HB 1266 — An Act amending the act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act, in licensing of health care facilities, providing for hospital pricing transparency; providing for acquisition of health care facilities; and conferring powers to the Department of Health and Attorney General.

PRINTER'S NO.   1409

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                         HOUSE BILL
                         No. 1266
                                               Session of
                                                 2025

     INTRODUCED BY D. WILLIAMS, HOWARD, SHUSTERMAN, GIRAL, HILL-
        EVANS, PIELLI, DONAHUE, SAPPEY, BOYD, GUENST, SANCHEZ, OTTEN,
        MAYES, HANBIDGE, BURNS, BOROWSKI, O'MARA, WEBSTER, K.HARRIS,
        NEILSON AND CEPEDA-FREYTIZ, APRIL 17, 2025

     REFERRED TO COMMITTEE ON HEALTH, APRIL 17, 2025


                                    AN ACT
 1   Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
 2      act relating to health care; prescribing the powers and
 3      duties of the Department of Health; establishing and
 4      providing the powers and duties of the State Health
 5      Coordinating Council, health systems agencies and Health Care
 6      Policy Board in the Department of Health, and State Health
 7      Facility Hearing Board in the Department of Justice;
 8      providing for certification of need of health care providers
 9      and prescribing penalties," in licensing of health care
10      facilities, providing for hospital pricing transparency;
11      providing for acquisition of health care facilities; and
12      conferring powers to the Department of Health and Attorney
13      General.
14      The General Assembly of the Commonwealth of Pennsylvania
15   hereby enacts as follows:
16      Section 1.    The act of July 19, 1979 (P.L.130, No.48), known
17   as the Health Care Facilities Act, is amended by adding a
18   section to read:
19   Section 823.    Hospital pricing transparency.
20      (a)   Requirement generally.--No later than six months after
21   the effective date of this subsection, a hospital or hospital
22   system shall establish, update and publish on the publicly
 1   accessible Internet website of the hospital or hospital system,
 2   a list of standard charges for each item or service provided as
 3   required under 42 U.S.C. § 300gg-18(e) (relating to bringing
 4   down the cost of health care coverage).
 5      (b)   Required data elements.--A hospital or hospital system
 6   shall include all of the following corresponding data elements
 7   in a list of standard charges for the hospital or hospital
 8   system, as applicable:
 9            (1)   A description of each item or service provided by
10      the hospital or hospital system.
11            (2)   The gross charge that applies to each individual
12      item or service when provided in, as applicable, the hospital
13      inpatient setting and outpatient department setting.
14            (3)   The payer-specific negotiated charge that applies to
15      each item or service when provided in, as applicable, the
16      hospital inpatient setting and outpatient department setting.
17      Each payer-specific negotiated charge must be clearly
18      associated with the name of the third-party payer and plan.
19            (4)   The de-identified minimum negotiated charge that
20      applies to each item or service when provided in, as
21      applicable, the hospital inpatient setting and outpatient
22      department setting.
23            (5)   The de-identified maximum negotiated charge that
24      applies to each item or service when provided in, as
25      applicable, the hospital inpatient setting and outpatient
26      department setting.
27            (6)   The discounted cash price that applies to each item
28      or service when provided in, as applicable, the hospital
29      inpatient setting and outpatient department setting.
30            (7)   Any code used by the hospital or hospital system for

