Indiana 2022 Regular Session

Indiana Senate Bill SB0298 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	ES0298.2
	2	+	Reprinted
	3	+	February 23, 2022
	4	+	ENGROSSED
	5	+	SENATE BILL No. 298
	6	+	_____
	7	+	DIGEST OF SB 298 (Updated February 22, 2022 5:16 pm - DI 104)
	8	+	Citations Affected: IC 16-18; IC 16-21.
	9	+	Synopsis: Certificates of public advantage. Defines "merger" and
	10	+	"merger agreement" for purposes of the certificate of public advantage
	11	+	(certificate) for certain hospital mergers. Requires the state department
	12	+	of health (state department) to actively supervise a merger. Allows the
	13	+	state department to enter into an agreement with a nonprofit
	14	+	organization or a postsecondary educational institution to study the
	15	+	impacts of the certificate of public advantage on the community's
	16	+	health metrics and outcomes. Requires holders of a certificate to pay
	17	+	for reasonable charges incurred by the state department.
	18	+	Effective: Upon passage.
	19	+	Charbonneau, Ford Jon
	20	+	(HOUSE SPONSORS — MORRISON, BARRETT, FLEMING)
	21	+	January 10, 2022, read first time and referred to Committee on Health and Provider
	22	+	Services.
	23	+	January 12, 2022, amended, reported favorably — Do Pass.
	24	+	January 18, 2022, read second time, ordered engrossed. Engrossed.
	25	+	January 20, 2022, read third time, passed. Yeas 46, nays 0.
	26	+	HOUSE ACTION
	27	+	February 1, 2022, read first time and referred to Committee on Public Health.
	28	+	February 10, 2022, amended, reported — Do Pass.
	29	+	February 22, 2022, read second time, amended, ordered engrossed.
	30	+	ES 298—LS 6529/DI 104 Reprinted
	31	+	February 23, 2022
1	32		Second Regular Session of the 122nd General Assembly (2022)
2	33		PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
3	34		Constitution) is being amended, the text of the existing provision will appear in this style type,
4	35		additions will appear in this style type, and deletions will appear in this style type.
5	36		Additions: Whenever a new statutory provision is being enacted (or a new constitutional
6	37		provision adopted), the text of the new provision will appear in this style type. Also, the
7	38		word NEW will appear in that style type in the introductory clause of each SECTION that adds
8	39		a new provision to the Indiana Code or the Indiana Constitution.
9	40		Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
10	41		between statutes enacted by the 2021 Regular Session of the General Assembly.
11		-	SENATE ENROLLED ACT No. 298
12		-	AN ACT to amend the Indiana Code concerning health.
	42	+	ENGROSSED
	43	+	SENATE BILL No. 298
	44	+	A BILL FOR AN ACT to amend the Indiana Code concerning
	45	+	health.
13	46		Be it enacted by the General Assembly of the State of Indiana:
14		-	SECTION 1. IC 16-18-2-226.2 IS ADDED TO THE INDIANA
15		-	CODE AS A NEW SECTION TO READ AS FOLLOWS
16		-	[EFFECTIVE UPON PASSAGE]: Sec. 226.2. (a) "Merger", for
17		-	purposes of IC 16-21-15, has the meaning set forth in
18		-	IC 16-21-15-1.5(a).
19		-	(b) "Merger agreement", for purposes of IC 16-21-15, has the
20		-	meaning set forth in IC 16-21-15-1.5(b).
21		-	SECTION 2. IC 16-21-15-0.5 IS ADDED TO THE INDIANA
22		-	CODE AS A NEW SECTION TO READ AS FOLLOWS
23		-	[EFFECTIVE UPON PASSAGE]: Sec. 0.5. (a) The general assembly
24		-	finds the following as it relates only to section 1 of this chapter:
25		-	(1) A hospital merger may benefit the public by maintaining
26		-	or improving the quality, efficiency, and accessibility of health
27		-	care services offered to the public.
	47	+	1 SECTION 1. IC 16-18-2-226.2 IS ADDED TO THE INDIANA
	48	+	2 CODE AS A NEW SECTION TO READ AS FOLLOWS
	49	+	3 [EFFECTIVE UPON PASSAGE]: Sec. 226.2. (a) "Merger", for
	50	+	4 purposes of IC 16-21-15, has the meaning set forth in
	51	+	5 IC 16-21-15-1.5(a).
