[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9156 Introduced in House (IH)]
<DOC>
118th CONGRESS
2d Session
H. R. 9156
To amend the Public Health Service Act to require the Secretary of
Health and Human Services to enforce certain requirements with respect
to for-profit corporations that own health care systems, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
July 25, 2024
Ms. Jayapal (for herself, Ms. Balint, Ms. Hoyle of Oregon, Ms. Norton,
and Mr. Pocan) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committees on
Financial Services, Ways and Means, and the Judiciary, for a period to
be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to require the Secretary of
Health and Human Services to enforce certain requirements with respect
to for-profit corporations that own health care systems, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Over Wealth Act''.
SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE ACT.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXXIV--REQUIREMENTS RELATING TO PRIVATE OWNERSHIP IN HEALTH
CARE
``SEC. 3401. DEFINITIONS.
``In this title:
``(1) Affiliate.--The term `affiliate' means--
``(A) a person that directly or indirectly owns,
controls, or holds with power to vote, 20 percent or
more of the outstanding voting securities of another
entity, other than a person that holds such
securities--
``(i) in a fiduciary or agency capacity
without sole discretionary power to vote such
securities; or
``(ii) solely to secure a debt, if such
entity has not in fact exercised such power to
vote;
``(B) a corporation 20 percent or more of whose
outstanding voting securities are directly or
indirectly owned, controlled, or held with power to
vote, by another entity (referred to in this
subparagraph as a `covered entity'), or by an entity
that directly or indirectly owns, controls, or holds
with power to vote, 20 percent or more of the
outstanding voting securities of the covered entity,
other than an entity that holds such securities--
``(i) in a fiduciary or agency capacity
without sole discretionary power to vote such
securities; or
``(ii) solely to secure a debt, if such
entity has not in fact exercised such power to
vote;
``(C) a person whose business is operated under a
lease or operating agreement by another entity, or
person substantially all of whose property is operated
under an operating agreement with that other entity; or
``(D) an entity that operates the business or
substantially all of the property of another entity
under a lease or operating agreement.
``(2) Corporation.--The term `corporation' means--
``(A) a joint-stock company;
``(B) a company or partnership association
organized under a law that makes only the capital
subscribed or callable up to a specified amount
responsible for the debts of the association, including
a limited partnership and a limited liability company;
``(C) a trust; or
``(D) an association having a power or privilege
that a private corporation, but not an individual or a
partnership, possesses.
``(3) Covered firm.--The term `covered firm' means a for-
profit corporation that owns or is an affiliate of a health
care entity.
``(4) Health care entity.--The term `health care entity'
means an entity that consists of 1 or more of the following
health care providers:
``(A) A hospital.
``(B) A physician practice.
``(C) A skilled nursing facility.
``(D) A hospice facility.
``(E) A mental or behavioral health care provider.
``(F) An opioid treatment program.
``(G) A provider of services (as defined in section
1861(u) of the Social Security Act (42 U.S.C. 1395x(u))
or a supplier (as defined in section 1861(d) of such
Act (42 U.S.C. 1395(d)) enrolled in the Medicare
program.
``(H) Any other entity the Secretary determines
appropriate.
``(5) Private equity fund.--The term `private equity fund'
means--
``(A)(i) a person that would be considered an
investment company under section 3 of the Investment
Company Act of 1940 (15 U.S.C. 80a-3) but for the
application of paragraph (1) or (7) of subsection (c)
of such section 3;
``(ii) a venture capital fund, as defined in
section 275.203(l)-1of title 17, Code of Federal
Regulations (or successor regulations); or
``(iii) a sovereign wealth fund; and
``(B) directly, or through an affiliate, acts as a
control person.
``SEC. 3402. HEALTH CARE OWNERSHIP TRANSPARENCY.
``(a) Required Reporting.--
``(1) In general.--The Secretary shall require each covered
firm to submit to the Secretary, at such times as the Secretary
determines appropriate, through the infrastructure established
under paragraph (2), a report containing--
``(A) for a covered firm with respect to which
there is a private equity fund that is a control person
of the covered firm, the information described in
subsection (b); and
``(B) for a covered firm not described in
subparagraph (A), the information described in
subsection (c).
``(2) Reporting infrastructure.--The Secretary, in
consultation with the Secretary of the Treasury and the Federal
Trade Commission, shall establish infrastructure to collect the
data submitted under paragraph (1).
``(3) Public availability.--The Secretary shall make the
data submitted under paragraph (1) publicly available.
``(4) Auditing.--The Secretary shall periodically conduct
audits to verify the data submitted under paragraph (1).
``(5) Annual reports.--The Secretary shall submit to
Congress annual reports describing trends identified through
analysis of the data submitted under paragraph (1) relating
to--
``(A) the financial status of covered firms; and
``(B) how the type of ownership of health care
entities impacts access to health care, health care
quality, and patient safety.
``(b) Reports Submitted by Covered Firms Owned by or Affiliated
With Private Equity.--For purposes of subsection (a), and with respect
to a covered firm described in subsection (a)(1)(A) and each private
equity fund that is a control person of the covered firm, the
information described in this subsection is the following information
with respect to each year of the previous 10-year period:
``(1) The percentage of the equity of the private equity
fund contributed by--
``(A) the general partners of the fund; and
``(B) the limited partners of the fund.
``(2) The level of debt of the covered firm at the end of
the applicable year.