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 1      purposes of accounting or billing for the item or service,
 2      including the Current Procedural Terminology code, the
 3      Healthcare Common Procedure Coding System code, the Diagnosis
 4      Related Group, the National Drug Code or other common payer
 5      identifier.
 6      (c)   Continued obligation.--A hospital or hospital system
 7   shall continue to publish charges and services if:
 8            (1)   42 U.S.C. § 300gg-18(e) is repealed; or
 9            (2)   Federal enforcement of 42 U.S.C. § 300gg-18 is
10      stopped.
11      (d)   Definitions.--As used in this section, the following
12   words and phrases shall have the meanings given to them in this
13   subsection unless the context clearly indicates otherwise:
14      "De-identified maximum negotiated charge."    The highest
15   charge that a hospital or hospital system has negotiated with
16   all third-party payers for an item or service.
17      "De-identified minimum negotiated charge."    The lowest charge
18   that a hospital or hospital system has negotiated with all
19   third-party payers for an item or service.
20      "Discounted cash price."    The charge that applies to an
21   individual who pays cash or a cash equivalent for a hospital
22   item or service.
23      "Gross charge."    The charge for an individual item or service
24   that is reflected on a hospital's chargemaster, absent any
25   discounts.
26      "Item or service."    As follows:
27            (1)   Each item or service, including an individual item
28      or service or service package, that could be provided by a
29      hospital to a patient in connection with an inpatient
30      admission or an outpatient department visit for which the

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 1      hospital has established a standard charge.
 2          (2)   The term includes, without limitation, the
 3      following:
 4                (i)    Any supply or procedure.
 5                (ii)    Room and board.
 6                (iii)    The use of the facility or any item that is
 7          generally described as a facility fee.
 8                (iv)    The service of an employed physician or
 9          nonphysician practitioner that is generally reflected as
10          a professional charge.
11                (v)    Any other item or service for which a hospital
12          has established a standard charge.
13      "Payer-specific negotiated charge."      The charge that a
14   hospital or hospital system has negotiated with a third-party
15   payer for an item or service.
16      "Standard charge."     As follows:
17          (1)   The regular rate established by a hospital or
18      hospital system for an item or service provided to a specific
19      group of paying patients.
20          (2)   The term includes the following:
21                (i)    The gross charge.
22                (ii)    The payer-specific negotiated charge.
23                (iii)    The de-identified minimum negotiated charge.
24                (iv)    The de-identified maximum negotiated charge.
25                (v)    The discounted cash price.
26      "Third-party payer."     An entity that is, by statute, contract
27   or agreement, legally responsible for payment of a claim for a
28   health care item or service.
29      Section 2.      The act is amended by adding a chapter to read:
30                                 CHAPTER 8-D

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 1                  ACQUISITION OF HEALTH CARE FACILITIES
 2   Section 801-D.      Definitions.
 3      The following words and phrases when used in this chapter
 4   shall have the meanings given to them in this section unless the
 5   context clearly indicates otherwise:
 6      "Acquisition."         An acquisition by a person of an interest in
 7   a hospital or hospital system by purchase, sale, option, merger,
 8   lease, gift, joint venture, spin-off, split-off,
 9   recapitalization, exchange, conveyance, transfer or otherwise
10   that results in any of the following:
11          (1)   A change of ownership or control of 20% or more of
12      the assets, operations or voting securities of the hospital
13      or hospital system.
14          (2)   The acquiring person holding or controlling 50% or
15      more of the assets, operations or voting securities of the
16      hospital or hospital system.
17          (3)   The direct or indirect transfer of control,
18      responsibility or governance of 20% or more of the assets,
19      operations or voting securities of the hospital or hospital
20      system. For purposes of this paragraph, a transfer includes:
21                (i)    The substitution of a new corporate member that
22          transfers the control of, responsibility for or
23          governance of the hospital or hospital system.
24                (ii)    The substitution of one or more members of the
25          governing body or any arrangement, written or oral, that
26          would transfer voting control of the members of the
27          governing body.
28                (iii)    Either of the following:
29                       (A)    The entry into a voting agreement covering,
30                or the deposit into a voting trust regarding, the

