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: A6004
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.com/finance/ 646-hospitals-
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-hospitals-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-hochul-
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:
2023-24: 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
________________________________________________________________________
6004
2025-2026 Regular Sessions
IN ASSEMBLY
February 25, 2025
___________
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, MAMDANI, DINOWITZ, TAPIA, LEE, KELLES, TAYLOR, BORES, RAGA --
Multi-Sponsored by -- M. of A. R. CARROLL, DAVILA, EPSTEIN, HEVESI,
PAULIN -- read once and referred to the Committee on Health
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. Process for the closure of a general hospital or a unit of a general
8 hospital. (a) This section sets forth a process for the closure of a
9 general hospital or a unit of a general hospital. As used in this
10 section, "unit" means a portion of a general hospital that offers
11 licensed emergency, maternity, mental health or substance use services,
12 including any specialty care or any other hospital service in an operat-
13 ing certificate as approved under section twenty-eight hundred five of
14 this article. For the purposes of this section, the closure of a unit of
15 a general hospital shall include a reduction of such services. As used
16 in this section, "reduction" means a reduction in services that results
17 in:
18 (i) more than fifteen percent of a reduction in patient capacity of a
19 unit within twelve months; or
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03821-01-5
A. 6004 2
1 (ii) a twenty-five percent or more reduction in patient capacity in
2 aggregate within a twenty-four month period; or
3 (iii) a thirty-five percent or more reduction in patient capacity in
4 aggregate within a thirty-six month period.
5 2. Closure of a general hospital. (a) Written notification of a
6 proposed closure of a general hospital must be provided to the depart-
7 ment and all parties listed in subparagraph (ii) of paragraph (c) of
8 this subdivision no later than two hundred seventy days prior to the
9 proposed closure date. Nothing in this section shall prohibit a general
10 hospital from conferring with the department prior to submitting such
11 written notification to give informal notice and seek guidance.
12 (b) Application. A general hospital that seeks to close entirely
13 shall submit an application that requires review by the public health
14 and health planning council, or any successor entity. The application
15 for the closure shall include a health equity impact assessment, as
16 defined by section twenty-eight hundred two-b of this article, and a
17 proposed closure plan. The application shall be submitted at least two
18 hundred ten days before the proposed closure. No cessation, pause,
19 transfer, or limitation of service may be carried out while the closure
20 application is pending without prior written approval by the commission-
21 er or the commissioner's designee, who may take into consideration the
22 impacts on quality of care and patient safety stemming from changes in
23 patient volume or services. As used in this section, "transfer of
24 services" shall include conversion of services from inpatient to outpa-
25 tient services, the moving of services to other facilities, or the
26 transfer of personnel that would constitute a reduction or unavailabili-
27 ty of services.
28 (c) Public community forum. (i) No later than [thirty] one hundred
29 fifty days [after] prior to the proposed closure of a general hospital,
30 the commissioner shall hold a public community forum for the purpose of
31 obtaining public input concerning the anticipated impact of the general
32 hospital's closure on access to health care services by members of the
33 surrounding community, including but not limited to recipients of
34 medical assistance for needy persons, the uninsured, and medically
35 underserved populations as defined in paragraph (d) of subdivision one
36 of section twenty-eight hundred two-b of this article, and options and
37 proposals to ameliorate such anticipated impact. The commissioner shall
38 afford community members, health care providers, labor unions, payers,
39 businesses and consumers a reasonable opportunity to speak about rele-
40 vant matters at such community forum.
41 [2.] (ii) No later than [sixty] thirty days [after] before holding a
42 community forum pursuant to [subdivision one of this section] this para-
43 graph, the commissioner shall make available to the public on the
44 department's website information regarding:
45 [(a)] (A) the proposed closure plan submitted by the general hospital;
46 (B) the anticipated impact of the general hospital's closure on access
47 to health care services by members of the surrounding community, includ-
48 ing but not limited to recipients of medical assistance for needy
49 persons, the uninsured, and underserved populations;
50 [(b)] (C) specific measures the department and other parties have
51 taken or will take to ameliorate such anticipated impact including but
52 not limited to ensuring that the services to be eliminated would be
53 available to Medicaid, or individuals that are insured by a publicly-
54 subsidized plan and uninsured patients at the surrounding area facili-
55 ties that are taking new patients; and
A. 6004 3
1 [(c)] (D) any further recommendations regarding access to health care
2 services in communities impacted by the general hospital's closure.
3 [3.] (iii) A community forum conducted pursuant to this section shall
4 be held at a location within a reasonable proximity to the general
5 hospital or unit subject to the proposed closure, and shall be announced
6 no less than [ten] fourteen days prior to the date of such community
7 forum. Such forum shall be held at a proper time and be accessible to
8 the impacted community virtually and physically.