	52	+	6 (b) "Merger agreement", for purposes of IC 16-21-15, has the
	53	+	7 meaning set forth in IC 16-21-15-1.5(b).
	54	+	8 SECTION 2. IC 16-21-15-0.5 IS ADDED TO THE INDIANA
	55	+	9 CODE AS A NEW SECTION TO READ AS FOLLOWS
	56	+	10 [EFFECTIVE UPON PASSAGE]: Sec. 0.5. (a) The general assembly
	57	+	11 finds the following as it relates only to section 1 of this chapter:
	58	+	12 (1) A hospital merger may benefit the public by maintaining
	59	+	13 or improving the quality, efficiency, and accessibility of health
	60	+	14 care services offered to the public.
	61	+	15 (2) Benefits resulting from a hospital merger may outweigh
	62	+	16 any anticompetitive effects of joining together competitors,
	63	+	17 including addressing unique challenges in providing health
	64	+	ES 298—LS 6529/DI 104 2
	65	+	1 care services in rural areas.
	66	+	2 (3) It is in the state's best interest to supplant state and federal
	67	+	3 antitrust law with a process for regulatory approval and
	68	+	4 active supervision by the state department, as provided in this
	69	+	5 chapter.
	70	+	6 (4) It is the intent of the general assembly that this chapter
	71	+	7 immunize, to the fullest extent possible, the following from all
	72	+	8 federal and state antitrust laws:
	73	+	9 (A) The execution of merger agreements approved under
	74	+	10 this chapter and the transactions concerning the merger.
	75	+	11 (B) Postmerger activities supervised under this chapter.
	76	+	12 (b) This section applies only to merger agreements allowed
	77	+	13 under this chapter.
	78	+	14 SECTION 3. IC 16-21-15-1.5 IS ADDED TO THE INDIANA
	79	+	15 CODE AS A NEW SECTION TO READ AS FOLLOWS
	80	+	16 [EFFECTIVE UPON PASSAGE]: Sec. 1.5. (a) As used in this
	81	+	17 chapter, "merger" means any change of ownership, including:
	82	+	18 (1) an acquisition or transfer of assets; or
	83	+	19 (2) the purchase of stock effectuated by a merger agreement.
	84	+	20 (b) As used in this chapter, "merger agreement" means an
	85	+	21 agreement between two (2) or more hospitals for the consolidation
	86	+	22 by merger or other acquisition or transfer of assets by which
	87	+	23 ownership or control over substantially all of the stock, assets, or
	88	+	24 activities of one (1) or more previously licensed and operating
	89	+	25 hospitals is placed under the control of another licensed hospital or
	90	+	26 other entity that controls hospitals.
	91	+	27 SECTION 4. IC 16-21-15-3, AS ADDED BY P.L.104-2021,
	92	+	28 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	93	+	29 UPON PASSAGE]: Sec. 3. (a) Any hospital entering into a merger
	94	+	30 agreement with another hospital may submit an application to the state
	95	+	31 department for a certificate of public advantage to govern the merger
	96	+	32 agreement in the manner prescribed by the state department. However,
	97	+	33 a hospital may not submit an application under this chapter after July
	98	+	34 1, 2026.
	99	+	35 (b) The application for a certificate of public advantage must
	100	+	36 include the following:
	101	+	37 (1) A written copy of the merger agreement.
	102	+	38 (2) A written description of the nature and scope of the merger.
	103	+	39 (c) Any documentation submitted under this section with the
	104	+	40 application that is deemed to be proprietary information shall be clearly
	105	+	41 identified as proprietary information and a copy of the application with
	106	+	42 the proprietary information redacted for public records must be
	107	+	ES 298—LS 6529/DI 104 3
	108	+	1 submitted by the applicant.
	109	+	2 (d) An applicant must also file a complete copy of the application
	110	+	3 for a certificate of public advantage with:
	111	+	4 (1) the office of the secretary of family and social services in a
	112	+	5 manner prescribed by the office of the secretary; and
	113	+	6 (2) the office of the attorney general in a manner prescribed by the
	114	+	7 office of the attorney general.
