Updated Hospital and Center Facility Closure Plan Guidelines

December 1, 2025 DHDTC D AL#: 25- 08 Revised Facil ity Closure Plan Guide lines Dear Chief Executive Of ficer and Administrator s: This letter is to p rovide you with upda ted guidance rega rding the submission of closu re plans for hospitals, diagnostic and treatment cent ers, end-stage renal dise ase facilities, midwifery birthing cen ters and ambulato ry surgery cente rs (each referred to herei n as a “facility”). This guidance supersedes DAL23-06.pdf. State regulations at 10 NYCR R § 401.3(a) requires tha t “Proposed change s in physical plant, bed capacit y and the extent and kind of ser vices provided shall be submitted to the Department in writin g...” 10 NYCR R § 401.3(e) also requires that “To reduce the operation from a certified bed capacity to a specified lesser bed capaci ty, the operator sh all obtain prior wri tten approval from the department, show satisfactory cause for the reques ted reduction…” In addition, under 10 NYCRR § 401.3(g), “ No medical facility shall discon tinue operation or surrender its ope rating certificate unless 90 days' notice o f its intention to do so is given t o the commissioner and his written app roval obtained.” No related actions, such as discontinuing a service or reducing the numbe r of beds, may be taken prior to receiving approval o f the closure plan; provided, however, that the Departmen t of Health (“Dep artment”) may take into considerati on the impacts on quality of care and patient safety during the closure plan proce ss and at its d iscretion, provide prior written approval to complete discre te actions prior to re ceiving approval of the closure plan. Even temporary closures require a closure plan, and the closure is not permitted unless it is approved by the Department in writing. Neither ac knowledgment o f the closure plan submission nor verbal comment from a Department representa tive can be considered approval of the closure plan. The Departmen t reserves the right to utilize any avail able sanctions in a ca se where this guidance is not foll owed. Facility Closure Plan Guidelines I. T emporary Closu res (Up to 60 Days Du ration): Step One: V erbal Notification by Facility V erbal notification of a p roposed closure mu st be provided to the Departm ent’s H ospital Program Direc tor in the appli cable Regional Of fice as soon as any facility contempla tes temporary cessation, pause, or li mitation of a service or reduction in the number of beds. A verbal statement from the Regi onal Program Dire ctor does not constitute the Depart ment’s approval of a closu re plan. <a href="https://www.health.ny.gov/professionals/hospitaladministrator/letters/2023/docs/dal_23-06.pdf">

Step T w o: W ritten notif ication by Facility Within 48 hours of the verbal notice, a written no tice must also be provided via e mail to the Department’s Hospi tal Program Di rector in the R egional Office. Step Three: Approval of T e mporary Closu re T o obtain approval for temporary closu res, the Department requires proof of a surety bond fo r which proceeds are forfeitable to the lowest-level local government where the facility is located. The proceeds wi ll be so forfeited if the service is not resumed within 60 days. It is the responsibili ty of the facility to ensure that commun ities and com munity members con tinue to have access to needed heal th care services and that this informati on is posted on its main website. II. Non-T emporary Clo sures (Greater than 60 Days Du ration or Permanent): Step One: V erbal Notification by Facility V erbal notification of a p roposed closure mu st be provided to the Departm ent’s H ospital Program Direc tor in the appli cable Regional Of fice as soon as any facility contempla tes non - temporary cessation, pause, or limita tion of a ser vice or reduction in the number of beds. A verbal statement from the Regi onal Program Dire ctor does not constitute the Depart ment’s approval of a closu re plan. Step T w o: W ritten notif ication by Facility Within 48 hours of the verbal notice and no less than 90 days in advan ce of the proposed closure, a written notice must also be provided via email to the Departme nt’s Hospital Progra m Director in the Reg ional Office. Step Three: Pub lic Meeting T he facility must aler t the public, physici ans, and s taff of the intent to submi t a closure pl an and must hold a publ ic meeting, with i nvitations to all af fected local, sta te and federal elected offici als and notice to the community, which shall at a minimum include a ff ected health care providers, labor unions, and if appli cable, the borou gh president and com munity board fo r the district in which the hospital is located. There must be 10 days’ advance notice of the publ ic meeting, includi ng to the Departmen t of Health, so that Depa rtment staf f may attend if desired. The public meeting must be held at a si te that is within reason able proximity to the facili ty or unit seeking to close and is accessi ble to individual s with disabilities. Bo th in-person and virtual attendance shall be of fered. The facility’s Chief Executive Officer and/or Chief Operating Of ficer must at tend and answ er questions. Public participants mu st be af forded a reasonabl e opportunity to speak about rel evant matters a t the public meeting. The facility and t he Department will accept comm ents submitted in writing at the publi c meeting, and by mail or el ectronic mail wi thin one week foll owing the public meeting.