9 [4. At least thirty days prior to a general hospital applying to the
10 federal centers for medicare and medicaid services to convert from a
11 general hospital with inpatients to a rural emergency hospital under 42
12 USC 1395x(kkk), or successor provisions, such hospital shall hold a
13 public community forum for the purpose of obtaining public input
14 concerning the anticipated impact of the hospital's closure of inpatient
15 units, including but not limited to, the impact on recipients of medical
16 assistance for needy persons, the uninsured, people with disabilities,
17 and medically underserved populations, and options and proposals to
18 ameliorate such anticipated impact.
19 The] (iv) No later than thirty days prior to a community forum under
20 this section, the general hospital shall notify health care providers,
21 labor unions, the [congressional] local, state, and federal legislative
22 representative, the office of the attorney general, the county execu-
23 tive, mayor, town supervisor, and in the case of the city of New York,
24 the borough president, and community board for [the] every district in
25 which the [facility] general hospital is located, [the county executive
26 of the county in which the facility is located, and the state senator
27 and assembly member representing the area within which the facility is
28 located] of the date, time, and location of the community forum. The
29 general hospital shall afford all public participants a reasonable
30 opportunity to speak about relevant matters at such community forum.
31 Prior to [any] a community forum and as soon as practicable, the general
32 hospital shall be required to:
33 [(a)] (A) notify the office of mental health and the local director of
34 community services in the event such general hospital has psychiatric
35 inpatient beds licensed under article thirty-one of the mental hygiene
36 law or designated pursuant to section 9.39 of the mental hygiene law,
37 and
38 [(b)] (B) notify the office of addiction services and supports in the
39 event such general hospital has inpatient substance use disorder treat-
40 ment programs or inpatient chemical dependence treatment programs
41 licensed under article thirty-two of the mental hygiene law. The commis-
42 sioner shall also accept comments submitted in writing at such public
43 forum and by mail or electronic mail within at least two weeks following
44 the community forum.
45 (v) The commissioner shall also accept comments submitted in writing
46 at such public forum and by mail or electronic mail within at least two
47 weeks following the community forum.
48 (d) Revised closure plan. No later than thirty days after the communi-
49 ty forum, the general hospital shall submit a revised closure plan to
50 the department addressing concerns raised by community stakeholders
51 during the community forum. The general hospital and the department
52 shall make the revised closure plan publicly available on their websites
53 no later than forty-five days after the community forum.
54 (e) Public health and health planning council review. No later than
55 ninety days prior to the proposed closure, the public health and health
56 planning council, or any successor entity, shall hold a public meeting
A. 6004 4
1 before the council to review the application, including the health equi-
2 ty impact assessment and revised closure plan. Within two weeks after
3 such meeting, the public health and health planning council shall make a
4 recommendation to the commissioner for the commissioner's consideration.
5 3. Closure of a unit of a general hospital. (a)(i) Written notifica-
6 tion of a proposed closure of a unit of a general hospital, as defined
7 in subdivision one of this section, must be provided to the department
8 and all parties listed in subparagraph (iv) of paragraph (c) of subdivi-
9 sion two of this section no later than two hundred ten days prior to the
10 proposed closure date. Nothing in this section shall prohibit a general
11 hospital from conferring with the department prior to submitting such
12 written notification to give informal notice and seek guidance.
13 (ii) A reduction in services or closure of a unit in a general hospi-
14 tal shall not be required to undergo the process set forth in this
15 section if the general hospital demonstrates to the department a good
16 cause for such reduction or closure of a unit, which shall include one
17 or more of the following:
18 (A) whether such closure or reduction is temporary in order to modern-
19 ize a facility;
20 (B) whether such closure addresses the current health care demand,
21 such as patient volume and the overall availability of services in the
22 facility's health service area or county served;
23 (C) there are acute labor shortages outside of the control of the
24 general hospital that impacts patient safety; or
25 (D) an acute financial emergency outside of the control of the general
26 hospital.
27 (b) Application. A general hospital that seeks the closure of a unit
28 shall submit an application to the department of health that requires
29 review by the public health and health planning council, or any succes-
30 sor entity in addition to approval by the commissioner. The application
31 for the closure shall include a health equity impact assessment, as
32 defined by section twenty-eight hundred two-b of this article, and a
33 proposed closure plan. The application shall be submitted at least one
34 hundred fifty days before the proposed closure. No cessation, pause,
35 transfer, or limitation of service may be carried out while the closure
36 application is pending without prior written approval by the commission-
37 er or the commissioner's designee, who shall take into consideration the
38 impacts on quality of care and patient safety stemming from changes in
39 patient volume or services. As used in this section, "transfer of
40 services" shall include conversion of services from inpatient to outpa-
41 tient services, the moving of services to other facilities, or the
42 transfer of personnel that would constitute a reduction or unavailabili-
43 ty of services.
44 (c) Community public forum. (i) No later than ninety days prior to the
45 proposed closure of a unit of a general hospital, the commissioner shall
46 hold a public community forum for the purpose of obtaining public input
47 concerning the anticipated impact of the unit's closure on quality and
48 access to health care services by members of the surrounding community,
49 including but not limited to recipients of medical assistance for needy
50 persons, the uninsured, and medically underserved populations as defined
51 in paragraph (d) of subdivision one of section twenty-eight hundred
52 two-b of this article, and options and proposals to ameliorate such
53 anticipated impact. The commissioner shall afford community members,
54 health care providers, labor unions, payers, businesses, and other
55 participants a reasonable opportunity to speak about relevant matters at
56 such community forum.
