On Dec. 1, 2025, the New York State Department of Health (Department) updated its guidance via a Dear Administrator Letter (DAL), an official communication sent to licensed healthcare providers to convey regulatory updates, guidance, policy changes, or required actions impacting their operations. DAL 25-08 requires all health facilities—general hospitals, nursing homes, skilled nursing facilities (SNFs), diagnostic and treatment centers (D&TCs), ambulatory surgery centers (ASCs), end stage renal dialysis (ESRD) units, and midwifery birthing centers—to follow new notification and planning procedures before any planned closure.
This guidance applies only to Article 28-regulated facilities. Adult care facilities (ACFs) regulated under Article 7 of the New York State Social Services Law are not subject to this guidance at this time.
Whether the closure of a New York State Public Health Law Article 28-regulated healthcare facility is temporary (up to 60 days) or permanent, facilities must provide early verbal and written notice, engage the community, submit a thorough closure plan, and wait for written Department of Health approval before taking any action. Failure to comply may result in penalties or loss of licensure.
The new requirements take precedence over all previous directives and establish dedicated procedures for both temporary and permanent closures.
Whether temporary or permanent, any contemplated facility closure now demands early, thorough, and ongoing communication with both regulators and the community—with no exceptions or shortcuts permitted.
Understanding the Types of Closures
The new guidance draws a distinction between temporary closures (lasting up to 60 days) and non-temporary or permanent closures (lasting more than 60 days or when a facility ceases operation entirely). Each category comes with its own set of steps and documentation requirements, with a central theme: no closure action can proceed without explicit, written approval from the Department.
Temporary Closures
A temporary closure is defined as the cessation, pause, or limitation of a service, or the reduction of beds, lasting no more than 60 days. Even these short-term disruptions require communication to the Department.
- Immediate verbal notification must be made to the Department’s regional hospital program director in the applicable regional office as soon as a closure is contemplated, not just when a decision has been finalized.
- Written notification, submitted by email, must follow within 48 hours, detailing the scope of and reason for the closure.
- Proof of a surety bond is required, with proceeds forfeited to the local government if the facility does not resume service within the 60-day window. This financial safeguard is designed to ensure continued community access to care.
- Public communication is also required: the facility must keep its community informed by posting closure information and alternative care access on its main website.
Facilities may wish to keep in mind that no aspect of the closure may proceed until they receive written approval from the Department. Verbal comments or email acknowledgments from Department staff do not constitute approval of any closure plan, including temporary closures.
Non-Temporary and Permanent Closures: A Multi-Step Process
For closures lasting more than 60 days, or for permanent shutdowns, the process requires more documentation and emphasizes transparency, communication, and continuity of care.
- Early notification: The facility must notify the applicable Department’s regional hospital program director in the regional office verbally as soon as closure is considered, followed by a written notice within 48 hours—and at least 90 days before the proposed closure date.
- Public engagement: Before submitting a closure plan, the facility must inform the public, physicians, staff, unions, and elected officials of its intent. A public meeting must be held (with 10 days’ notice), accessible both in person and virtually, to discuss the closure and gather feedback. Written comments must be accepted for one week after the meeting.
- Thorough closure plan: The closure plan must specify the target closure date, affected services or beds, and the rationale for closure (including supporting data and financials). The plan must detail the process for communicating with the Department, provide historical patient and staffing data, and document all required notifications and meetings.
- Continuity of care and community impact: The plan must describe how patients, especially Medicaid recipients, will continue to receive care, including information on alternative facilities and assurances of language access. The facility must demonstrate that it has coordinated with other providers and respected patient preferences in transfer arrangements.
- Operational and administrative steps: The facility must plan for secure transfer of patient belongings and records, as well as safe disposal of drugs and hazardous materials. The facility must also outline how it will maintain adequate staffing throughout the closure and assist staff with employment opportunities.
- Special coordination: If psychiatric or substance use disorder services are affected, the facility must consult with the Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS) and include a summary of those discussions.
As with temporary closures, no closure-related action is permitted until the Department issues written approval.
Once approved, the facility must promptly notify all patients, staff, contractors, and agencies, and in the case of a permanent closure, surrender its operating certificate to the regional office on its final day of operation.
Special Cases and Compliance
If beds or services have not been operational for seven or more years, the facility must inform the Department in writing, explaining the circumstances, and post a 90-day notice on its website. The updated guidance also reminds providers that a Health Equity Impact Assessment is now required for Certificate of Need applications.
Finally, the Department’s guidance indicates that failure to comply with these procedures may result in penalties, including fines and actions against licensure or certification.
Conclusion
The new guidance provides detailed and prescriptive requirements, emphasizing transparency, patient safety, and community engagement during facility closures. Facilities may wish to review the full directive carefully and direct any questions to the Department. Facilities may also need to monitor potential changes to closure plan requirements for ACFs, as the Department may update its guidance in the future.