Pennsylvania 2025 2025-2026 Regular Session

Pennsylvania House Bill HB1266 Introduced / Bill

                     
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
Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An 
act relating to health care; prescribing the powers and 
duties of the Department of Health; establishing and 
providing the powers and duties of the State Health 
Coordinating Council, health systems agencies and Health Care 
Policy Board in the Department of Health, and State Health 
Facility Hearing Board in the Department of Justice; 
providing for certification of need of health care providers 
and prescribing penalties," 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.
The General Assembly of the Commonwealth of Pennsylvania 
hereby enacts as follows:
Section 1.  The act of July 19, 1979 (P.L.130, No.48), known 
as the Health Care Facilities Act, is amended by adding a 
section to read:
Section  823 .  Hospital pricing transparency. 
(a)  Requirement generally.--No later than six months after 
the effective date of this subsection, a hospital or hospital 
system shall establish, update and publish on the publicly 
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22 accessible Internet website  	of the hospital or hospital system,  
a list of standard charges for each item or service  	provided as  
required under 42 U.S.C. § 300gg-18(e)  	(relating to bringing  
down the cost of health care coverage).
(b)  Required data elements.--A hospital or hospital system 
shall include all of the following corresponding data elements 
in a list of standard charges  	for the hospital or hospital  
system , as applicable: 
(1)  A description of each item or service provided by 
the hospital or hospital system.
(2)  The gross charge that applies to each individual 
item or service when provided in, as applicable, the hospital 
inpatient setting and outpatient department setting.
(3)  The payer-specific negotiated charge that applies to 
each item or service when provided in, as applicable, the 
hospital inpatient setting and outpatient department setting. 
Each payer-specific negotiated charge must be clearly 
associated with the name of the third-party payer and plan.
(4)  The de-identified minimum negotiated charge that 
applies to each item or service when provided in, as 
applicable, the hospital inpatient setting and outpatient 
department setting.
(5)  The de-identified maximum negotiated charge that 
applies to each item or service when provided in, as 
applicable, the hospital inpatient setting and outpatient 
department setting.
(6)  The discounted cash price that applies to each item 
or service when provided in, as applicable, the hospital 
inpatient setting and outpatient department setting.
(7)  Any code used by the hospital or hospital system for 
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30 purposes of accounting or billing for the item or service, 
including the Current Procedural Terminology code, the 
Healthcare Common Procedure Coding System code, the Diagnosis 
Related Group, the National Drug Code or other common payer 
identifier.
(c)  Continued obligation.--A hospital or hospital system 
shall continue to publish charges and services if:
(1)   42 U.S.C. § 300gg-18(e) is repealed;  or 
(2)  Federal enforcement of  	42 U.S.C. § 300gg-18  	is  
stopped.
(d)  Definitions.--As used in this section, the following 
words and phrases shall have the meanings given to them in this 
subsection unless the context clearly indicates otherwise:
"De-identified maximum negotiated charge."  The highest 
charge that a hospital or hospital system has negotiated with 
all third-party payers for an item or service.
"De-identified minimum negotiated charge."  The lowest charge 
that a hospital or hospital system has negotiated with all 
third-party payers for an item or service.
"Discounted cash price."  The charge that applies to an 
individual who pays cash or a cash equivalent for a hospital 
item or service.
"Gross charge."  The charge for an individual item or service 
that is reflected on a hospital's chargemaster, absent any 
discounts.
"Item or service."  As follows:
(1)  Each item or service, including an individual item 
or service or service package, that could be provided by a 
hospital to a patient in connection with an inpatient 
admission or an outpatient department visit for which the 
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30 hospital has established a standard charge.
(2)  The term includes, without limitation, the 
following:
(i)  Any supply or procedure.
(ii)  Room and board.
(iii)  The use of the facility or any item that is 
generally described as a facility fee.
(iv)  The service of an employed physician or 
nonphysician practitioner that is generally reflected as 
a professional charge.
(v)  Any other item or service for which a hospital 
has established a standard charge.