	115	+	8 (e) The state department shall assess a filing fee for an application
	116	+	9 for a certificate of public advantage that is reasonably sufficient to fully
	117	+	10 fund the costs of the review of the application and ongoing supervision
	118	+	11 if the application is granted, including any fees for consultants and
	119	+	12 experts. The state department may not spend any money on the
	120	+	13 implementation of this chapter until the state department has received
	121	+	14 a filed application and received the filing fee.
	122	+	15 (f) If the state department incurs costs of the review of the
	123	+	16 application and administration of the program that exceed the
	124	+	17 application fee collected, the applicant for a certificate of public
	125	+	18 advantage shall pay the reasonable charges incurred by the state
	126	+	19 department, as determined by the state department.
	127	+	20 (g) The reasonable costs of services concerning the program:
	128	+	21 (1) include the cost of fees for consultants and experts; and
	129	+	22 (2) must be commensurate with the usual compensation for
	130	+	23 like services.
	131	+	24 SECTION 5. IC 16-21-15-4, AS ADDED BY P.L.104-2021,
	132	+	25 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	133	+	26 UPON PASSAGE]: Sec. 4. (a) The state department, in consultation
	134	+	27 with the office of the secretary of family and social services, shall
	135	+	28 review an application for a certificate of public advantage and the
	136	+	29 documentation filed under section 3 of this chapter to determine
	137	+	30 whether there is clear evidence that the proposed merger agreement:
	138	+	31 (1) would benefit the population's health outcomes, health care
	139	+	32 access, and quality of health care; and
	140	+	33 (2) meets the standards described in this section.
	141	+	34 (b) The state department shall consider in the review of the
	142	+	35 application and documentation the effect of the merger agreement on
	143	+	36 the following:
	144	+	37 (1) The quality and price of hospital and health care services
	145	+	38 provided to Indiana residents, including the demonstration of
	146	+	39 population health improvement of the region serviced and the
	147	+	40 extent to which medically underserved populations have access
	148	+	41 to and are projected to use the proposed services.
	149	+	42 (2) The preservation of sufficient health care services within the
	150	+	ES 298—LS 6529/DI 104 4
	151	+	1 geographic area to ensure public access to acute care.
	152	+	2 (3) The cost efficiency of services, resources, and equipment
	153	+	3 provided or used by the hospitals that are a party to the merger
	154	+	4 agreement, including avoidance of duplication of services to
	155	+	5 better meet the needs of the community.
	156	+	6 (4) The ability of health care payors to negotiate payments and
	157	+	7 service agreements with hospitals proposed to be merged under
	158	+	8 the merger agreement.
	159	+	9 (5) Employment.
	160	+	10 (6) Economic impact.
	161	+	11 (c) The state department shall grant the certification if the state
	162	+	12 department determines in the review of the application and
	163	+	13 documentation that, under the totality of the circumstances, the
	164	+	14 following:
	165	+	15 (1) There is clear evidence that the proposed merger would
	166	+	16 benefit the population's health outcomes, health care access, and
	167	+	17 quality of care in the county.
	168	+	18 (2) The likely benefits resulting from the proposed merger
	169	+	19 agreement outweigh any disadvantages attributable to a potential
	170	+	20 reduction in competition that is authorized to may result from the
	171	+	21 proposed merger.
	172	+	22 The holder of a certificate of public advantage issued by the state
	173	+	23 department under this chapter receives immunity from claims of made
	174	+	24 pursuant to federal or state antitrust laws for the duration of the
	175	+	25 certificate.
	176	+	26 (d) The state department has one hundred twenty (120) days from
	177	+	27 the filing of the application to review and make a determination on the
	178	+	28 application. The state department's determination on whether to grant
	179	+	29 the application must:
	180	+	30 (1) be in writing;
	181	+	31 (2) specify the basis for the determination; and
	182	+	32 (3) be provided to the applicant on the date of the determination.
	183	+	33 (e) The state department may include terms or conditions of
	184	+	34 compliance with the issuance of a certificate of public advantage under
	185	+	35 this chapter.
	186	+	36 (f) The state department shall maintain records of all of the
	187	+	37 applications filed under this chapter, including records of any terms or
	188	+	38 conditions of issuing a certificate of public advantage that are imposed
	189	+	39 by the state department.