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 1                  direct or indirect transfer of control,
 2                  responsibility or governance.
 3                      (B)   The grant of a proxy regarding the direct or
 4                  indirect transfer of control, responsibility or
 5                  governance.
 6      "Health care services."        Medical, surgical, chiropractic,
 7   hospital, optometric, podiatric, pharmaceutical, ambulance,
 8   mental health, substance use disorder, therapeutic,
 9   preventative, diagnostic, curative, rehabilitative, palliative,
10   custodial and any other services relating to the prevention,
11   cure or treatment of illness, injury or disease.
12      "Hospital system."        Any of the following:
13            (1)   A parent corporation of one or more hospitals and
14      any entity affiliated with the parent corporation through
15      ownership or control.
16            (2)   A hospital and any entity affiliated with the
17      hospital through ownership.
18      "Merger."     A consolidation of two or more organizations,
19   including two or more organizations joining through a common
20   parent organization or two or more organizations forming a new
21   organization.
22   Section 802-D.     Acquisition of health care facilities.
23      (a)     Requirement.--A person may not engage in the acquisition
24   of a hospital or hospital system without first having applied
25   for and received the approval of the department under this
26   chapter.
27      (b)     Contents of application.--An application under
28   subsection (a) must be submitted to the department and must
29   include the following information:
30            (1)   The name of the hospital or hospital system being

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 1    acquired and the name of the acquiring person or other
 2    parties to the acquisition.
 3        (2)   The acquisition price.
 4        (3)   A full description of the acquisition agreement.
 5        (4)   A copy of the acquisition agreement.
 6        (5)   A statement from the hospital or hospital system's
 7    board of directors that explains the effect that the
 8    acquisition will likely have on delivery and cost of health-
 9    related services to the community served by each facility
10    involved in the acquisition, along with the basis for this
11    opinion. The statement shall also describe all dissenting
12    viewpoints of which the board of directors is aware.
13        (6)   If applicable, a copy of the two most recent
14    community needs assessments or any similar evaluations or
15    assessments prepared by or for the hospital or hospital
16    system that is the subject of the acquisition, and the
17    identity of all persons who assisted or contributed to the
18    evaluations or assessments.
19        (7)   A description of all charity care provided in the
20    last three years and the projected charity care for three
21    years following the acquisition by each health facility that
22    is the subject of the acquisition agreement. The description
23    must include:
24              (i)    Annual total charity care spending.
25              (ii)    Inpatient, outpatient and emergency room
26        charity care spending.
27              (iii)    A description of how the amount of charity
28        care spending was calculated.
29              (iv)    Annual charity care inpatient discharges,
30        outpatient visits and emergency visits.

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 1               (v)    A description of the types of charity care
 2        services provided annually.
 3               (vi)    A description of the policies, procedures and
 4        eligibility requirements for the provision of charity
 5        care.
 6        (8)    A description of the health care services currently
 7    provided at each facility that is the subject of the
 8    acquisition.
 9        (9)    A description of all services provided by each
10    health care facility that is the subject of the acquisition
11    in the past five years to medical assistance patients,
12    qualified health plan patients and indigent patients. The
13    description must include, at a minimum, the following:
14               (i)    The type and volume of services provided.
15               (ii)    The payors for the services provided.
16               (iii)    The demographic characteristics of and zip
17        code data for the patients served by the hospital or
18        hospital system.
19               (iv)    The costs and revenues for the services
20        provided.
21        (10)    The following current policies for any hospital
22    that is the subject of the acquisition:
23               (i)    Admission policies.
24               (ii)    Nondiscrimination policies.
25               (iii)    End-of-life policies.
26               (iv)    Reproductive health policies.
27               (v)    Other policies or information as appropriate.
28        (11)    The following postacquisition policies for any
29    hospital that is the subject of the acquisition:
30               (i)    Admission policies.