``(3) Information on the debt held by the private equity
fund, including--
``(A) the dollar amount of total debt;
``(B) the percentage of debt for which the creditor
is a financial institution in the United States;
``(C) the percentage of debt for which the creditor
is a financial institution outside of the United
States;
``(D) the percentage of debt for which the creditor
is an entity that is located in the United States and
is not a financial institution; and
``(E) the percentage of debt for which the creditor
is an entity that is located outside of the United
States and is not a financial institution.
``(4) The total amount of debt held by the covered firm
that is categorized as--
``(A) liabilities;
``(B) long-term liabilities; and
``(C) payment in kind or zero coupon debt.
``(5) The average debt-to-equity ratio of--
``(A) each covered firm with respect to the private
equity fund; and
``(B) the private equity fund.
``(6) The average debt-to-EBITDA (Earnings Before Interest,
Taxes, Depreciation, and Amortization) of each covered firm
with respect to the private equity fund.
``(7) The total number of covered firms with respect to the
private equity fund that experienced a default during the
applicable year, and the name of any such covered firm.
``(8) The total gross asset value of each covered firm with
respect to the private equity fund.
``(9) The gross performance of the private equity fund
during the applicable year.
``(10) The total dollar amount of aggregate fees and
expenses collected by the private equity fund, the manager of
the fund, or related parties from covered firms with respect to
the private equity fund, which shall--
``(A) be categorized by the type of fee; and
``(B) include a description of the purpose of the
fees.
``(11) Any transaction, monitoring, management,
performance, or other fees collected by the private equity fund
from the covered firm.
``(12) In dollars, the total amount of regulatory assets
under management by the private equity fund.
``(13) In dollars, the total amount of net assets under
management by the private equity fund.
``(14) With respect to the applicable year, the difference
obtained by subtracting the financial gains of the private
equity fund by the fees that the general partners of the fund
charged to the limited partners of the fund (commonly referred
to as the `performance net of fees').
``(15) Any management services agreements between the
covered firm and the private equity fund, including a
disclosure of fees paid through management services agreements.
``(16) Any other services procured by the covered firm from
the private equity fund or any other company owned by the
private equity fund.
``(17) Dividends paid by the covered firm to the private
equity fund.
``(18) The names of--
``(A) the limited partners of the private equity
fund;
``(B) the board members of the private equity fund;
and
``(C) the leadership of the covered firm.
``(19) All political spending by the covered firm,
including contributions, lobbying spending, and contributions
to groups that do not share their donor list.
``(20) All political spending by the private equity fund,
an affiliate of the fund, or an investment professional at the
fund, with respect to--
``(A) health care related issues; or
``(B) members of congressional committees with
oversight of health care.
``(21) Information on the extent to which the covered firm
entered into any sale lease back transactions with the private
equity fund.
``(22) Every asset purchased by the covered firm during the
applicable year.
``(23) Information that is similar to the information
required to be contained in a notification filed pursuant to
the rules under subsection 7A(d)(1) of the Clayton Act (15
U.S.C. 18a(d)(1)).
``(24) Data related to real estate, mortgage, and lease
payments.
``(25) Interest expenses and payments made by the private
equity fund and each covered firm with respect to the private
equity fund to comply with tax receivable agreements.
``(26) Average interest rate paid on secured and unsecured
lines of credit by the private equity fund and each covered
firm with respect to the private equity fund.
``(27) For the private equity fund and each covered firm
with respect to the private equity fund, a list of--
``(A) all transactions with the 10 largest vendors
or service providers; and
``(B) any new vendors or service providers.
``(28) For the private equity fund and each covered firm
with respect to the private equity fund, the number of payments
to staffing firms.
``(29) For the covered firm, the staffing of each health
care provider owned by such covered firm, disaggregated by
position and ratio of staff to patients.
``(30) For the covered firm, the staff retention rates,
number of job postings, and vacancy rates, disaggregated by
position, with respect to each health care provider owned by
such covered firm.
``(31) For a covered firm that owns 1 or more hospitals,
the number of beds in use and the capacity of each such
hospital.
``(32) For the covered firm, the number of health care
facilities or providers owned by such covered firm that have
closed during such year.
``(33) For the covered firm, health care costs charged to
patients and public and private health plans.
``(34) For the covered firm, the percentage and number of
non-patient care areas in health care facilities owned by such
covered firm that have been converted into patient care areas.
``(35) For the covered firm, reductions in the wages or
benefits of health workers employed by health care providers
owned by such covered firm.
``(36) For the private equity fund and each covered firm
with respect to the private equity fund, complaints of, or
citations for violations of, State or Federal worker protection
laws, including charges of unfair labor practices, complaints
of violations of State or Federal antidiscrimination laws,
complaints of violations of wage and hour laws, and
whistleblower complaints.
``(37) For the private equity fund and each covered firm
with respect to the private equity fund, disclosure of any
agreement or arrangement with a labor relations consultant or
other independent contractor or organization for which a report
is required to be filed under section 203(a)(4) of the Labor-
Management Reporting and Disclosure Act of 1959 (29 U.S.C.
433(a)(4)).
``(38) Any other information that the Secretary determines
relevant for evaluating the impact of private equity ownership
of health care entities on the provision of health care, health
care quality, and safety.
``(c) Information Submitted by Covered Firms Not Owned by Private
Equity.--For purposes of subsection (a) and with respect to a covered
firm described in subsection (a)(1)(B), the information described in
this subsection is the following information with respect to each year
of the previous 10-year period:
``(1) The level of debt of the covered firm at the end of
the applicable year.
``(2) The total amount of debt held by the covered firm
that is categorized as--
``(A) liabilities;
``(B) long-term liabilities; and
``(C) payment in kind or zero coupon debt.