	190	+	40 (g) The office of the attorney general may, at any time after an
	191	+	41 application is filed under this chapter and before the state department
	192	+	42 makes a determination on the application, require by civil investigative
	193	+	ES 298—LS 6529/DI 104 5
	194	+	1 demand the attendance of witnesses and the production of documents
	195	+	2 for purposes of investigating whether the merger agreement satisfies
	196	+	3 the requirements of this chapter. Any documents produced or testimony
	197	+	4 given under this subsection are subject to confidentiality if the
	198	+	5 information is deemed proprietary information. The attorney general
	199	+	6 may seek compliance with the issuance of a civil investigative demand
	200	+	7 with the appropriate district court of the county in which the merger is
	201	+	8 to occur.
	202	+	9 SECTION 6. IC 16-21-15-4.5 IS ADDED TO THE INDIANA
	203	+	10 CODE AS A NEW SECTION TO READ AS FOLLOWS
	204	+	11 [EFFECTIVE UPON PASSAGE]: Sec. 4.5. (a) As a part of a
	205	+	12 certificate of public advantage granted by the state department
	206	+	13 under this chapter, the state department may enter into an
	207	+	14 agreement with a nonprofit organization or a postsecondary
	208	+	15 educational institution to study the impacts of the certificate of
	209	+	16 public advantage on the community's health metrics and outcomes,
	210	+	17 including any item included in section 4(b) of this chapter.
	211	+	18 However, the state department may not enter into an agreement
	212	+	19 for more than one (1) study.
	213	+	20 (b) If a study is entered into under subsection (a) the following
	214	+	21 requirements must be met:
	215	+	22 (1) The hospital operating under the certificate of public
	216	+	23 advantage shall supply data it owns or maintains that is
	217	+	24 related to the certificate of public advantage and that is
	218	+	25 required by the nonprofit organization or a postsecondary
	219	+	26 educational institution to conduct the study and the data
	220	+	27 supplied must comply with the requirements under the
	221	+	28 federal Health Insurance Portability and Accountability Act
	222	+	29 (HIPAA).
	223	+	30 (2) The preliminary report must be completed within four (4)
	224	+	31 years of the certificate of public advantage being granted.
	225	+	32 (3) A final report must be completed within ten (10) years of
	226	+	33 the certificate of public advantage being granted.
	227	+	34 (4) Copies of the preliminary and final report must be
	228	+	35 distributed to the following:
	229	+	36 (A) The state department.
	230	+	37 (B) The general assembly, including members of the
	231	+	38 interim study committee on public health, behavioral
	232	+	39 health, and human services in an electronic format under
	233	+	40 IC 5-14-6.
	234	+	41 (c) Nothing in this section requires the state department to pay
	235	+	42 for a study.
	236	+	ES 298—LS 6529/DI 104 6
	237	+	1 (d) Nothing in this section requires a hospital operating under
	238	+	2 the certificate of public advantage to supply data that it does not
	239	+	3 own or maintain for purposes of a study.
	240	+	4 SECTION 7. IC 16-21-15-6, AS ADDED BY P.L.104-2021,
	241	+	5 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	242	+	6 UPON PASSAGE]: Sec. 6. (a) The state department shall annually
	243	+	7 review a certificate of public advantage issued by the state department
	244	+	8 under this chapter.
	245	+	9 (b) The holder of a certificate of public advantage shall pay the
	246	+	10 reasonable costs incurred by the state department shall require a
	247	+	11 reasonably sufficient fee for the renewal of the certification of public
	248	+	12 advantage that covers the reasonable costs of the ongoing supervision
	249	+	13 of the certification, including any fees for consultants and experts.
	250	+	14 (c) In conducting the review, the state department shall consider
	251	+	15 whether the hospital continues to meet the standards required for the
	252	+	16 issuance of a certificate under this chapter.
	253	+	17 (d) This section expires July 1, 2026.
	254	+	18 SECTION 8. IC 16-21-15-7, AS ADDED BY P.L.104-2021,
	255	+	19 SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
	256	+	20 UPON PASSAGE]: Sec. 7. (a) The state department shall actively
	257	+	21 supervise and monitor a hospital operating under a certificate of public
	258	+	22 advantage issued under this chapter to ensure that the conduct of the
	259	+	23 hospital furthers the purposes of this chapter.