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 1               (ii)    Nondiscrimination policies.
 2               (iii)    End-of-life policies.
 3               (iv)    Reproductive health policies.
 4               (v)    Other policies or information as appropriate.
 5        (12)    If the acquisition will have any impact on
 6    reproductive health care services provided by any health care
 7    facility that is the subject of the acquisition, or any
 8    impact on the availability or accessibility of reproductive
 9    health care services, a description of all reproductive
10    health care services provided in the last five years by each
11    health care facility that is the subject of the acquisition.
12    The description must include the types and levels of
13    reproductive services, including:
14               (i)    Information about contraception provision.
15               (ii)    The number of pregnancy terminations, tubal
16        ligations and in vitro fertilization procedures provided.
17               (iii)    A description of how the information under
18        this paragraph was compiled.
19        (13)    If the acquisition will have any impact on end-of-
20    life health care services provided by any health care
21    facility that is the subject of the acquisition, or any
22    impact on the availability or accessibility of end-of-life
23    health care services, a description of all end-of-life health
24    care services provided in the last five years by each health
25    care facility that is the subject of the acquisition. The
26    description must include the types and levels of end-of-life
27    services provided and a description of how this information
28    was compiled.
29        (14)    If the acquisition will have any impact on gender-
30    affirming health care services, provided by any health care

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 1    facility that is the subject of the acquisition, or any
 2    impact on the availability or accessibility of gender-
 3    affirming health care services, a description of all gender-
 4    affirming health care services provided in the last five
 5    years by each health care facility that is the subject of the
 6    acquisition. The description must include the types and
 7    levels of gender-affirming health care provided, including
 8    information about the number of gender-affirming surgical
 9    procedures provided and a description of how this information
10    was compiled.
11        (15)    A description of any community benefit program
12    provided by the hospital or hospital system during the past
13    five years with an annual cost of at least $10,000 and the
14    annual cost of each program for the past five years.
15        (16)    As follows:
16               (i)    For each hospital or hospital system that is the
17        subject of the acquisition, a description of the
18        following:
19                      (A)   The current policies and procedures on
20               staffing for patient care areas.
21                      (B)   Employee input on health quality and
22               staffing issues.
23                      (C)   Employee wages, salaries, benefits, working
24               conditions and employment protections.
25               (ii)    The description under subparagraph (i) must
26        include a list of all:
27                      (A)   Existing staffing plans.
28                      (B)   Policy and procedure manuals.
29                      (C)   Employee handbooks.
30                      (D)   Collective bargaining agreements.

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 1                     (E)   Similar employment-related documents.
 2        (17)    For each hospital or hospital system that is the
 3    subject of the acquisition, all existing documents specifying
 4    any guarantees made by an entity that would be taking over
 5    operation or control of the hospital or hospital system
 6    relating to employee job security and retraining, or the
 7    continuation of current staffing levels and policies,
 8    employee wages, salaries, benefits, working conditions and
 9    employment protections.
10        (18)    For each hospital or hospital system that is the
11    subject of the acquisition, a statement as to whether,
12    following the acquisition, nonstance will be maintained
13    through all communications and usage of funds regarding
14    nonunion employees forming a union.
15        (19)    For each hospital or hospital system that is the
16    subject of the acquisition, a statement as to whether any
17    successor of the employer or union will be bound to any
18    existing union certification and any existing collective
19    bargaining agreement.
20        (20)    For each hospital or hospital system that is the
21    subject of the acquisition, a description of current debt
22    collection practices and a description of any anticipated
23    changes to debt collection practices following the
24    acquisition.
25        (21)    A description of any anticipated postacquisition
26    changes in services at any health care facility that is the
27    subject of the acquisition. If anticipated changes include a
28    reduction, relocation or elimination of a service, the
29    following information must be included:
30               (i)   The need that the population presently has for

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 1        the service.
 2               (ii)    How the need will be adequately met by the
 3        proposed change.
 4               (iii)    Alternative arrangements designed to meet the
 5        identified need.
 6        (22)    A detailed statement and all documents relating to
 7    the parties' plans for assuring the continuance of existing
 8    hospital privileges following the acquisition.
 9        (23)    A detailed statement and all documents relating to
10    the parties' plans for ensuring the maintenance of
11    appropriate health science research and health care provider
12    education following the acquisition.
13        (24)    A detailed statement and all documents relating to
14    the parties' plans for ensuring safeguards to avoid conflict
15    of interest in postacquisition patient referral.
16        (25)    A detailed statement and all documents relating to
17    the parties' commitment and plans to provide health care to
18    the disadvantaged, the uninsured and the underinsured and how
19    benefits to promote improved health in the affected community
20    will be provided following the acquisition.
21        (26)    A description of each measure proposed by the
22    applicant to mitigate or eliminate any potential adverse
23    effect on the availability or accessibility of health care
24    services to the affected community that may result from the
25    acquisition.
26        (27)    A list of the primary languages spoken at the
27    hospital or hospital system and the threshold languages for
28    medical assistance health beneficiaries, as determined by the
29    department for the county in which any health care facility
30    that is the subject of the acquisition is located.