A. 6004 5
1 (ii) No later than two weeks before holding a community forum pursuant
2 to this paragraph, the commissioner shall make available to the public
3 on the department's website information regarding: (A) the proposed
4 closure plan submitted by the general hospital; (B) the anticipated
5 impact of the closure on quality and access to health care services by
6 members of the surrounding community, including but not limited to
7 recipients of medical assistance for needy persons, the uninsured, and
8 underserved populations; (C) specific measures the department and other
9 parties have taken or will take to ameliorate such anticipated impact
10 including but not limited to ensuring that the services to be eliminated
11 would be available to Medicaid, or individuals that are insured by a
12 publicly-subsidized plan and uninsured patients at the surrounding area
13 facilities that are taking new patients; and (D) any further recommenda-
14 tions regarding quality and access to health care services in communi-
15 ties impacted by the closure.
16 (iii) A community forum conducted pursuant to this paragraph shall be
17 held at a location within a reasonable proximity to the unit subject to
18 the proposed closure and shall be announced no less than fourteen days
19 prior to the date of such community forum. Such forum shall be held at a
20 proper time and be accessible to the impacted community virtually and
21 physically.
22 (iv) No later than two weeks prior to the community forum under this
23 section, the general hospital seeking to close a unit shall notify
24 health care providers, labor unions, the local, state, and federal
25 legislative representative, the office of the attorney general, the
26 county executive, mayor, town supervisor, and in the case of the city of
27 New York, the borough president, and community board for every district
28 in which the general hospital is located, of the date, time, and
29 location of the community forum. Prior to the community forum and as
30 soon as practicable, the general hospital shall be required to: (A)
31 notify the office of mental health and the local director of community
32 services in the event such general hospital is seeking to close an inpa-
33 tient psychiatric unit licensed under article thirty-one of the mental
34 hygiene law or designated pursuant to section 9.39 of the mental hygiene
35 law, and (B) notify the office of addiction services and supports in the
36 event the general hospital is seeking to close an inpatient substance
37 use disorder treatment programs or inpatient chemical dependence treat-
38 ment programs licensed under article thirty-two of the mental hygiene
39 law.
40 (v) The commissioner shall also accept comments submitted in writing
41 at such public forum and by mail or electronic mail within at least two
42 weeks following the community forum.
43 (d) Revised closure plan. No later than thirty days after the communi-
44 ty forum, the general hospital shall submit a revised closure plan to
45 the department addressing concerns raised by community stakeholders
46 during the community forum. The general hospital and the department
47 shall make the revised closure plan publicly available on their websites
48 no later than forty-five days after the community forum.
49 (e) Public health and health planning council review. No later than
50 thirty days prior to the proposed closure, the public health and health
51 planning council, or any successor entity, shall hold a public meeting
52 to review the application, including the health equity impact assessment
53 and revised closure plan. Within two weeks after such meeting, the
54 public health and health planning council shall make a recommendation to
55 the commissioner for the commissioner's consideration.
A. 6004 6
1 4. The commissioner shall make their decision to either approve or
2 deny the closure plan within thirty days following receipt of the recom-
3 mendation from the public health and health planning council.
4 5. At least thirty days prior to a general hospital applying to the
5 federal centers for medicare and medicaid services to convert from a
6 general hospital with inpatients to a rural emergency hospital under 42
7 USC 1395x(kkk), or successor provisions, such general hospital shall
8 hold a public community forum for the purpose of obtaining public input
9 concerning the anticipated impact of the general hospital's closure of
10 inpatient units, including but not limited to, the impact on recipients
11 of medical assistance for needy persons, the uninsured, people with
12 disabilities, and medically underserved populations, and options and
13 proposals to ameliorate such anticipated impact.
14 6. No later than January first, two thousand twenty-six and annually
15 thereafter, the commissioner shall provide a report to the legislature,
16 including but not limited to, identifying the general hospital or unit
17 of a general hospital that has provided written notice of a closure, the
18 proposed closure date and the services impacted by the proposed closure.
19 Such report shall be provided in electronic format and shall be distrib-
20 uted to the temporary president and minority leader of the senate, the
21 speaker and minority leader of the assembly, the chair of the senate
22 standing committee on health, and the chair of the assembly health
23 committee.
24 7. No provision of this section shall modify any other requirement or
25 process for the closure of a general hospital or a unit of a general
26 hospital that is required pursuant to this chapter or the regulations
27 promulgated pursuant to it, including but not limited to any department
28 or public health and health planning council review or approval process.
29 § 3. This act shall take effect on the sixtieth day after it shall
30 have become a law, and shall not apply to any proposed closures on
31 notice to the department as of the date it shall take effect.