	260	+	24 (b) The holder of a certificate of public advantage shall pay the
	261	+	25 reasonable costs incurred by the state department shall assess an
	262	+	26 annual monitoring fee to a hospital issued a certificate of public
	263	+	27 advantage under this chapter that covers to cover the reasonable costs
	264	+	28 of the ongoing monitoring and supervision of the certification,
	265	+	29 including any fees for consultants and experts.
	266	+	30 (c) A hospital operating under a certificate of public advantage may
	267	+	31 not increase the charge for each individual service the hospital offers
	268	+	32 by more than the increase in the preceding year's annual average of the
	269	+	33 Consumer Price Index for Medical Care as published by the federal
	270	+	34 Bureau of Labor Statistics.
	271	+	35 (d) For the first five (5) years that a hospital is operating under a
	272	+	36 certificate of public advantage the hospital must:
	273	+	37 (1) invest the realized cost savings from the identified efficiencies
	274	+	38 and improvements included in the certificate of public advantage
	275	+	39 application in the areas of Indiana the hospital serves for the
	276	+	40 benefit of the community; and
	277	+	41 (2) summarize the realized cost savings and investments in the
	278	+	42 hospital's annual report submitted under section 8 of this chapter.
	279	+	ES 298—LS 6529/DI 104 7
	280	+	1 SECTION 9. An emergency is declared for this act.
	281	+	ES 298—LS 6529/DI 104 8
	282	+	COMMITTEE REPORT
	283	+	Madam President: The Senate Committee on Health and Provider
	284	+	Services, to which was referred Senate Bill No. 298, has had the same
	285	+	under consideration and begs leave to report the same back to the
	286	+	Senate with the recommendation that said bill be AMENDED as
	287	+	follows:
	288	+	Page 1, line 12, after "(1)" insert "A hospital merger may benefit
	289	+	the public by maintaining or improving the quality, efficiency, and
	290	+	accessibility of health care services offered to the public.
28	291		(2) Benefits resulting from a hospital merger may outweigh
29	292		any anticompetitive effects of joining together competitors,
30	293		including addressing unique challenges in providing health
31	294		care services in rural areas.
32		-	(3) It is in the state's best interest to supplant state and federal
33		-	antitrust law with a process for regulatory approval and
34		-	active supervision by the state department, as provided in this
35		-	chapter.
36		-	SEA 298 — Concur 2
37		-	(4) It is the intent of the general assembly that this chapter
38		-	immunize, to the fullest extent possible, the following from all
39		-	federal and state antitrust laws:
40		-	(A) The execution of merger agreements approved under
41		-	this chapter and the transactions concerning the merger.
42		-	(B) Postmerger activities supervised under this chapter.
43		-	(b) This section applies only to merger agreements allowed
44		-	under this chapter.
45		-	SECTION 3. IC 16-21-15-1.5 IS ADDED TO THE INDIANA
46		-	CODE AS A NEW SECTION TO READ AS FOLLOWS
47		-	[EFFECTIVE UPON PASSAGE]: Sec. 1.5. (a) As used in this
48		-	chapter, "merger" means any change of ownership, including:
49		-	(1) an acquisition or transfer of assets; or
50		-	(2) the purchase of stock effectuated by a merger agreement.
51		-	(b) As used in this chapter, "merger agreement" means an
52		-	agreement between two (2) or more hospitals for the consolidation
53		-	by merger or other acquisition or transfer of assets by which
54		-	ownership or control over substantially all of the stock, assets, or
55		-	activities of one (1) or more previously licensed and operating
56		-	hospitals is placed under the control of another licensed hospital or
57		-	other entity that controls hospitals.
58		-	SECTION 4. IC 16-21-15-3, AS ADDED BY P.L.104-2021,
59		-	SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
60		-	UPON PASSAGE]: Sec. 3. (a) Any hospital entering into a merger
61		-	agreement with another hospital may submit an application to the state
62		-	department for a certificate of public advantage to govern the merger
63		-	agreement in the manner prescribed by the state department. However,
64		-	a hospital may not submit an application under this chapter after July
65		-	1, 2026.
66		-	(b) The application for a certificate of public advantage must
67		-	include the following:
68		-	(1) A written copy of the merger agreement.
69		-	(2) A written description of the nature and scope of the merger.