Step Four: Sub mission of Closure Plan by Facil ity All the informa tion below must be included (in seq uential order) in the facility closu re plan submitted to the Dep artment’ s Hospital Program Directo r in the Regional Office via email for the Department’ s approval. Please include the da te, name, addres s, telephone number, and email address of the facility and operator on all pages o f the closure plan. 1. T arget closure date, whether the entire facili ty is closing or, if the entire facility is not closing, what service (s) or beds w ill be closing a nd what service (s) will be remai ning at the facility. 2. Reason(s) for closu re. Please provide de tailed informa tion, data, fina ncials, and all relevant documen tation to support the reason(s) for closure 3. Name, title, telephone number, and email add ress of the individual desi gnated as the operator's conta ct person throughout the closure process. 4. Name, title, telephone number, and email add ress of the individual respons ible for coordinating closu re, if dif ferent from the individual identified in number 3 above. If more than one indivi dual has been assign ed to separate closure duties (e.g., discharg e coordination, directing care, media contacts, equi pment disposal, reco rd disposi tion), all names and con tact information must be included. 5. How the facili ty will establi sh and maintain ongoing com munication wi th the Departmen t throughout each milestone of the closure proce ss. 6. Number of patient visits to the facili ty for the previ ous three years (o r for the timefra me that the facility operated if open less than three ye ars). 7. Number of staf f af fected by the closure. 8. Evidence of verbal and written notifi cation to the Department’ s Hospital P rogram Di rector in the Regional Office at the time closu re was contemplated. 9. Evidence of written notification to pa tients, staf f, physician s, applicable unions, elec ted offici als, and the co mmunity of the intent to sub mit a closure pl an. This must include dates and times o f meetings inclusi ve of public meeting s and a roster of attendees a t those meetings. 10. Evidence that all required reports e.g., Financial Reports and Census Reports, have been submitted to the Depart ment. 11. Evidence that all required Health Co mmerce Syst em information is up to date. 12. A plan to manage medi a contacts initial ly and througho ut the process. Med ia releases must be coordinated with the Dep artment prior to release. 13. A plan regarding disconti nuation of ad missions, includi ng the date new admissions wi ll stop, and the plan to notify all refe rring institutions /facilities. 14. A summary of the faci lity's current financi al condition and desc ription of the assets available to the opera tor to maintain app ropriate s ervices during the cl osure period. 15. A description of the popu lation served by the facility and how current pa tients will continue to ob tain access to care incl uding the nu mber of patients af fected by the closure. Identify the zip codes where at least 80% o f patients originate. T he process must include asses sing the needs of the p atients.