``(3) The average debt-to-equity ratio of the covered firm.
``(4) The average debt-to-EBITDA (Earnings Before Interest,
Taxes, Depreciation, and Amortization) of the covered firm.
``(5) Whether the covered firm experienced a default during
the applicable year.
``(6) The total gross asset value of the covered firm.
``(7) Dividends paid by the covered firm.
``(8) The names of the leadership of the covered firm.
``(9) All political spending by the covered firm, including
contributions, lobbying spending, and contributions to groups
that do not share their donor list.
``(10) Every asset purchased by the covered firm during the
applicable year.
``(11) Information that is similar to the information
required to be included in a notification filed pursuant to the
rules under subsection 7A(d)(1) of the Clayton Act (15 U.S.C.
18a(d)(1)).
``(12) Data related to real estate, mortgage, and lease
payments.
``(13) Interest expenses and payments made to comply with
tax receivable agreements.
``(14) Average interest rate paid on secured and unsecured
lines of credit.
``(15) A list of--
``(A) all transactions with the 10 largest vendors
or service providers; and
``(B) any new vendors or servicer providers.
``(16) The number of payments to staffing firms.
``(17) The salaries of the executives of the covered firm
and each health care entity owned by such covered firm.
``(18) The board membership of the covered firm and each
health care entity owned by such covered firm.
``(19) The staff retention rates, number of job postings,
and vacancy rates, disaggregated by position, with respect to
each health care provider owned by the covered firm.
``(20) The percentage and number of non-patient care areas
in health care facilities owned by the covered firm that have
been converted into patient care areas.
``(21) Reductions in the wages or benefits of health
workers employed by health care providers owned by the covered
firm.
``(22) Complaints of, or citations for violations of, State
or Federal worker protection laws, including charges of unfair
labor practices, complaints of violations of State or Federal
antidiscrimination laws, complaints of violations of wage and
hour laws, and whistleblower complaints.
``(23) Disclosure of any agreement or arrangement with a
labor relations consultant or other independent contractor or
organization for which a report is required to be filed under
section 203(a)(4) of the Labor-Management Reporting and
Disclosure Act of 1959 (29 U.S.C. 433(a)(4)).
``(24) Any other information that the Secretary determines
relevant for evaluating the impact of for-profit ownership of
health care entities on the provision of health care, health
care quality, and safety.
``(d) Nonduplication; Reduction of Administrative Burden.--To the
maximum extent practicable, the Secretary shall--
``(1) ensure that the reporting requirements under this
section are not duplicative of other reporting requirements
under Federal law; and
``(2) reduce the administrative burden on covered firms of
complying with such requirements.
``SEC. 3403. RISK MITIGATION AND ACCOUNTABILITY.
``(a) Risk Mitigation.--
``(1) Definition of essential services.--In this
subsection, the term `essential services', with respect to a
health care provider of a health care entity owned by or
affiliated with a covered firm, means services that are
necessary for preserving health care access, health care
quality, and patient safety, as determined by the Secretary,
including services for which the Secretary determines--
``(A) there are no equivalent services available
within the same travel time;
``(B) that loss of the services would result in
meaningful reductions in surge capacity that will
negatively impact access to services, health care
quality, and patient safety;
``(C) that loss of the services would limit health
care access, health care quality, and patient safety
for specific demographics of individuals based on sex,
sexuality, race, nationality, age, or disability
status; or
``(D) that loss of the services would have a
meaningful impact on the ability of health care
entities to provide care in the surrounding
geographical area of the health care provider.
``(2) Mechanism to ensure risk mitigation.--The Secretary
shall establish a mechanism to ensure that the risks of covered
firms with respect to which there is a private equity fund that
is a control person of the covered firm are mitigated. Such
mechanism may require each such covered firm--
``(A) to establish an escrow account with
sufficient funding to cover operating and capital
expenditures for not less than 5 years, including, in
the case of the closure of a health care provider of a
health care entity owned by or affiliated with such
covered firm or if there are reductions of essential
health services at such a health care provider,
sufficient funding--
``(i) to pay out contract obligations to
health care providers and other staff of such
health care entity; and
``(ii) to provide supplemental funding to
community health care or non-profit health care
providers in the surrounding geographical area
impacted by such closure or service reductions;
``(B) to obligate a minimum capital investment in
any health care entity that is owned by or affiliated
with such covered firm; or
``(C) to carry out such other activities as the
Secretary determines appropriate to ensure that such
covered firm provides a financial contribution
sufficient to mitigate the impact of a potential
closure, reduction of essential services, workforce
shortage, or reduction in quality or safety of care or
health care access.
``(b) Limitation on the Use of Real Estate Investment Trusts in
Health Care.--
``(1) Prohibition.--No health care entity or covered firm
may enter into agreement to sell to, or lease from, a real
estate investment trust (as defined in section 856 of the
Internal Revenue Code of 1986) an interest in real property if
the terms of such sale or lease would lead to long-term
weakened financial status of the health care entity or place
the public health at risk.
``(2) Review of sale or lease terms.--
``(A) In general.--The Secretary shall require each
health care entity, or the covered firm that owns such
health care entity, seeking to enter into an agreement
described in paragraph (1) to submit to the Secretary
for review the terms of the sale or lease, as
applicable.
``(B) Standard.--In conducting a review of a sale
or lease under subparagraph (A), the Secretary shall
determine whether the terms of such sale or lease would
lead to long-term weakened financial status of the
health care entity or place the public health at risk.