70		-	(c) Any documentation submitted under this section with the
71		-	application that is deemed to be proprietary information shall be clearly
72		-	identified as proprietary information and a copy of the application with
73		-	the proprietary information redacted for public records must be
74		-	submitted by the applicant.
75		-	(d) An applicant must also file a complete copy of the application
76		-	for a certificate of public advantage with:
77		-	(1) the office of the secretary of family and social services in a
78		-	manner prescribed by the office of the secretary; and
79		-	SEA 298 — Concur 3
80		-	(2) the office of the attorney general in a manner prescribed by the
81		-	office of the attorney general.
82		-	(e) The state department shall assess a filing fee for an application
83		-	for a certificate of public advantage that is reasonably sufficient to fully
84		-	fund the costs of the review of the application and ongoing supervision
85		-	if the application is granted, including any fees for consultants and
86		-	experts. The state department may not spend any money on the
87		-	implementation of this chapter until the state department has received
88		-	a filed application and received the filing fee.
89		-	(f) If the state department incurs costs of the review of the
90		-	application and administration of the program that exceed the
91		-	application fee collected, the applicant for a certificate of public
92		-	advantage shall pay the reasonable charges incurred by the state
93		-	department, as determined by the state department.
94		-	(g) The reasonable costs of services concerning the program:
95		-	(1) include the cost of fees for consultants and experts; and
96		-	(2) must be commensurate with the usual compensation for
97		-	like services.
98		-	SECTION 5. IC 16-21-15-4, AS ADDED BY P.L.104-2021,
99		-	SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
100		-	UPON PASSAGE]: Sec. 4. (a) The state department, in consultation
101		-	with the office of the secretary of family and social services, shall
102		-	review an application for a certificate of public advantage and the
103		-	documentation filed under section 3 of this chapter to determine
104		-	whether there is clear evidence that the proposed merger agreement:
105		-	(1) would benefit the population's health outcomes, health care
106		-	access, and quality of health care; and
107		-	(2) meets the standards described in this section.
108		-	(b) The state department shall consider in the review of the
109		-	application and documentation the effect of the merger agreement on
110		-	the following:
111		-	(1) The quality and price of hospital and health care services
112		-	provided to Indiana residents, including the demonstration of
113		-	population health improvement of the region serviced and the
114		-	extent to which medically underserved populations have access
115		-	to and are projected to use the proposed services.
116		-	(2) The preservation of sufficient health care services within the
117		-	geographic area to ensure public access to acute care.
118		-	(3) The cost efficiency of services, resources, and equipment
119		-	provided or used by the hospitals that are a party to the merger
120		-	agreement, including avoidance of duplication of services to
121		-	better meet the needs of the community.
122		-	SEA 298 — Concur 4
123		-	(4) The ability of health care payors to negotiate payments and
124		-	service agreements with hospitals proposed to be merged under
125		-	the merger agreement.
126		-	(5) Employment.
127		-	(6) Economic impact.
128		-	(c) The state department shall grant the certification if the state
129		-	department determines in the review of the application and
130		-	documentation that, under the totality of the circumstances, the
131		-	following:
132		-	(1) There is clear evidence that the proposed merger would
133		-	benefit the population's health outcomes, health care access, and
134		-	quality of care in the county.
135		-	(2) The likely benefits resulting from the proposed merger
136		-	agreement outweigh any disadvantages attributable to a potential
137		-	reduction in competition that is authorized to may result from the
138		-	proposed merger.
139		-	The holder of a certificate of public advantage issued by the state
140		-	department under this chapter receives immunity from claims of made
141		-	pursuant to federal or state antitrust laws for the duration of the
142		-	certificate.
143		-	(d) The state department has one hundred twenty (120) days from
144		-	the filing of the application to review and make a determination on the
145		-	application. The state department's determination on whether to grant
146		-	the application must:
147		-	(1) be in writing;
148		-	(2) specify the basis for the determination; and
149		-	(3) be provided to the applicant on the date of the determination.
150		-	(e) The state department may include terms or conditions of
151		-	compliance with the issuance of a certificate of public advantage under
152		-	this chapter.
153		-	(f) The state department shall maintain records of all of the
154		-	applications filed under this chapter, including records of any terms or
155		-	conditions of issuing a certificate of public advantage that are imposed
156		-	by the state department.