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 1            (28)   For each hospital or hospital system that is the
 2      subject of the acquisition or otherwise involved in the
 3      acquisition, a financial and economic analysis and report
 4      from an independent expert or consultant that includes a
 5      description of current costs and competition in the relevant
 6      geographic and product market and any anticipated changes in
 7      the costs and competition as a result of the acquisition.
 8            (29)   Any other information deemed necessary by the
 9      department.
10      (c)   Public records.--An application and all related
11   documents shall be deemed public records and accessible for
12   inspection and duplication in accordance with the act of
13   February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law.
14      (d)   Fee.--The department shall charge an applicant fee
15   sufficient to cover the costs of implementing this chapter.
16      (e)   Multiple acquisitions.--If a hospital or hospital system
17   has engaged in multiple acquisitions, in a manner designed to
18   avoid review by the department and Attorney General under this
19   chapter, all related agreements or transactions shall be
20   considered and analyzed as a single acquisition for purposes of
21   this chapter.
22   Section 803-D.    Completed applications.
23      (a)   Completeness.--The department shall determine if an
24   application in accordance with section 802-D is complete for the
25   purposes of review. If the department determines that an
26   application is incomplete, the department shall notify the
27   applicant within 30 business days after the date the application
28   was received stating the reasons for the department's
29   determination of incompleteness.
30      (b)   Receipt.--A completed application shall be deemed

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 1   received on the date when all the information required by
 2   section 802-D has been submitted to the department.
 3      (c)   Notice.--
 4            (1)   Within five business days after receipt of a
 5      completed application, the department shall:
 6                  (i)    Publish notice of the application:
 7                         (A)   On the publicly accessible Internet website
 8                  of the department.
 9                         (B)   In a newspaper of general circulation in the
10                  county or counties where the hospital or hospital
11                  system has health care facilities that are the
12                  subject of the acquisition.
13                  (ii)    Notify, by first-class United States mail,
14            email or facsimile transmission, any person who has
15            requested notice of the filing of the application.
16            (2)   The notice must:
17                  (i)    State that the application has been received.
18                  (ii)    State the names of the parties to the
19            agreement.
20                  (iii)    Describe the contents of the application.
21                  (iv)    State the date and process by which a person
22            may submit written comments about the application to the
23            department.
24   Section 804-D.        Public hearings.
25      (a)   Hearing requirements.--
26            (1)   During the course of review under this chapter, the
27      department shall conduct one or more public hearings, at
28      least one of which shall be in a county where the hospital or
29      hospital system to be acquired is located.
30            (2)   At the hearings, anyone may file written comments

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 1      and exhibits or appear and make a statement.
 2            (3)   The department may subpoena additional information
 3      or witnesses, require and administer oaths, require sworn
 4      statements, take depositions and use related discovery
 5      procedures for purposes of the hearing and at any time prior
 6      to making a decision on the application.
 7      (b)   Timing.--A public hearing under this section must be
 8   held no later than 45 days after receipt of a completed
 9   application, unless the department determines that a new health
10   care impact statement is required in accordance with section
11   805-D, in which case a public hearing must be held no later than
12   30 days after the health care impact statement is completed.
13      (c)   Notice.--
14            (1)   At least 30 days prior to the public hearing, the
15      department shall provide notice of the time and place of the
16      hearing on the department's publicly accessible Internet
17      website and to any person who has requested notice in
18      writing, unless a new health care impact statement is
19      required in accordance with section 805-D, in which case the
20      department shall provide at least 15 days' notice of the
21      public hearing.
22            (2)   At least 30 days prior to the public hearing, the
23      following apply, unless a new health care impact statement is
24      required in accordance with section 805-D, in which case the
25      parties shall provide at least 15 days' notice:
26                  (i)   The parties to the acquisition agreement shall
27            provide notice of the time and place of the hearing:
28                        (A)   Through publication in a newspaper of
29                  general circulation in the affected communities.
30                        (B)   At the public entrance and on the bulletin