``(C) Consultation.--The Secretary may consult with
the relevant State attorney general in conducting a
review under subparagraph (A).
``(3) Litigation authority.--Except as provided in section
518 of title 28, United States Code (relating to litigation
before the Supreme Court), attorneys designated by the
Secretary may appear for the Department of Health and Human
Services and represent the Department in any civil action
brought in connection with a violation of paragraph (1).
``(c) Licensure.--
``(1) Definition of private equity firm.--In this
subsection, the term `private equity firm' means a for-profit
corporation with respect to which there is a private equity
fund that is a control person of the corporation.
``(2) Licenses.--The Secretary shall issue licenses for
private equity firms to invest, directly or indirectly, in or
purchase a health care entity.
``(3) Fees.--The Secretary may charge a fee for
applications for licenses under paragraph (1), which shall be
deposited into a special account, the amounts in which shall
remain available to the Secretary, until expended and without
further appropriation, for funding for the National Health
Service Corps, the community health centers program under
section 330, teaching health centers that operate graduate
medical education programs under section 340H, and other health
workforce programs carried out by the Health Resources and
Services Administration, and hospitals that have received
disproportionate share hospital payments under section 1886 of
the Social Security Act or section 1923 of such Act.
``(4) Denial; revocation.--
``(A) In general.--The Secretary may deny or revoke
a license under this subsection--
``(i) in cases in which the Secretary
determines that the private equity firm--
``(I) has failed to comply with any
of the provisions of this title; or
``(II) has engaged in price
gauging, understaffing, access
barriers, or such other metrics as the
Secretary determines appropriate, with
respect to the private equity firm's
ownership of health care entities; or
``(ii) for such other reason involving
actions or practices of the private equity firm
that may impact or interfere with access to, or
quality of, health care, as the Secretary
determines appropriate.
``(B) Divestment.--A private equity firm the
license of which is revoked under subparagraph (A)
shall be required to divest from any investments in any
health care entity.
``(5) Civil monetary penalties.--Any private equity firm
that violates a requirement of this subsection with respect to
a health care entity shall be liable for a civil monetary
penalty of not more than the amount that is equal to the amount
of Federal funding received by the health care entity, which
shall be deposited in the account described in paragraph (3).
``SEC. 3404. TASK FORCE REVIEW OF THE ROLE OF PRIVATE EQUITY AND
CONSOLIDATION IN HEALTH CARE.
``(a) Establishment.--The Secretary shall establish and operate a
task force to monitor changes in the health care marketplace, to
address and limit the role of private equity and consolidation in
health care, and to address changes to the health care marketplace and
private equity or market consolidation patterns that may create,
continue, or exacerbate health care disparities or disparate health
outcomes based on sex, sexuality, race, nationality, ethnicity, age,
disability, immigration status, socioeconomic status, or location of
residence (referred to in this section as the `Task Force').
``(b) Composition.--
``(1) Chair.--The Secretary shall chair the Task Force.
``(2) Co-chair.--The Secretary shall select from among the
members appointed under paragraph (3) a co-chair of the Task
Force, who shall be a practicing health care provider.
``(3) Members.--The Secretary shall appoint the members of
the Task Force from among the following:
``(A) Academic experts and researchers with
expertise on--
``(i) the role of private equity in
healthcare; and
``(ii) the impact of mergers and
acquisitions in healthcare on costs and
patients.
``(B) Representatives from organizations focused on
consumer protection, antitrust, health care equity,
patient advocacy, and worker advocacy.
``(C) Hospital and health care staff (and the labor
organizations representing such staff).
``(D) Patients.
``(4) Advisory members.--In addition to the members
described in paragraph (3), the Chair of the Federal Trade
Commission and the Attorney General shall serve as advisory
members of the Task Force.
``(5) Member appointment.--Not later than 180 days after
the date of enactment of this Act, the Secretary shall appoint
the members of the Task Force--
``(A) in accordance with paragraph (2); and
``(B) using a competitive application process.
``(c) Recommendations.--The Task Force shall--
``(1) identify best practices and, for purposes of
subsection (d), develop recommendations, for limiting the role
of private equity in health care, taking into account the
implications on health outcomes and staff working conditions;
``(2) identify emerging trends within the health care
marketplace that may undermine access to health care, quality
of care, or patient safety or create financial instability and
risk for health providers; and
``(3) develop legislative recommendations for preserving
and expanding health care quality, safety, and access under
this title.
``(d) Report.--The Secretary shall submit to Congress annually a
report--
``(1) on the recommendations developed subsection (c); and
``(2) that includes regulatory and legislative
recommendations to address any adverse effects of health care
consolidation, private equity's involvement in health care, or
any other change or emerging trend in the health care
marketplace.
``(e) Moratorium.--The Secretary may prohibit a private equity fund
from purchasing voting securities of a covered firm, and may prohibit
any merger or acquisition that would result in a private equity fund
gaining control of voting securities of a covered firm, until the date
on which the Secretary determines that the Task Force has had
sufficient time to study and identify whether abuses are taking place
in specific health care sectors or by health care entities related to
price gauging, understaffing, access barriers, or such other metrics as
the Secretary determines appropriate.
``SEC. 3405. CORPORATE ACCOUNTABILITY.
``The Secretary shall--
``(1) maintain a corporate accountability data collection
program for the reporting of any person subject to the
requirements of this title for failure to comply with this
title; and
``(2) furnish the information collected under paragraph (1)
to the National Practitioner Data Bank established pursuant to
the Health Care Quality Improvement Act of 1986.
``SEC. 3406. ENFORCEMENT.