"Payer-specific negotiated charge."  The charge that a 
hospital or hospital system has negotiated with a third-party 
payer for an item or service.
"Standard charge."  As follows:
(1)  The regular rate established by a hospital or 
hospital system for an item or service provided to a specific 
group of paying patients.
(2)  The term includes the following:
(i)  The gross charge.
(ii)  The payer-specific negotiated charge.
(iii)  The de-identified minimum negotiated charge.
(iv)  The de-identified maximum negotiated charge.
(v)  The discounted cash price.
"Third-party payer."  An entity that is, by statute, contract 
or agreement, legally responsible for payment of a claim for a 
health care item or service.
Section 2.  The act is amended by adding a chapter to read:
CHAPTER 8-D
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30 ACQUISITION OF HEALTH CARE FACILITIES
Section 801-D.  Definitions.
The following words and phrases when used in this chapter 
shall have the meanings given to them in this section unless the 
context clearly indicates otherwise:
"Acquisition."  An acquisition by a person of an interest in 
a hospital or hospital system by purchase, sale, option, merger, 
lease, gift, joint venture, spin-off, split-off, 
recapitalization, exchange, conveyance, transfer or otherwise 
that results in any of the following:
(1)  A change of ownership or control of 20% or more of 
the assets, operations or voting securities of the hospital 
or hospital system.
(2)  The acquiring person holding or controlling 50% or 
more of the assets, operations or voting securities of the 
hospital or hospital system.
(3)  The direct or indirect transfer of control, 
responsibility or governance of 20% or more of the assets, 
operations or voting securities of the hospital or hospital 
system. For purposes of this paragraph, a transfer includes:
(i)  The substitution of a new corporate member that 
transfers the control of, responsibility for or 
governance of the hospital or hospital system.
(ii)  The substitution of one or more members of the 
governing body or any arrangement, written or oral, that 
would transfer voting control of the members of the 
governing body.
(iii)  Either of the following:
(A)  The entry into a voting agreement covering, 
or the deposit into a voting trust regarding,  	the  
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30 direct or indirect transfer of  control, 
responsibility or governance.
(B)  The grant of a proxy regarding  	the direct or 
indirect transfer of  control, responsibility or  
governance.
"Health care services."  Medical, surgical, chiropractic, 
hospital, optometric, podiatric, pharmaceutical, ambulance, 
mental health, substance use disorder, therapeutic, 
preventative, diagnostic, curative, rehabilitative, palliative, 
custodial and any other services relating to the prevention, 
cure or treatment of illness, injury or disease.
"Hospital system."  Any of the following:
(1)  A parent corporation of one or more hospitals and 
any entity affiliated with the parent corporation through 
ownership or control.
(2)  A hospital and any entity affiliated with the 
hospital through ownership.
"Merger."  A consolidation of two or more organizations, 
including two or more organizations joining through a common 
parent organization or two or more organizations forming a new 
organization.
Section 802-D.  Acquisition of health care facilities.
(a)  Requirement.--A person may not engage in the acquisition 
of a hospital or hospital system without first having applied 
for and received the approval of the department under this 
chapter.
(b)  Contents of application.--An application under 
subsection (a) must be submitted to the department and must 
include the following information:
(1)  The name of the hospital or hospital system being 
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30 acquired and the name of the acquiring person or other 
parties to the acquisition.
(2)  The acquisition price.
(3)  A full description of the acquisition agreement.
(4)  A copy of the acquisition agreement.
(5)  A statement from the hospital or hospital system's 
board of directors that explains the effect that the 
acquisition will likely have on delivery and cost of health-
related services to the community served by each facility 
involved in the acquisition, along with the basis for this 
opinion. The statement shall also describe all dissenting 
viewpoints of which the board of directors is aware.
(6)  If applicable, a copy of the two most recent 
community needs assessments or any similar evaluations or 
assessments prepared by or for the hospital or hospital 
system that is the subject of the acquisition, and the 
identity of all persons who assisted or contributed to the 
evaluations or assessments.
