLICK, WEPRIN, BURDICK,
JACOBSON, OTIS, CUNNINGHAM, SEAWRIGHT, SANTABARBARA, MITAYNES, GONZA-
LEZ-ROJAS, COLTON, FORREST, PHEFFER AMATO, BARRETT, SHRESTHA, LEVEN-
BERG, ARDILA, MAMDANI, DINOWITZ, TAPIA, LEE -- Multi-Sponsored by --
M. of A. CARROLL, COOK, DAVILA, EPSTEIN, HEVESI, PAULIN, STECK, WALKER
-- read once and referred to the Committee on Health -- ordered to a
third reading, amended and ordered reprinted, retaining its place on
the order of third reading
AN ACT to amend the public health law, in relation to providing public
notice and public engagement when a general hospital seeks to close
entirely or a unit that provides maternity, mental health or substance
use care
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Short title. This act shall be known and may be cited as
2 the "local input in community healthcare act".
3 § 2. Section 2801-g of the public health law, as added by chapter 541
4 of the laws of 2010, subdivision 4 as added by section 3 of part E of
5 chapter 57 of the laws of 2023, is amended to read as follows:
6 § 2801-g. Community [forum] notice and engagement on hospital closure.
7 1. Written notification of a proposed closure of a general hospital or
8 unit of a general hospital must be provided to the department and all
9 parties listed in subdivision seven of this section no later than two
10 hundred seventy days prior to the proposed closure date. As used in
11 this section, "unit" means a portion of a general hospital that offers
12 emergency, maternity, and mental health or substance use services.
13 "Unit" shall also mean any other hospital service or health-related
14 service of a hospital, including specialty care services, if the
15 proposed closure will result in the reduction or unavailability of such
16 services in the hospital's service area or county where it is located.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD02692-06-4
A. 1633--A 2
1 2. A general hospital that seeks to close entirely or close one or
2 more units shall submit an application that requires review and approval
3 by the public health and health planning council, or any successor enti-
4 ty. The application for the closure shall include a health equity impact
5 assessment, as defined by section twenty-eight hundred two-b of this
6 article, and a proposed closure plan. The application shall be submitted
7 at least two hundred ten days before the proposed closure. No cessation,
8 pause, transfer, or limitation of service may be carried out without
9 prior written approval by the commissioner. As used in this section,
10 "transfer of services" shall include conversion of services from inpa-
11 tient to outpatient services, the moving of services to other facili-
12 ties, or the transfer of personnel that would constitute a reduction or
13 unavailability of services.
14 3. No later than [thirty] one hundred fifty days [after] prior to the
15 proposed closure of a general hospital or a unit of a general hospital,
16 the commissioner shall hold a public community forum for the purpose of
17 obtaining public input concerning the anticipated impact of the general
18 hospital's or general hospital unit's closure on access to health care
19 services by members of the surrounding community, including but not
20 limited to recipients of medical assistance for needy persons, the unin-
21 sured, and medically underserved populations as defined in paragraph (d)
22 of subdivision one of section twenty-eight hundred two-b of this
23 article, and options and proposals to ameliorate such anticipated
24 impact. The commissioner shall afford community members, health care
25 providers, labor unions, payers, businesses and consumers a reasonable
26 opportunity to speak about relevant matters at such community forum.
27 [2.] 4. No later than [sixty] thirty days [after] before holding a
28 community forum pursuant to subdivision [one] three of this section, the
29 commissioner shall make available to the public on the department's
30 website information regarding:
31 (a) the proposed closure plan submitted by the health facility;
32 (b) the anticipated impact of the general hospital's closure or unit's
33 closure on access to health care services by members of the surrounding
34 community, including but not limited to recipients of medical assistance
35 for needy persons, the uninsured, and underserved populations;
36 [(b)] (c) specific measures the department and other parties have
37 taken or will take to ameliorate such anticipated impact including but
38 not limited to ensuring that the services to be eliminated would be
39 available to Medicaid, or individuals that are insured by a publicly-
40 subsidized plan and uninsured patients at the surrounding area facili-
41 ties that are taking new patients; and
42 [(c)] (d) any further recommendations regarding access to health care
43 services in communities impacted by the general hospital's closure or
44 unit's closure.
45 [3.] 5. A community forum conducted pursuant to this section shall be
46 held at a location within a reasonable proximity to the general hospital
47 or unit subject to the proposed closure, and shall be announced no less
48 than [ten] fourteen days prior to the date of such community forum. Such
49 forum shall be held at a proper time and be accessible to the impacted
50 community virtually and physically.
51 [4.] 6. At least thirty days prior to a general hospital applying to
52 the federal centers for medicare and medicaid services to convert from a
53 general hospital with inpatients to a rural emergency hospital under 42
54 USC 1395x(kkk), or successor provisions, such general hospital shall
55 hold a public community forum for the purpose of obtaining public input
56 concerning the anticipated impact of the general hospital's closure of
A. 1633--A 3
1 inpatient units, including but not limited to, the impact on recipients
2 of medical assistance for needy persons, the uninsured, people with
3 disabilities, and medically underserved populations, and options and
4 proposals to ameliorate such anticipated impact.
5 [The] 7. No later than thirty days prior to a community forum under
6 this section, the general hospital shall notify health care providers,
7 labor unions, the [congressional] local, state, and federal legislative
8 representative, the office of the attorney general, the county execu-
9 tive, mayor, town supervisor, and in the case of the city of New York,
10 the borough president, and community board for [the] every district in
11 which the [facility] general hospital and unit is or are located, [the
12 county executive of the county in which the facility is located, and the
13 state senator and assembly member representing the area within which the
14 facility is located] of the date, time, and location of the community
15 forum. The general hospital shall afford all public participants a
16 reasonable opportunity to speak about relevant matters at such community
17 forum. Prior to any community forum and as soon as practicable, the
18 general hospital shall be required to:
19 (a) notify the office of mental health and the local director of
20 community services in the event such general hospital has psychiatric
21 inpatient beds licensed under article thirty-one of the mental hygiene
22 law or designated pursuant to section 9.39 of the mental hygiene law,
23 and
24 (b) notify the office of addiction services and supports in the event
25 such general hospital has inpatient substance use disorder treatment
26 programs or inpatient chemical dependence treatment programs licensed
27 under article thirty-two of the mental hygiene law. The commissioner
28 shall also accept comments submitted in writing at such public forum and
29 by mail or electronic mail within at least two weeks following the
30 community forum.
31 8. No later than thirty days after the community forum, the general
32 hospital shall submit a revised closure plan to the department address-
33 ing concerns raised by community stakeholders during the community
34 forum. The general hospital and the department shall make the revised
35 closure plan publicly available on their websites no later than forty-
36 five days after the community forum.
37 9. No later than January first two thousand twenty-five and annually
38 thereafter, the commissioner shall provide a report to the legislature,
39 including but not limited to, identifying the general hospital or unit
40 of a general hospital that has provided written notice of a closure, the
41 proposed closure date and the services impacted by the proposed closure.
42 Such report shall be provided in electronic format and shall be distrib-
43 uted to the temporary president and minority leader of the senate, the
44 speaker and minority leader of the assembly, the chair of the senate
45 standing committee on health, and the chair of the assembly health
46 committee.
47 § 3. This act shall take effect on the sixtieth day after it shall
48 have become a law, and shall not apply to any matter subject to section
49 2801-g of the public health law that is pending on the date it shall
50 take effect.