``(a) State Enforcement.--
``(1) State authority.--Each State may require a person
subject to the requirements of this title to satisfy such
requirements applicable to the person.
``(2) Failure to implement requirements.--In the case of a
State that fails to substantially enforce the requirements of
this title with respect to applicable persons in the State, the
Secretary shall enforce the requirements of this title under
subsection (b) to the extent that such requirements relate to
actions prohibited under this title occurring in such State.
``(b) Secretarial Enforcement Authority.--
``(1) In general.--If a person is found by the Secretary to
be in violation of this title, the Secretary may apply a civil
monetary penalty with respect to such person in an amount not
to exceed $10,000 per violation.
``(2) Licensure penalties.--A civil monetary penalty under
paragraph (1) shall be in addition to any civil monetary
penalty assessed under section 3403(c)(4).
``(c) Continued Applicability of State Law.--This title shall not
be construed to supersede any provision of State law that establishes,
implements, or continues in effect any requirement or prohibition
except to the extent that such requirement or prohibition prevents the
application of a requirement or prohibition of this title.
``SEC. 3407. RESEARCH.
``The Secretary shall conduct or support research on--
``(1) the impact of transitioning to a ban on for-profit
corporations owning or investing in health care entities;
``(2) the impact of private equity investment in health
care entities on--
``(A) health care costs;
``(B) access to health care;
``(C) clinical decision making;
``(D) health care entity recruitment and retention;
``(E) labor organization membership rates and
collective bargaining power of health worker labor
organizations;
``(F) health care worker pay, pensions, and other
benefits;
``(G) health outcomes; and
``(H) health disparities;
``(3) the effectiveness of State law (including
regulations) and State enforcement on ensuring acquisition of
health care entities by covered firms does not place access to
health care, health care quality, or patient safety at risk;
and
``(4) compliance the CMS-855A Medicare Enrollment
Application and other Federal ownership transparency
requirements.''.
SEC. 3. PROHIBITED ACTS BY INVESTMENT COMPANIES WITH RESPECT TO HEALTH
CARE.
Section 12 of the Investment Company Act of 1940 (15 U.S.C. 80a-12)
is amended by adding at the end the following:
``(h)(1) In this subsection, the term `health care entity' has the
meaning given the term in section 3401 of the Public Health Service
Act.
``(2) It shall be unlawful for any registered investment company to
engage in any act, practice, or course of business that would strip an
asset from a health care entity or otherwise undermine the quality or
safety of, or access to, health care.
``(3) The Commission, in consultation with the Secretary of Health
and Human Services, shall, for the purposes of this subsection, by
rules and regulations define, and prescribe means reasonably designed
to prevent, actions, practices, and courses of business described in
paragraph (2).''.
SEC. 4. AMENDMENTS TO TITLE 11, UNITED STATES CODE.
(a) Priorities of Claims in Bankruptcy.--
(1) In general.--Section 507(a) of title 11, United States
Code, is amended--
(A) by redesignating paragraphs (1) through 10 as
paragraphs (2) through (11), respectively;
(B) by inserting before paragraph (2), as so
redesignated, the following:
``(A) First, withdrawal liability determined under
part 1 of subtitle E of title IV of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1381
et seq.).'';
(C) in the matter preceding subparagraph (A) of
paragraph (2), as so redesignated, by striking
``First:'' and inserting ``Second:'';
(D) in paragraph (3), as so redesignated, by
striking ``Second,'' and inserting ``Third,'';
(E) in paragraph (4), as so redesignated, by
striking ``Third,'' and inserting ``Fourth,'';
(F) in the matter preceding subparagraph (A) of
paragraph (5), as so redesignated, by striking
``Fourth,'' and inserting ``Fifth,'';
(G) in the matter preceding subparagraph (A) of
paragraph (6), as so redesignated, by striking
``Fifth,'' and inserting ``Sixth,'';
(H) in the matter preceding subparagraph (A) of
paragraph (7), as so redesignated, by striking
``Sixth,'' and inserting ``Seventh,'';
(I) in paragraph (8), as so redesignated, by
striking ``Seventh,'' and inserting ``Eighth,'';
(J) in the matter preceding subparagraph (A) of
paragraph (9), as so redesignated, by striking
``Eighth,'' and inserting ``Ninth,'';
(K) in paragraph (10), as so redesignated, by
striking ``Ninth,'' and inserting ``Tenth,''; and
(L) in paragraph (11), as so redesignated, by
striking ``Tenth,'' and inserting ``Eleventh,''.
(2) Technical and conforming amendments.--
(A) Section 502(i) of title 11, United States Code,
is amended by striking ``section 507(a)(8)'' and
inserting ``section 507(a)(9)''.
(B) Section 503(b)(1)(B)(i) of title 11, United
States Code, is amended by striking ``section
507(a)(8)'' and inserting ``section 507(a)(9)''.
(C) Section 507(d) of title 11, United States Code,
is amended by striking ``(a)(1), (a)(4), (a)(5),
(a)(6), (a)(7), (a)(8) excluding subparagraph (F), or
(a)(9)'' and inserting ``(a)(2), (a)(5), (a)(6),
(a)(7), (a)(8), (a)(9) excluding subparagraph (F), or
(a)(10)''.
(D) Section 523(a)(1)(A) of title 11, United States
Code, is amended by striking ``section 507(a)(3) or
507(a)(8)'' and inserting ``section 507(a)(4) or
507(a)(9)''.