(7)  A description of all charity care provided in the 
last three years and the projected charity care for three 
years following the acquisition by each health facility that 
is the subject of the acquisition agreement. The description 
must include:
(i)  Annual total charity care spending.
(ii)  Inpatient, outpatient and emergency room 
charity care spending.
(iii)  A description of how the amount of charity 
care spending was calculated.
(iv)  Annual charity care inpatient discharges, 
outpatient visits and emergency visits.
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30 (v)  A description of the types of charity care 
services provided annually.
(vi)  A description of the policies, procedures and 
eligibility requirements for the provision of charity 
care.
(8)  A description of the health care services currently 
provided at each facility that is the subject of the 
acquisition.
(9)  A description of all services provided by each 
health care facility that is the subject of the acquisition 
in the past five years to medical assistance patients, 
qualified health plan patients and indigent patients. The 
description must include, at a minimum, the following:
(i)  The type and volume of services provided.
(ii)  The payors for the services provided.
(iii)  The demographic characteristics of and zip 
code data for the patients served by the hospital or 
hospital system.
(iv)  The costs and revenues for the services 
provided.
(10)  The following current policies for any hospital 
that is the subject of the acquisition:
(i)  Admission policies.
(ii)  Nondiscrimination policies.
(iii)  End-of-life policies.
(iv)  Reproductive health policies.
(v)  Other policies or information as appropriate.
(11)  The following postacquisition policies for any 
hospital that is the subject of the acquisition:
(i)  Admission policies.
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30 (ii)  Nondiscrimination policies.
(iii)  End-of-life policies.
(iv)  Reproductive health policies.
(v)  Other policies or information as appropriate.
(12)  If the acquisition will have any impact on 
reproductive health care services provided by any health care 
facility that is the subject of the acquisition, or any 
impact on the availability or accessibility of reproductive 
health care services, a description of all reproductive 
health care services provided in the last five years by each 
health care facility that is the subject of the acquisition. 
The description must include the types and levels of 
reproductive services, including:
(i)  Information about contraception provision.
(ii)  The number of pregnancy terminations, tubal 
ligations and in vitro fertilization procedures provided.
(iii)  A description of how the information under 
this paragraph was compiled.
(13)  If the acquisition will have any impact on end-of-
life health care services provided by any health care 
facility that is the subject of the acquisition, or any 
impact on the availability or accessibility of end-of-life 
health care services, a description of all end-of-life health 
care services provided in the last five years by each health 
care facility that is the subject of the acquisition. The 
description must include the types and levels of end-of-life 
services provided and a description of how this information 
was compiled.
(14)  If the acquisition will have any impact on gender- 
affirming health care services, provided by any health care 
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30 facility that is the subject of the acquisition, or any 
impact on the availability or accessibility of gender- 
affirming health care services, a description of all gender-
affirming health care services provided in the last five 
years by each health care facility that is the subject of the 
acquisition. The description must include the types and 
levels of gender-affirming health care provided, including 
information about the number of gender-affirming surgical 
procedures provided and a description of how this information 
was compiled.
(15)  A description of any community benefit program 
provided by the hospital or hospital system during the past 
five years with an annual cost of at least $10,000 and the 
annual cost of each program for the past five years.
(16)  As follows:
(i)  For each hospital or hospital system that is the 
subject of the acquisition, a description of the 
following:
(A)  The current policies and procedures on 
staffing for patient care areas.
(B)  Employee input on health quality and 
staffing issues.
(C)  Employee wages, salaries, benefits, working 
conditions and employment protections.
(ii)  The description under subparagraph (i) must 
include a list of all:
(A)  Existing staffing plans.
(B)  Policy and procedure manuals.
(C)  Employee handbooks.
(D)  Collective bargaining agreements.
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30 (E)  Similar employment-related documents.