157		-	(g) The office of the attorney general may, at any time after an
158		-	application is filed under this chapter and before the state department
159		-	makes a determination on the application, require by civil investigative
160		-	demand the attendance of witnesses and the production of documents
161		-	for purposes of investigating whether the merger agreement satisfies
162		-	the requirements of this chapter. Any documents produced or testimony
163		-	given under this subsection are subject to confidentiality if the
164		-	information is deemed proprietary information. The attorney general
165		-	SEA 298 — Concur 5
166		-	may seek compliance with the issuance of a civil investigative demand
167		-	with the appropriate district court of the county in which the merger is
168		-	to occur.
169		-	SECTION 6. IC 16-21-15-4.5 IS ADDED TO THE INDIANA
	295	+	(3)".
	296	+	Page 1, line 16, delete "(2)" and insert "(4)".
	297	+	Page 3, line 13, delete "shall" and insert "must".
	298	+	and when so amended that said bill do pass.
	299	+	(Reference is to SB 298 as introduced.)
	300	+	CHARBONNEAU, Chairperson
	301	+	Committee Vote: Yeas 11, Nays 0.
	302	+	_____
	303	+	COMMITTEE REPORT
	304	+	Mr. Speaker: Your Committee on Public Health, to which was
	305	+	referred Senate Bill 298, has had the same under consideration and
	306	+	begs leave to report the same back to the House with the
	307	+	recommendation that said bill be amended as follows:
	308	+	Page 1, delete lines 8 through 17.
	309	+	Page 2, delete lines 1 through 11.
	310	+	Page 5, between lines 6 and 7, begin a new paragraph and insert:
	311	+	"SECTION 5. IC 16-21-15-4.5 IS ADDED TO THE INDIANA
170	312		CODE AS A NEW SECTION TO READ AS FOLLOWS
171	313		[EFFECTIVE UPON PASSAGE]: Sec. 4.5. (a) As a part of a
172	314		certificate of public advantage granted by the state department
173	315		under this chapter, the state department may enter into an
174	316		agreement with a nonprofit organization or a postsecondary
175	317		educational institution to study the impacts of the certificate of
	318	+	ES 298—LS 6529/DI 104 9
176	319		public advantage on the community's health metrics and outcomes,
177	320		including any item included in section 4(b) of this chapter.
178		-	However, the state department may not enter into an agreement
179		-	for more than one (1) study.
180	321		(b) If a study is entered into under subsection (a) the following
181	322		requirements must be met:
182	323		(1) The hospital operating under the certificate of public
183	324		advantage shall supply data it owns or maintains that is
184		-	related to the certificate of public advantage and that is
185	325		required by the nonprofit organization or a postsecondary
186	326		educational institution to conduct the study and the data
187	327		supplied must comply with the requirements under the
188	328		federal Health Insurance Portability and Accountability Act
189	329		(HIPAA).
190	330		(2) The preliminary report must be completed within four (4)
191	331		years of the certificate of public advantage being granted.
192	332		(3) A final report must be completed within ten (10) years of
193	333		the certificate of public advantage being granted.
194	334		(4) Copies of the preliminary and final report must be
195	335		distributed to the following:
196	336		(A) The state department.
197	337		(B) The general assembly, including members of the
198	338		interim study committee on public health, behavioral
199	339		health, and human services in an electronic format under
200	340		IC 5-14-6.
201	341		(c) Nothing in this section requires the state department to pay
202	342		for a study.
203	343		(d) Nothing in this section requires a hospital operating under
204	344		the certificate of public advantage to supply data that it does not
205		-	own or maintain for purposes of a study.
206		-	SECTION 7. IC 16-21-15-6, AS ADDED BY P.L.104-2021,
207		-	SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
208		-	SEA 298 — Concur 6
209		-	UPON PASSAGE]: Sec. 6. (a) The state department shall annually
210		-	review a certificate of public advantage issued by the state department
211		-	under this chapter.
212		-	(b) The holder of a certificate of public advantage shall pay the
213		-	reasonable costs incurred by the state department shall require a
214		-	reasonably sufficient fee for the renewal of the certification of public
215		-	advantage that covers the reasonable costs of the ongoing supervision
216		-	of the certification, including any fees for consultants and experts.
217		-	(c) In conducting the review, the state department shall consider
218		-	whether the hospital continues to meet the standards required for the
219		-	issuance of a certificate under this chapter.