1. Evidence identifying and confirming availabil ity of services at other area facil ities including obtai ning information to en sure that the facility can accept new p atients, identifying where Medicaid patients can obtain car e if the closing facility pr ovides services to Medicai d patients; providing i nformation about other facili ties to patients and families, ensuring lang uage access (i.e., that information abou t the closu re and continuing care wi th another facili ty is communicated in the patient’ s prefer red language) and that the wishes of curren t patients/famil ies are respected; and ensuring tha t concerns such as geog raphic loca tion, public transporta tion, type of fa cility, medi cal care, etc., are add ressed in identifying future placement options and ensur ing continuity of care for patien ts. Please note, a s always, it is t he responsibility of facilities to ensure that individual patients are of fered choi ces, and that the patient accept s the transfer p rior to any movemen t taking place. 17. A plan to ensure that pati ents’ belongi ngs will be secu red if a facility is closing, and the plan if a patient is being transfe rred to another ho spital. 18. A plan to determine the appropriate me thod of tra nsport to be util ized for patients i f they are being transfer red to another facility to obtain i npatient care. 19. A plan to dispose of any drugs and biologi cals, chemicals, and radioactive mate rials. 20. A plan for proper main tenance, storage, and retrieval of medical records, i ncluding: a. plan for completio n of medi cal records, b. plan for maintenan ce of records in accordance wit h federal, state, and local regulations, c. identification of a medical record custodian accep table to the Depa rtment of Health, and d. a process for hand ling medical information that may co me post-closure. 21. Provisions for the storage and sa fekeeping of s tained slides and pa raf fin blocks. 22. The plan to ensu re adequate staf fing th roughout the closure process, and to ensu re that staff have information regarding other e mployment opportunities. 23. A description of what the building wil l be used for once the fa cility is closed, if known, and the disposition of the buil ding’s conten ts. 24. If the proposal is to close psychiat ric or substance use disorder beds o r services, the proposed closure must also be discussed with the New Y ork State Office o f Mental Health (OMH) and the New Y ork State Of fice of Addiction Services and Su pports (OASAS). Evidence and summary of this discussi on must be includ ed in the closure plan. Step 5: Closu re Plan Decision by the Department The closure plan i s not approved un til you receive written notification o f the closure plan’ s approval from the Department. Neither acknow ledgment of the cl osure plan submission nor a verbal comment f rom an individual who works for the De partment can be considered an app roval.

Step 6: Contact ing Stake holders after the Closure Plan is Approved The facility shall notify p atients, contracted services, staf f, other agen cies, and managed care programs immediatel y upon receipt of the D epartment's approval of the closu re plan. Step 7: Facility Surrender of the Operating Ce rtificate If the facility is permanently closi ng, t he facility’s o perating certi ficate must be surrendered on the last day of opera tions to the Department ’s Hospi tal Program Director in the Regional Office. Note: Beds and/or Servi ces that have not been operational fo r seven or m ore years For closures o f beds or services that have not been opera tional for seven or more years, please notify the Department’ s Hospital Program Regional Office in wri ting and provide the following informa tion: • Service or bed/bed type(s) that are no lon ger operational. • Date the beds, se rvices, or dialysi s stations stopp ed operating. • Description of why the beds and se rvices are not operating. In these cases, the facility will al so post a notice f or no less than 90 days on its main website that provi des the information listed above. Facilities shou ld note: The closure plan will be returned without approval if the plan does not meet the require ments detailed above or if the proce ss is not followed. Failure to mee t these requirements may also resul t in penalties to the facility, includi ng but not limited to, actions related to a licen se, certificatio n, or designation, o r administrative fines issued on a per- day - of - violation basis fo r each day that the facil ity fails to opera te without approva l from the Department to close. Effective June 22, 2023, a Health Equi ty Impact A ssessment is required as part of Certificate of Nee d applications sub mitted to the Department. For addi tional informa tion, please visit the Depar tment’s HEIA web site at https://www.heal th.ny.gov/community /healthequi ty/impactassess ment.htm. Questions rega rding this corresponden ce may be referred to hospinfo@he alth.ny.gov Sincerely, Stephanie Shulman, DrPH, MS Director Division of Hospitals and Diagnostic & T rea tment Centers