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 1                  boards designated for legal or public notices of any
 2                  health care facility that is affected by the
 3                  acquisition.
 4                         (C)   Prominently on the website available to the
 5                  public of any health care facility that is affected
 6                  by the acquisition.
 7                         (D)   Prominently on the website available to the
 8                  employees of any health care facility that is
 9                  affected by the acquisition.
10                  (ii)    (Reserved).
11            (3)   Each notice under this subsection shall be provided
12      in English and in the languages spoken in the county or
13      counties in which the health care facilities are located or
14      provide care.
15      (d)   Summary report.--Within 15 business days of the last
16   public hearing, the department shall compile a summary report of
17   each public hearing proceeding and post the summary report on
18   the department's publicly accessible Internet website. The
19   department shall also provide a copy of the summary report to
20   the Attorney General.
21      (e)   Changes.--If after the initial public hearing there is
22   any change in the terms of the acquisition that materially
23   alters any of the information that the parties to the
24   acquisition provided under section 802-D(b), the department
25   shall conduct an additional public hearing to ensure adequate
26   public comment regarding the proposed change.
27   Section 805-D.        Health care impact statements.
28      (a)   Authorization.--The department shall engage an
29   independent contractor to prepare an independent health care
30   impact statement for any acquisition that satisfies any of the

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 1   following conditions:
 2            (1)   The acquisition directly affects a hospital that is
 3      licensed under Chapter 8 and has more than 50 acute care
 4      beds.
 5            (2)   There is a reasonable basis to conclude that the
 6      acquisition may significantly reduce the availability or
 7      accessibility or cost of any existing health care service.
 8      (b)     Construction.--Nothing in this section shall preclude
 9   the department from obtaining an independent health care impact
10   statement or any other report that is not required under this
11   section.
12      (c)     Contents.--An independent health care impact statement
13   must contain the following information:
14            (1)   An assessment of the effect of the acquisition on
15      emergency services, reproductive health care services, end-
16      of-life health care services, gender-affirming health care
17      services and any other health care services that the hospital
18      or hospital system is providing.
19            (2)   An assessment of the effect of the acquisition on
20      the level and type of charity care that the hospital or
21      hospital system has historically provided.
22            (3)   An assessment of the effect of the acquisition on
23      the provision of health care services to medical assistance
24      patients, patients with disabilities, women, racial and
25      ethnic minorities, lesbian, gay, bisexual, transgender and
26      queer patients and other underserved or marginalized
27      populations.
28            (4)   An assessment of the effect of the acquisition on
29      any community benefit program that the hospital or hospital
30      system has historically funded or operated.

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 1             (5)   An assessment of the effect of the acquisition on
 2      staffing for patient care areas as the acquisition may affect
 3      availability of care, on the likely retention of employees as
 4      the acquisition may affect continuity of care and on the
 5      rights of employees to provide input on health quality and
 6      staffing issues.
 7             (6)   An assessment of the effect of the acquisition on
 8      the cost of patient care.
 9             (7)   An assessment of the effectiveness of any mitigation
10      measure proposed by the applicant to reduce any potential
11      adverse effect on health care services identified in the
12      health care impact statement.
13             (8)   A discussion of alternatives to the acquisition,
14      including closure of the hospital or hospital system.
15             (9)   Recommendations for additional feasible mitigation
16      measures that would reduce or eliminate any significant
17      adverse effect on health care services identified in the
18      health care impact statement.
19      (d)    Consideration.--The information contained in a health
20   care impact statement shall be used in considering whether the
21   acquisition may negatively impact the availability or
22   accessibility of health care services as specified in section
23   807-D.
24      (e)    Copies.--A copy of a health care impact statement shall
25   be made available to any individual or entity that has requested
26   a copy.
27   Section 806-D.     Duties of department.
28      (a)    Determination.--The department shall review the
29   completed application and, within 45 days of the last public
30   hearing held under section 804-D, shall determine whether the