(E) Section 724 of title 11, United States Code, is
amended--
(i) in subsection (b)(2)--
(I) by striking ``section
507(a)(1)(C) or 507(a)(2)'' and
inserting ``section 507(a)(2)(C) or
507(a)(3)''; and
(II) by striking ``507(a)(1)(A),
507(a)(1)(B), 507(a)(3), 507(a)(4),
507(a)(5), 507(a)(6), or 507(a)(7)''
and inserting ``507(a)(2)(A),
507(a)(2)(B), 507(a)(4), 507(a)(5),
507(a)(6), 507(a)(7), or 507(a)(8)'';
and
(ii) in subsection (f)--
(I) in paragraph (1), by striking
``section 507(a)(4)'' and inserting
``section 507(a)(5)''; and
(II) in paragraph (2), by striking
``section 507(a)(5)'' and inserting
``section 507(a)(6)''.
(F) Section 726(b) of title 11, United States Code,
is amended by striking ``paragraph (1), (2), (3), (4),
(5), (6), (7), (8), (9), or (10) of section 507(a)''
and inserting ``paragraphs (2) through (11) of section
507(a)''.
(G) Section 752(a) of title 11, United States Code,
is amended by striking ``section 507(a)(2)'' and
inserting ``section 507(a)(3)''.
(H) Section 766 of title 11, United States Code, is
amended--
(i) in subsection (h), by striking
``section 507(a)(2)'' and inserting ``section
507(a)(3)''; and
(ii) in subsection (i)--
(I) in paragraph (1), by striking
``section 507(a)(2)'' and inserting
``section 507(a)(3)''; and
(II) in paragraph (2), by striking
``section 507(a)(2)'' and inserting
``section 507(a)(3)''.
(I) Section 901 of title 11, United States Code, is
amended by striking ``507(a)(2)'' and inserting
``507(a)(3)''.
(J) Section 943(b)(5) of title 11, United States
Code, is amended by striking ``section 507(a)(2)'' and
inserting ``section 507(a)(3)''.
(K) Section 1123(a)(1) of title 11, United States
Code, is amended by striking ``section 507(a)(2),
507(a)(3), or 507(a)(8)'' and inserting ``section
507(a)(3), 507(a)(4), or 507(a)(9)''.
(L) Section 1129(a)(9) of title 11, United States
Code, is amended--
(i) in subparagraph (A), by striking
``section 507(a)(2) or 507(a)(3)'' and
inserting ``section 507(a)(3) or 507(a)(4)'';
(ii) in the matter preceding clause (i) of
subparagraph (B), by striking ``section
507(a)(1), 507(a)(4), 507(a)(5), 507(a)(6), or
507(a)(7)'' and inserting ``section 507(a)(2),
507(a)(5), 507(a)(6), 507(a)(7), or
507(a)(8)'';
(iii) in the matter preceding clause (i) of
subparagraph (C), by striking ``section
507(a)(8)'' and inserting ``section
507(a)(9)''; and
(iv) in subparagraph (D), by striking
``section 507(a)(8)'' and inserting ``section
507(a)(9)''.
(M) Section 1191(e) of title 11, United States
Code, is amended by striking ``paragraph (2) or (3)''
and inserting ``paragraph (3) or (4)''.
(N) Section 1222(a)(4) of title 11, United States
Code, is amended by striking ``section 507(a)(1)(B)''
and inserting ``507(a)(2)(B)''.
(O) Section 1226(b)(1) of title 11, United States
Code, is amended by striking ``section 507(a)(2)'' and
inserting ``section 507(a)(3)''.
(P) Section 1322(a)(4) of title 11, United States
Code, is amended by striking ``section 507(a)(1)(B)''
and inserting ``section 507(a)(2)(B)''.
(Q) Section 1326(b)(1) of title 11, United States
Code, is amended by striking ``section 507(a)(2)'' and
inserting ``section 507(a)(3)''.
(R) Section 1328(a)(2) of title 11, United States
Code, is amended by striking ``section 507(a)(8)(C)''
and inserting ``section 507(a)(9)(C)''.
(S) Section 6(e) of the Securities Investor
Protection Act of 1970 (15 U.S.C. 78fff(e)) is amended,
in the last sentence, by striking ``section 507(a)(2)''
and inserting ``section 507(a)(3)''.
(b) Confirmation of Plan.--Section 1129 of title 11, United States
Code, is amended by adding at the end the following:
``(f) Notwithstanding any other provision of this section, if the
debtor is a health care business, the court, in confirming a plan,
shall give substantial weight to the extent to which the plan would
allow for maintenance of regional health care access, quality and
safety of health care provided regionally, and health care provider and
staff retention regionally.''.
SEC. 5. MAINTENANCE OF HEALTH CARE ACCESS RELATING TO HOSPITAL
DISCONTINUATION OF SERVICES OR CLOSURE.
Section 1866 of the Social Security Act (42 U.S.C. 1395cc) is
amended--
(1) in subsection (a)(1)--
(A) in subparagraph (X), by striking ``and'' at the
end;
(B) in subparagraph (Y)(ii)(V), by striking the
period and inserting ``, and''; and
(C) by inserting after subparagraph (Y) the
following new subparagraph:
``(Z) beginning 60 days after the date of the enactment of
this subparagraph, in the case of a hospital, to comply with
the requirements of subsection (l) (relating to discontinuation
of services or closure).''; and
(2) by adding at the end the following new subsection:
``(l) Requirements for Hospitals Relating to Discontinuation of
Services or Closure.--
``(1) Requirements.--
``(A) In general.--For purposes of subsection
(a)(1)(Z), except as provided in subparagraph (B), the
requirements described in this subsection are that a
hospital--
``(i) notify the Secretary, in accordance
with paragraph (2), not less than 90 days prior
to the discontinuation of services or full
hospital closure;
``(ii) prohibit the discontinuation of
essential services (as defined in paragraph
(6)) during the notification period (as defined
in such paragraph) unless there is a clear harm
posed to patient or employee health or safety
in the hospital continuing to furnish such
services;
``(iii) respond to any inquiries by the
Secretary relating to the implementation of
this subsection, including the determination of
essential services under paragraph (6)(C); and
``(iv) if applicable--
``(I) submit a mitigation plan and
related information as described in
paragraph (3); and
``(II) participate in the public
comment and review process (including,
if applicable, the alternative
mitigation plan) described in paragraph
(4).