220		-	(d) This section expires July 1, 2026.
221		-	SECTION 8. IC 16-21-15-7, AS ADDED BY P.L.104-2021,
222		-	SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
223		-	UPON PASSAGE]: Sec. 7. (a) The state department shall actively
224		-	supervise and monitor a hospital operating under a certificate of public
225		-	advantage issued under this chapter to ensure that the conduct of the
226		-	hospital furthers the purposes of this chapter.
227		-	(b) The holder of a certificate of public advantage shall pay the
228		-	reasonable costs incurred by the state department shall assess an
229		-	annual monitoring fee to a hospital issued a certificate of public
230		-	advantage under this chapter that covers to cover the reasonable costs
231		-	of the ongoing monitoring and supervision of the certification,
232		-	including any fees for consultants and experts.
233		-	(c) A hospital operating under a certificate of public advantage may
234		-	not increase the charge for each individual service the hospital offers
235		-	by more than the increase in the preceding year's annual average of the
236		-	Consumer Price Index for Medical Care as published by the federal
237		-	Bureau of Labor Statistics.
238		-	(d) For the first five (5) years that a hospital is operating under a
239		-	certificate of public advantage the hospital must:
240		-	(1) invest the realized cost savings from the identified efficiencies
241		-	and improvements included in the certificate of public advantage
242		-	application in the areas of Indiana the hospital serves for the
243		-	benefit of the community; and
244		-	(2) summarize the realized cost savings and investments in the
245		-	hospital's annual report submitted under section 8 of this chapter.
246		-	SECTION 9. An emergency is declared for this act.
247		-	SEA 298 — Concur President of the Senate
248		-	President Pro Tempore
249		-	Speaker of the House of Representatives
250		-	Governor of the State of Indiana
251		-	Date: Time:
252		-	SEA 298 — Concur
	345	+	own or maintain for purposes of a study.".
	346	+	Renumber all SECTIONS consecutively.
	347	+	and when so amended that said bill do pass.
	348	+	(Reference is to SB 298 as printed January 13, 2022.)
	349	+	BARRETT
	350	+	Committee Vote: yeas 12, nays 0.
	351	+	_____
	352	+	HOUSE MOTION
	353	+	Mr. Speaker: I move that Engrossed Senate Bill 298 be amended to
	354	+	read as follows:
	355	+	Page 1, between lines 7 and 8, begin a new paragraph and insert:
	356	+	ES 298—LS 6529/DI 104 10
	357	+	"SECTION 2. IC 16-21-15-0.5 IS ADDED TO THE INDIANA
	358	+	CODE AS A NEW SECTION TO READ AS FOLLOWS
	359	+	[EFFECTIVE UPON PASSAGE]: Sec. 0.5. (a) The general assembly
	360	+	finds the following as it relates only to section 1 of this chapter:
	361	+	(1) A hospital merger may benefit the public by maintaining
	362	+	or improving the quality, efficiency, and accessibility of health
	363	+	care services offered to the public.
	364	+	(2) Benefits resulting from a hospital merger may outweigh
	365	+	any anticompetitive effects of joining together competitors,
	366	+	including addressing unique challenges in providing health
	367	+	care services in rural areas.
	368	+	(3) It is in the state's best interest to supplant state and federal
	369	+	antitrust law with a process for regulatory approval and
	370	+	active supervision by the state department, as provided in this
	371	+	chapter.
	372	+	(4) It is the intent of the general assembly that this chapter
	373	+	immunize, to the fullest extent possible, the following from all
	374	+	federal and state antitrust laws:
	375	+	(A) The execution of merger agreements approved under
	376	+	this chapter and the transactions concerning the merger.
	377	+	(B) Postmerger activities supervised under this chapter.
	378	+	(b) This section applies only to merger agreements allowed
	379	+	under this chapter.".
	380	+	Page 4, line 36, after "chapter." insert "However, the state
	381	+	department may not enter into an agreement for more than one (1)
	382	+	study.".
	383	+	Page 4, line 40, after "maintains" insert "that is related to the
	384	+	certificate of public advantage and".
	385	+	Renumber all SECTIONS consecutively.
	386	+	(Reference is to ESB 298 as printed February 10, 2022.)
	387	+	MORRISON
	388	+	ES 298—LS 6529/DI 104