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 1   acquisition meets the requirements for approval in section 807-
 2   D. At that point, the department shall:
 3            (1)   approve the acquisition, with or without any
 4      specific modifications or conditions; or
 5            (2)   disapprove the acquisition.
 6      (b)   Conditions.--
 7            (1)   Subject to paragraphs (2) and (3), the department
 8      may impose conditions on an acquisition to ensure the
 9      requirements of section 807-D are met and that sufficient
10      safeguards are in place to ensure that communities have
11      continued or improved access to affordable quality care.
12            (2)   The department may not make a decision subject to
13      any condition not directly and rationally related to the
14      requirements in section 807-D.
15            (3)   Any condition or modification must bear a direct and
16      rational relationship to the application under review.
17      (c)   Disapproval.--If the department disapproves the
18   acquisition, the disapproval shall constitute a final decision.
19      (d)   Challenges.--A person engaged in an acquisition and
20   affected by a final decision of the department or a person
21   residing in a community affected by a final decision of the
22   department has the right to an adjudicative proceeding to
23   challenge the decision of the department. The adjudicative
24   proceeding shall be governed by 2 Pa.C.S. (relating to
25   administrative law and procedure).
26      (e)   Extensions.--The department may extend, by not more than
27   30 days, any deadline established under this chapter one time
28   during consideration of any application, for good cause.
29      (f)   Contracts and reimbursement.--The department may
30   contract with and provide reasonable reimbursement to qualified

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 1   persons to assist in determining whether the requirements of
 2   section 807-D have been met.
 3      (g)   Rules and regulations.--The department may issue rules
 4   and promulgate regulations necessary to implement this chapter.
 5   Section 807-D.        Approval of acquisition.
 6      The department:
 7            (1)   Shall only approve an application for an acquisition
 8      if the acquisition will not detrimentally affect the
 9      continued existence of accessible and affordable health care
10      that is responsive to the needs of the communities in which
11      the hospital or hospital system health facilities are
12      located.
13            (2)   May not approve an application unless, at a minimum,
14      the department determines that:
15                  (i)    After the acquisition, the affected community
16            will have the same or greater access to quality,
17            affordable care, including reproductive, end-of-life and
18            gender-affirming health care services, and that, if the
19            health care facilities that are the subject of the
20            acquisition will not provide these services, there are
21            alternative sources of quality affordable care in the
22            community that will ensure the community has the same or
23            greater access to these services.
24                  (ii)    The acquisition will not result in the
25            revocation of hospital privileges.
26                  (iii)    Sufficient safeguards are included to maintain
27            appropriate capacity for health science research and
28            health care provider education.
29                  (iv)    The acquiring person and parties to the
30            acquisition are committed to providing health care to the

