Beds Out of Service and Discontinuation of Service

(A) A hospital may remove beds from service temporarily, within the discretion of the licensee, except that any hospital that intends to remove beds from service for more than six months shall notify the Department in writing at least 30 days prior to such removal. (B) Nothing in 105 CMR 130.122 shall be construed to authorize a licensee to discontinue any service, as defined in 105 CMR 130.020 to the public entirely or in substantial part except upon notice to the Department as described in 105 CMR 130.122. Notice to the Department shall be given at least 90 calendar days in advance of the planned closure of the service: At least 30 days prior to notifying the Department of the proposed closure of an essential health service, the hospital shall inform either electronically or in writing the Department and the following parties of its intent to submit notice to close a service: (1) The hospital’s patient and family council; (2) Each staff member of the hospital; (3) Every labor organization that represents the hospital’s workforce during the period of the essential services closure; (4) The members of the General Court who represent the city or town in which the hospital is located; and (5) A representative of the local officials of the city or town in which the hospital is located. With respect to the proposed closure of an essential health service, the 90 day notice to the Department shall at a minimum provide current utilization rates for service(s) being discontinued, describe the anticipated impact on individuals in the hospital’s service area, provide the date set for discontinuation, include the names and addresses of any organized health care coalitions and community groups that are known to the hospital when the notice is issued to the Department, a detailed account of any community engagement and planning which has occurred prior to such filing, and such other information as the Commissioner may require. With respect to the proposed closure of an essential health service, the hospital shall also send a copy of the notice that it submits to the Department to the Health Policy Commission, Office of the Attorney General, Center for Health Information and Analysis, and Executive Office of Labor and Workforce Development as well as each of the health care coalitions and community groups identified by the hospital in its notice to the Department. The Commissioner or his or her designee may waive the 90-day time frame for notifying the Department of a planned discontinuation of a service only in extraordinary circumstances where the Commissioner has determined that such a waiver is necessary to protect the health and safety of patients served by the hospital. (C) The Commissioner may, in exceptional circumstances, find that a health service not otherwise defined as an essential health service, is necessary for preserving access and health status of patients in the hospital’s service area. If the Commissioner makes such a determination, the Department shall immediately notify the hospital of its decision and inform the hospital that the procedures and requirements contained in 105 CMR 130.122(C) through (I) are applicable to its proposal for discontinuation of the health service(s) in question. (D) Except in the circumstances noted in 105 CMR 130.122(E)(1) and (2); if the Department finds that a hospital proposes to discontinue an essential health service, discontinue an essential health service at a campus, or discontinue services entirely at a campus, the Department shall publish a notice of a public hearing in the legal notice section of local newspapers serving residents of the hospital’s service area at least 21 calendar days prior to the date of the hearing. The notice shall set forth the name and address of the hospital, briefly describe the proposed modifications in existing services, and indicate the date, time and location of the hearing. The hearing shall take place in the hospital’s service area no later than 60 calendar days prior to the proposed closure date set out in the hospital’s notice submitted pursuant to 105 CMR 130.122(C). At the public hearing, the hospital shall describe the services to be closed, plans for alternate access to the service, and shall afford the opportunity for interested parties to present their comments on the hospital’s proposal. (1) The requirements at 105 CMR 130.122(D) through (I) for a public notice, hearing and subsequent determinations, planning and reporting by the Department and the hospital shall not be applicable when here is no interruption in services to patients because the Department expects to license another applicant that is simultaneously seeking licensure pursuant to M.G.L. c. 111, §§ 51 through 56, or, in the case of hospice services, licensure pursuant to M.G.L. c. 111, § 57D to continue providing the same services to the same patients as are currently served by the hospital that is providing a notice of discontinuation pursuant to 105 CMR 130.122(C). To qualify for this exception, the hospital and the applicant who is seeking the Department’s licensure approval, must ensure that there is no interruption in the service(s) that are provided to the patients currently served by the hospital at this same site. (2) The requirements at 105 CMR 130.122(D) through (I) for a public notice, hearing and subsequent determinations, planning and reporting by the Department and the hospital shall not be applicable when a hospital proposes to discontinue services at an existing campus or site in order to continue providing the same service(s), without interruption, to the same patient population at a new site that is located within the same zip code area, or within a five- mile or equivalent driving distance radius of the location where service(s) are being discontinued. The new site must have sufficient physical capacity and resources to serve the same patient volume as was previously served by the hospital at the site where service(s) are to be discontinued. (E) Within 15 calendar days of the hearing held pursuant to 105 CMR 130.122(E), the Department shall make a determination as to whether the discontinued service is necessary for preserving access and health status in the hospital’s service area. In making its determination, the Department shall consider the evidence presented at the public hearing, the current utilization of the service, the capacity of alternative delivery sites to provide the service, travel times to alternative service delivery sites, the clinical importance of local access to the service, and any other relevant information available to the Department. (F) If the Department finds that the discontinued service is necessary for preserving access and health status in the hospital’s service area, the hospital shall, within 15 calendar days of such finding, submit a plan for assuring access to such necessary service(s) following the hospital’s closure of the service(s). The plan must include the following elements: (1) Information on utilization of the service prior to proposed closure. (2) Information on the location and service capacity of alternative delivery sites. (3) Travel times to alternative service delivery sites. (4) An assessment of transportation needs post closure and a plan for meeting those needs. (5) A protocol that details mechanisms to maintain continuity of care for current patients of the discontinued service. (6) A protocol that describes how patients in the hospital’s service area will obtain the services at alternative delivery sites. (G) The Department shall review the plan submitted by the hospital pursuant to 105 CMR 130.122(G) to determine if the plan ensures access to the essential service(s) in question following the hospital’s closure of the service(s). The Department shall complete its review of the plan and send the hospital written approval or written comments within ten calendar days of receiving the plan from the hospital. In the event that the essential service is a psychiatric or mental health service, the Department shall consult with the Department of Mental Health. The hospital shall submit a response within ten calendar days to any comments issued by the Department. (H) The Department shall monitor implementation of the hospital’s plan for preserving access to necessary health care services following closure of the service(s).