(17)  For each hospital or hospital system that is the 
subject of the acquisition, all existing documents specifying 
any guarantees made by an entity that would be taking over 
operation or control of the hospital or hospital system 
relating to employee job security and retraining, or the 
continuation of current staffing levels and policies, 
employee wages, salaries, benefits, working conditions and 
employment protections.
(18)  For each hospital or hospital system that is the 
subject of the acquisition, a statement as to whether, 
following the acquisition, nonstance will be maintained 
through all communications and usage of funds regarding 
nonunion employees forming a union.
(19)  For each hospital or hospital system that is the 
subject of the acquisition, a statement as to whether any 
successor of the employer or union will be bound to any 
existing union certification and any existing collective 
bargaining agreement.
(20)  For each hospital or hospital system that is the 
subject of the acquisition, a description of current debt 
collection practices and a description of any anticipated 
changes to debt collection practices following the 
acquisition.
(21)  A description of any anticipated postacquisition 
changes in services at any health care facility that is the 
subject of the acquisition. If anticipated changes include a 
reduction, relocation or elimination of a service, the 
following information must be included:
(i)  The need that the population presently has for 
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30 the service.
(ii)  How the need will be adequately met by the 
proposed change.
(iii)  Alternative arrangements designed to meet the 
identified need.
(22)  A detailed statement and all documents relating to 
the parties' plans for assuring the continuance of existing 
hospital privileges following the acquisition.
(23)  A detailed statement and all documents relating to 
the parties' plans for ensuring the maintenance of 
appropriate health science research and health care provider 
education following the acquisition.
(24)  A detailed statement and all documents relating to 
the parties' plans for ensuring safeguards to avoid conflict 
of interest in postacquisition patient referral.
(25)  A detailed statement and all documents relating to 
the parties' commitment and plans to provide health care to 
the disadvantaged, the uninsured and the underinsured and how 
benefits to promote improved health in the affected community 
will be provided following the acquisition.
(26)  A description of each measure proposed by the 
applicant to mitigate or eliminate any potential adverse 
effect on the availability or accessibility of health care 
services to the affected community that may result from the 
acquisition.
(27)  A list of the primary languages spoken at the 
hospital or hospital system and the threshold languages for 
medical assistance health beneficiaries, as determined by the 
department for the county in which any health care facility 
that is the subject of the acquisition is located.
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30 (28)  For each hospital or hospital system that is the 
subject of the acquisition or otherwise involved in the 
acquisition, a financial and economic analysis and report 
from an independent expert or consultant that includes a 
description of current costs and competition in the relevant 
geographic and product market and any anticipated changes in 
the costs and competition as a result of the acquisition.
(29)  Any other information deemed necessary by the 
department.
(c)  Public records.--An application and all related 
documents shall be deemed public records and accessible for 
inspection and duplication in accordance with the act of 
February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law.
(d)  Fee.--The department shall charge an applicant fee 
sufficient to cover the costs of implementing this chapter.
(e)  Multiple acquisitions.--If a hospital or hospital system 
has engaged in multiple acquisitions, in a manner designed to 
avoid review by the department and Attorney General under this 
chapter, all related agreements or transactions shall be 
considered and analyzed as a single acquisition for purposes of 
this chapter.
Section 803-D.  Completed applications.
(a)  Completeness.--The department shall determine if an 
application in accordance with section 802-D is complete for the 
purposes of review. If the department determines that an 
application is incomplete,  	the department  shall notify the  
applicant within 30 business days after the date the application 
was received stating the reasons for  	the department's  
determination of incompleteness.
(b)  Receipt.--A completed application shall be deemed 
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30 received on the date when all the information required by 
section 802-D has been submitted to the department.
(c)  Notice.--
(1)  Within five business days after receipt of a 
completed application, the department shall:
(i)  Publish notice of the application:
(A)  On the publicly accessible Internet website 
of the department.
(B)  In a newspaper of general circulation in the 
county or counties where the hospital or hospital 
system has health care facilities that are the 
subject of the acquisition.
(ii)  Notify, by first-class United States mail, 
email or facsimile transmission, any person who has 
requested notice of the filing of the application.