``(B) Application in case of catastrophic events.--
In the case where a discontinuation of services or
closure of a hospital is due to an unforeseen
catastrophic event (as defined by the Secretary), the
requirements described in subparagraph (A) shall apply,
except--
``(i) the hospital shall provide the
notification under clause (i) of such
subparagraph not later than 30 days after the
catastrophic event or as soon as feasible as
determined by the Secretary; and
``(ii) clause (ii) of such subparagraph
(relating to prohibiting the discontinuation of
services) shall not apply.
``(2) Notification information.--For purposes of paragraph
(1)(A)(i), the notification under such paragraph shall include
the following information with respect to a hospital:
``(A) Discontinuation of services.--In the case
where the hospital is discontinuing services (without
full hospital closure):
``(i) The services that will be
discontinued and number of hospital beds
impacted.
``(ii) The number of individuals furnished
such services annually and a breakdown of the
type of insurance used by such individuals for
such services.
``(iii) The number of impacted employees
and what labor organization represents them
(and the contact information for such
organization).
``(iv) The names and addresses of any
organized health care coalitions and community
groups that represent the communities impacted
by the discontinuation of such services.
``(v) Alternative providers of such
services, including provider type, contact
information, and distance and transportation
time by car and public transit from the
hospital.
``(B) Full hospital closure.--In the case of full
hospital closure:
``(i) Hospital ownership entities.
``(ii) The full extent of services that
will no longer be furnished by the hospital.
``(iii) The number of individuals furnished
services annually by the hospital, a
description of the services furnished, and a
breakdown of the type of insurance used by such
individuals for such services.
``(iv) The number of impacted employees
and, if applicable, what labor organizations
represent them (and the contact information for
each such organization).
``(v) The names and addresses of any
organized health care coalitions and community
groups that represent the communities impacted
by the closure.
``(vi) Alternative providers, including
provider type, contact information, and
distance and transportation time by car and
public transit from the hospital.
``(vii) Steps taken prior to the decision
to close in order to avoid closure.
``(viii) Distribution of liquidation
proceeds (cash or assets) or any payments (cash
or assets) made to employees, owners, or
contractors related to the closure.
``(3) Submission of mitigation plan and related information
for essential services.--
``(A) Notification by secretary.--If the Secretary
determines that the discontinuation of services or
closure of an applicable hospital would negatively
impact access to essential services, the Secretary
shall notify the applicable hospital of such
determination.
``(B) Submission of mitigation plan and related
information.--If an applicable hospital receives a
notification under subparagraph (A), the applicable
hospital shall, not later than 15 days after receiving
such notification, submit to the Secretary, the State
health department, and the local department of public
health--
``(i) a plan to--
``(I) preserve access to essential
services for impacted communities
through partnerships, commitments from
surrounding facilities, transportation
plan access, and preparation for surge
response; and
``(II) support employees in
transitioning to new positions within
health care;
``(ii) information on workforce and public
engagement to ensure awareness of the
discontinuation of services or closure;
``(iii) a description of potential
alternatives to the discontinuation of services
or closure that the hospital considered and an
explanation of why those alternatives are not a
viable option; and
``(iv) a local market study to ascertain
regional bed supply, payor mix distribution
among all providers, demographic trends, and
remaining health systems in the area.
``(C) Public availability.--The Secretary shall
make a mitigation plan and related information
submitted by an applicable hospital under this
paragraph available to the public on the internet
website of the Centers for Medicare & Medicaid
Services.
``(4) Public comment and review process; alternative
mitigation plan.--
``(A) Public comment period.--
``(i) In general.--The Secretary shall
provide a public comment period of not less
than 45 days with the opportunity to submit
written comments regarding the impact of the
potential discontinuation of services or
closure of an applicable hospital.
``(ii) Notice.--Notice of the opportunity
to submit comments shall be published in the
Federal Register and distributed to--
``(I) providers of services and
suppliers that may be impacted by the
discontinuation of services or closure
of the applicable hospital;
``(II) any labor organization that
represents any subdivision of employees
of the applicable hospital;
``(III) organized health care
coalitions and community groups that
represent the communities impacted by
the discontinuation of services or
closure;
``(IV) the State health agency; and
``(V) the local department of
public health.
``(iii) Recommendations of state health
agency and local departments of public
health.--In reviewing a mitigation plan
submitted by an applicable hospital under
paragraph (3), the Secretary shall take into
consideration any recommendations submitted by
the State health agency and local departments
of public health, as applicable, regarding
whether such plan should be approved.