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 1            disadvantaged, the uninsured and the underinsured and to
 2            providing benefits to promote improved health in the
 3            affected community.
 4                  (v)   Sufficient safeguards are included to avoid
 5            conflict of interest in patient referral.
 6   Section 808-D.       Duty of Secretary of the Commonwealth.
 7      The Secretary of the Commonwealth may not accept any forms or
 8   documents in connection with any acquisition of a hospital or
 9   hospital system until the acquisition has been approved by the
10   department under this chapter.
11   Section 809-D.       Reports.
12      (a)   Compliance.--
13            (1)   The department shall monitor ongoing compliance with
14      the terms and conditions of the acquisition for at least 10
15      years from when the acquisition agreement is finalized.
16            (2)   The department shall require periodic reports from
17      the parties to the acquisition or any successor persons to
18      ensure compliance with commitments made. The department shall
19      determine the frequency of the periodic reports, but the
20      periodic reports shall be made at least annually.
21            (3)   The department may subpoena information and
22      documents and may conduct onsite compliance audits at the
23      acquiring person's expense.
24      (b)   Experts and consultants.--To effectively monitor ongoing
25   compliance with the terms and conditions of the acquisition, the
26   department may, in the department's discretion, contract with
27   experts and consultants. Contract costs may not exceed an amount
28   that is reasonable and necessary to conduct the review and
29   evaluation.
30      (c)   Reimbursement.--

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 1          (1)   The department shall be entitled to reimbursement
 2    from the acquiring person for all actual and direct costs
 3    incurred in monitoring ongoing compliance with the terms and
 4    conditions of the acquisition, including contract and
 5    administrative costs.
 6          (2)   The department may bill the acquiring person or any
 7    successor for the costs incurred.
 8          (3)   The acquiring person or successor billed by the
 9    department under paragraph (2) shall promptly pay for the
10    costs incurred.
11          (4)   If the acquiring person or successor fails to pay
12    the costs incurred within 30 days, the department may assess
13    a civil fine.
14    (d)   Hearing.--
15          (1)   If the department has reason to believe or receives
16    information indicating that the acquiring person or successor
17    is not fulfilling commitments to the affected community under
18    section 807-D, including the acquiring person or successor
19    not complying with any conditions imposed by the department
20    under section 806-D, the department shall hold a hearing upon
21    10 days' notice to the affected parties.
22          (2)   The cost of the hearing and any onsite reviews
23    related to determining the validity of the information shall
24    be borne by the acquiring person or successor.
25          (3)   If after the hearing the department determines that
26    the acquiring person or successor is not fulfilling the
27    commitments to the affected community under section 807-D,
28    the department may:
29                (i)   Revoke or suspend the license issued to the
30          acquiring person or successor or impose civil fines until

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 1            the acquiring person or successor submits or begins to
 2            follow a corrective plan of action.
 3                  (ii)    Refer the matter to the Attorney General for
 4            appropriate action. The Attorney General may seek a court
 5            order compelling the acquiring person to fulfill the
 6            commitments under section 807-D.
 7   Section 810-D.        Powers of Attorney General.
 8      (a)   Powers.--The Attorney General may:
 9            (1)   Ensure compliance with commitments that inure to the
10      public interest.
11            (2)   Take legal action to enforce this chapter and any
12      conditions that the department imposes on the approval of the
13      acquisition.
14            (3)   Obtain damages, injunctive relief, attorney fees and
15      other relief as the court deems necessary to ensure
16      compliance with this chapter.
17            (4)   Seek an injunction to prevent any acquisition not
18      approved by the department under this chapter.
19      (b)   Construction.--No provision of this chapter shall
20   derogate from any authority granted to the Attorney General
21   under law.
22   Section 811-D.        Study.
23      The department shall conduct a study on the impact that
24   provider organization acquisitions have on access to affordable
25   quality health care services throughout the communities of this
26   Commonwealth according to the following:
27            (1)   The study shall address health care services
28      generally and shall specifically address access to
29      reproductive, end-of-life and gender-affirming health care
30      services.

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 1          (2)   For purposes of the study, the department shall
 2      consult with health care providers, health care advocates and
 3      community members to determine both the scope of the study
 4      and what constitutes a provider organization, but a provider
 5      organization shall not include a hospital or hospital system
 6      as defined under this chapter.
 7   Section 812-D.   Review.
 8      If a hospital or hospital system is subject to a review by
 9   the department, the review shall be concurrent with the review
10   under this chapter, to the extent practicable.
11      Section 3.    This act shall take effect in 60 days.




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