(2)  The notice must:
(i)  State that the application has been received.
(ii)  State the names of the parties to the 
agreement.
(iii)  Describe the contents of the application.
(iv)  State the date and process by which a person 
may submit written comments about the application to the 
department.
Section 804-D.  Public hearings.
(a)  Hearing requirements.--
(1)  During the course of review under this chapter, the 
department shall conduct one or more public hearings, at 
least one of which shall be in a county where the hospital or 
hospital system to be acquired is located.
(2)  At the hearings, anyone may file written comments 
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30 and exhibits or appear and make a statement.
(3)  The department may subpoena additional information 
or witnesses, require and administer oaths, require sworn 
statements, take depositions and use related discovery 
procedures for purposes of the hearing and at any time prior 
to making a decision on the application.
(b)  Timing.--A public hearing under this section must be 
held no later than 45 days after receipt of a completed 
application, unless the department determines that a new health 
care impact statement is required in accordance with section 
805-D, in which case a public hearing must be held no later than 
30 days after the health care impact statement is completed.
(c)  Notice.--
(1)  At least 30 days prior to the public hearing, the 
department shall provide notice of the time and place of the 
hearing on  the department's  publicly accessible Internet  
website and to any person who has requested notice in 
writing, unless a new health care impact statement is 
required in accordance with section 805-D, in which case the 
department shall provide at least 15  	days' notice of the  
public hearing.
(2)  At least 30 days prior to the public hearing, the 
following apply, unless a new health care impact statement is 
required in accordance with section 805-D, in which case the 
parties shall provide at least 15  	days' notice: 
(i)  The parties to the acquisition agreement shall 
provide notice of the time and place of the hearing:
(A)  Through publication in a newspaper of 
general circulation in the affected communities.
(B)  At the public entrance and on the bulletin 
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30 boards designated for legal or public notices of any 
health care facility that is affected by the 
acquisition.
(C)  Prominently on the website available to the 
public of any health care facility that is affected 
by the acquisition.
(D)  Prominently on the website available to the 
employees of any health care facility that is 
affected by the acquisition.
(ii)  (Reserved).
(3)  Each notice under this subsection shall be provided 
in English and in the languages spoken in the county or 
counties in which the health care facilities are located or 
provide care.
(d)  Summary report.--Within 15 business days of the last 
public hearing, the department shall compile a summary report of 
each public hearing proceeding and post the summary report on 
the department's  publicly accessible Internet website. The  
department shall also provide a copy of the summary report to 
the Attorney General.
(e)  Changes.--If after the initial public hearing there is 
any change in the terms of the acquisition that materially 
alters any of the information that the parties to the 
acquisition provided under section 802-D(b), the department 
shall conduct an additional public hearing to ensure adequate 
public comment regarding the proposed change.
Section 805-D.  Health care impact statements.
(a)  Authorization.--The department shall engage an 
independent contractor to prepare an independent health care 
impact statement for any acquisition that satisfies any of the 
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30 following conditions:
(1)  The acquisition directly affects a hospital that is 
licensed under Chapter 8 and has more than 50 acute care 
beds.
(2)  There is a reasonable basis to conclude that the 
acquisition may significantly reduce the availability or 
accessibility or cost of any existing health care service.
(b)  Construction.--Nothing in this section shall preclude 
the department from obtaining an independent health care impact 
statement or any other report that is not required under this 
section.
(c)  Contents.--An independent health care impact statement 
must contain the following information:
(1)  An assessment of the effect of the acquisition on 
emergency services, reproductive health care services, end-
of-life health care services, gender-affirming health care 
services and any other health care services that the hospital 
or hospital system is providing.
(2)  An assessment of the effect of the acquisition on 
the level and type of charity care that the hospital or 
hospital system has historically provided.
(3)  An assessment of the effect of the acquisition on 
the provision of health care services to medical assistance 
patients, patients with disabilities, women, racial and 
ethnic minorities, lesbian, gay, bisexual, transgender and 
queer patients and other underserved or marginalized 
populations.