``(B) Alternative mitigation plan.--
``(i) In general.--If, after reviewing the
mitigation plan submitted by an applicable
hospital under paragraph (3) and the comments
submitted during the public comment period
under subparagraph (A) with respect to the
discontinuation of services or closure of the
applicable hospital, the Secretary finds that
the discontinuation of services or closure of
the applicable hospital would have a
significant impact on access to essential
services, the Secretary shall work with the
applicable hospital or other providers of
services and suppliers in the area, as
appropriate, to develop and implement an
alternative plan to the plan submitted by the
applicable hospital under paragraph (3)
(referred to in this subsection as the
`alternative mitigation plan') in order to
ensure continued access to essential services,
which may include an agreement to delay the
discontinuation of services or closure of the
applicable hospital until the alternative
mitigation plan is complete.
``(ii) Technical assistance.--An
alternative mitigation plan under clause (i)
may include technical assistance or information
on available funding mechanisms to support the
furnishing of essential services.
``(iii) Collaboration.--The Secretary
should, to the extent practicable, collaborate
with State and municipal government officials
in the development of an alternative mitigation
plan under clause (i).
``(iv) Public availability.--The Secretary
shall make any information submitted and the
alternative mitigation plan developed under
this paragraph available to the public on the
internet website of the Centers for Medicare &
Medicaid Services.
``(C) Implementation.--The Secretary shall
promulgate regulations to detail the required response
time by an applicable hospital and the speed of the
review process under this paragraph in order to ensure
that such process can be completed with respect to an
applicable hospital prior to the proposed service
discontinuation date or closure date of the applicable
hospital.
``(D) Prohibition.--In the case where the Secretary
finds that a hospital has violated the requirements of
this subsection, the Secretary may prohibit the
hospital and any hospital under the same hospital
ownership entity from being eligible to enroll or
reenroll under the program under this title under
section 1866(j) until the earlier of--
``(i) the date that is 3 years after the
date on which the hospital discontinues
services or closes;
``(ii) the date on which the Secretary
determines essential health services that were
negatively impacted by the discontinuation or
closure have been restored; or
``(iii) such time as the Secretary is
satisfied with the mitigation plan submitted by
the hospital under paragraph (3) or the
alternative mitigation plan under paragraph
(4).
``(5) Annual reports.--The Secretary shall submit an annual
report to Congress on the discontinuation of services and full
closure of hospitals. Each report submitted under the preceding
sentence shall include--
``(A) a description of trends in the
discontinuation of services and closures of hospitals,
including hospital ownership type, geographic location,
types of services furnished, demographic served, and
insurance type;
``(B) an analysis of the impact of the
discontinuation of services and closures on health care
access and ability to meet surge demand due to
emergency (such as a pandemic or climate disaster); and
``(C) recommendations for such administrative or
legislative changes as the Secretary determines
appropriate to preserve access to essential services
nationwide.
``(6) Definitions.--In this subsection:
``(A) Applicable hospital.--The term `applicable
hospital' means a hospital that submits a notification
under paragraph (1)(A)(i) of a discontinuation of
services or full hospital closure.
``(B) Discontinuation.--The term `discontinuation'
may include any reduction or discontinuation of
services furnished by an applicable hospital, including
those that occur as part of a merger or acquisition
agreement.
``(C) Essential services.--The term `essential
services' means, with respect to an applicable
hospital, services that are necessary for preserving
health care access (as determined by the Secretary),
including services for which the Secretary determines--
``(i) there are no equivalent services
available within the same travel time;
``(ii) that loss of the services would
result in meaningful reductions in surge
capacity that will negatively impact access to
services;
``(iii) that loss of the services would
limit health care access for specific
demographics of individuals based on sex,
sexuality, race, nationality, age, or
disability status;
``(iv) that loss of the services would have
a meaningful impact on the ability of health
systems to respond to impacts of climate
change; or
``(v) there is a health or health care-
related emergency declaration status applicable
to the surrounding geographical area of the
hospital on the date on which the hospital
submits notification under paragraph (1)(A)(i)
of a discontinuation of services or full
hospital closure.
``(D) Notification period.--The term `notification
period' means, with respect to an applicable hospital,
the period beginning on the date on which the hospital
submits notification under paragraph (1)(A)(i) of a
discontinuation of services or full hospital closure
and ending on the date of such discontinuation of
services or closure.
``(7) No preemption of state law.--Nothing in subsection
(a)(1)(Z) or this subsection shall be construed to limit any
rights or remedies under State or local law relating to
protecting access to essential services or reviewing proposed
hospital closures or reduction of services.''.
SEC. 6. TREATMENT OF RENTS FROM QUALIFIED HEALTH CARE PROPERTY.
(a) In General.--Section 856(d)(2) of the Internal Revenue Code of
1986 is amended by striking ``and'' at the end of subparagraph (B), by
striking the period and inserting ``, and'' at the end of subparagraph
(C), and by adding at the end the following new subparagraph:
``(D) notwithstanding paragraphs (4), (6), and (8),
any amount received or accrued directly or indirectly
from qualified health care property (as defined in
subsection (e)(6)(D)(i)).''.
(b) Conforming Amendments.--
(1) Section 856(d)(8)(B) of the Internal Revenue Code of
1986 is amended--
(A) by striking ``or a qualified health care
property (as defined in subsection (e)(6)(D)(i))'', and
(B) by striking ``qualified health care property
or''.
(2) Section 856(d)(9) of such Code is amended--
(A) by striking ``or a qualified health care
property (as defined in subsection (e)(6)(D)(i))'' in
subparagraph (A),
(B) by striking ``or qualified health care
property'' each place it appears in subparagraph (A)
and (B), and
(C) by striking ``or qualified health care
properties'' in subparagraph (A).
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after the date of the enactment of
this Act.
<all>