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: A1633B
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-OFCLOSURE-RANKED-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://ONS.COM/2020/03/DEMISE-OFTHREE:QUEENS-HOSPITALS-11-
YEARS-AGO-ADDS-TO-OAIN-OF-BOROUGHS-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-MENTALHEALTH.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.