(4)  An assessment of the effect of the acquisition on 
any community benefit program that the hospital or hospital 
system has historically funded or operated.
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30 (5)  An assessment of the effect of the acquisition on 
staffing for patient care areas as  	the acquisition  may affect 
availability of care, on the likely retention of employees as 
the acquisition  may affect continuity of care and on the  
rights of employees to provide input on health quality and 
staffing issues.
(6)  An assessment of the effect of the acquisition on 
the cost of patient care.
(7)  An assessment of the effectiveness of any mitigation 
measure proposed by the applicant to reduce any potential 
adverse effect on health care services identified in the 
health care impact statement.
(8)  A discussion of alternatives to the acquisition, 
including closure of the hospital or hospital system.
(9)  Recommendations for additional feasible mitigation 
measures that would reduce or eliminate any significant 
adverse effect on health care services identified in the 
health care impact statement.
(d)  Consideration.--The information contained in a health 
care impact statement shall be used in considering whether the 
acquisition may negatively impact the availability or 
accessibility of health care services as specified in section 
807-D.
(e)  Copies.--A copy of a health care impact statement shall 
be made available to any individual or entity that has requested 
a copy.
Section 806-D.  Duties of department.
(a)  Determination.--The department shall review the 
completed application and, within 45 days of the last public 
hearing held under section 804-D, shall determine whether the 
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30 acquisition meets the requirements for approval in section 807-
D. At that point, the department shall:
(1)  approve the acquisition, with or without any 
specific modifications or conditions; or
(2)  disapprove the acquisition.
(b)  Conditions.--
(1)  Subject to paragraphs (2) and (3), the department 
may impose conditions on an acquisition to ensure the 
requirements of section 807-D are met and that sufficient 
safeguards are in place to ensure that communities have 
continued or improved access to affordable quality care.
(2)  The department may not make a decision subject to 
any condition not directly and rationally related to the 
requirements in section 807-D.
(3)  Any condition or modification must bear a direct and 
rational relationship to the application under review.
(c)  Disapproval.--If the department disapproves the 
acquisition, the disapproval shall constitute a final decision.
(d)  Challenges.--A person engaged in an acquisition and 
affected by a final decision of the department or a person 
residing in a community affected by a final decision of the 
department has the right to an adjudicative proceeding to 
challenge the decision of the department. The adjudicative 
proceeding shall be governed by 2 Pa.C.S. (relating to 
administrative law and procedure).
(e)  Extensions.--The department may extend, by not more than 
30 days, any deadline established under this chapter one time 
during consideration of any application, for good cause.
(f)  Contracts and reimbursement.--The department may 
contract with and provide reasonable reimbursement to qualified 
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30 persons to assist in determining whether the requirements of 
section 807-D have been met.
(g)  Rules and regulations.--The department may issue rules 
and promulgate regulations necessary to implement this chapter.
Section 807-D.  Approval of acquisition.
The department:
(1)  Shall only approve an application for an acquisition 
if the acquisition will not detrimentally affect the 
continued existence of accessible and affordable health care 
that is responsive to the needs of the communities in which 
the hospital or hospital system health facilities are 
located.
(2)  May not approve an application unless, at a minimum, 
the department determines that:
(i)  After the acquisition, the affected community 
will have the same or greater access to quality, 
affordable care, including reproductive, end-of-life and 
gender-affirming health care services, and that, if the 
health care facilities that are the subject of the 
acquisition will not provide these services, there are 
alternative sources of quality affordable care in the 
community that will ensure the community has the same or 
greater access to these services.
(ii)  The acquisition will not result in the 
revocation of hospital privileges.
(iii)  Sufficient safeguards are included to maintain 
appropriate capacity for health science research and 
health care provider education.
(iv)  The acquiring person and parties to the 
acquisition are committed to providing health care to the 
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30 disadvantaged, the uninsured and the underinsured and to 
providing benefits to promote improved health in the 
affected community.
(v)  Sufficient safeguards are included to avoid 
conflict of interest in patient referral.
Section 808-D.  Duty of Secretary of the Commonwealth.
The Secretary of the Commonwealth may not accept any forms or 
documents in connection with any acquisition of a hospital or 
hospital system until the acquisition has been approved by the 
department under this chapter.
Section 809-D.  Reports.
(a)  Compliance.--
(1)  The department shall monitor ongoing compliance with 
the terms and conditions of the acquisition for at least 10 
years from when the acquisition agreement is finalized.
(2)  The department shall require periodic reports from 
the parties to the acquisition or any successor persons to 
ensure compliance with commitments made. The department shall 
determine the frequency of the periodic reports, but the 
periodic reports shall be made at least annually.
(3)  The department may subpoena information and 
documents and may conduct onsite compliance audits at the 
acquiring person's expense.
(b)  Experts and consultants.--To effectively monitor ongoing 
compliance with the terms and conditions of the acquisition, the 
department may, in  	the department's  discretion, contract with  
experts and consultants. Contract costs may not exceed an amount 
that is reasonable and necessary to conduct the review and 
evaluation.
(c)  Reimbursement.--
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30 (1)  The department shall be entitled to reimbursement 
from the acquiring person for all actual and direct costs 
incurred in monitoring ongoing compliance with the terms and 
conditions of the acquisition, including contract and 
administrative costs.
(2)  The department may bill the acquiring person or any 
successor for the costs incurred.
(3)  The acquiring person or successor billed by the 
department under paragraph (2) shall promptly pay for the 
costs incurred.
(4)  If the acquiring person or successor fails to pay 
the costs incurred within 30 days, the department may assess 
a civil fine.
(d)  Hearing.--
(1)  If the department has reason to believe or receives 
information indicating that the acquiring person or successor 
is not fulfilling commitments to the affected community under 
section 807-D, including the acquiring person or successor 
not complying with any conditions imposed by the department 
under section 806-D, the department shall hold a hearing upon 
10 days' notice to the affected parties.
(2)  The cost of the hearing and any onsite reviews 
related to determining the validity of the information shall 
be borne by the acquiring person or successor.
(3)  If after the hearing the department determines that 
the acquiring person or successor is not fulfilling the 
commitments to the affected community under section 807-D, 
the department may:
(i)  Revoke or suspend the license issued to the 
acquiring person or successor or impose civil fines until 
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30 the acquiring person or successor submits or begins to 
follow a corrective plan of action.
(ii)  Refer the matter to the Attorney General for 
appropriate action. The Attorney General may seek a court 
order compelling the acquiring person to fulfill the 
commitments under section 807-D.
Section 810-D.  Powers of Attorney General.
(a)  Powers.--The Attorney General may:
(1)  Ensure compliance with commitments that inure to the 
public interest.
(2)  Take legal action to enforce this chapter and any 
conditions that the department imposes on the approval of the 
acquisition.
(3)  Obtain damages, injunctive relief, attorney fees and 
other relief as the court deems necessary to ensure 
compliance with this chapter.
(4)  Seek an injunction to prevent any acquisition not 
approved by the department under this chapter.
(b)  Construction.--No provision of this chapter shall 
derogate from any authority granted to the Attorney General 
under law.
Section 811-D.  Study.
The department shall conduct a study on the impact that 
provider organization acquisitions have on access to affordable 
quality health care services throughout the communities of this 
Commonwealth according to the following:
(1)  The study shall address health care services 
generally and shall specifically address access to 
reproductive, end-of-life and gender-affirming health care 
services.
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30 (2)  For purposes of the study, the department shall 
consult with health care providers, health care advocates and 
community members to determine both the scope of the study 
and what constitutes a provider organization, but a provider 
organization shall not include a hospital or hospital system 
as defined under this chapter.
Section 812-D.  Review.
If a hospital or hospital system is subject to a review by 
the department, the review shall be concurrent with the review 
under this chapter, to the extent practicable.
Section 3.  This act shall take effect in 60 days.
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