PRINTER'S NO. 840
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
864
Session of
2023
INTRODUCED BY D. WILLIAMS, HOWARD, SHUSTERMAN, BURGOS, CIRESI,
CONKLIN, DELLOSO, FREEMAN, KAZEEM, KINSEY, MADDEN, NEILSON,
O'MARA, OTTEN, PARKER, PIELLI, PROBST, RABB AND SAPPEY,
APRIL 10, 2023
REFERRED TO COMMITTEE ON HEALTH, APRIL 10, 2023
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
imposing duties on 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 December 31, 2023,
a hospital or hospital system shall establish, update and
publish on the publicly accessible Internet website of the
hospital or hospital system, a list of standard charges for each
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
item or service provided as required under 42 U.S.C. § 300gg-18
(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
purposes of accounting or billing for the item or service,
including, but not limited to, the Current Procedural
20230HB0864PN0840 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Terminology (CPT) code, the Healthcare Common Procedure
Coding System (HCPCS) code, the Diagnosis Related Group
(DRG), the National Drug Code (NDC) 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 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
hospital has established a standard charge.
20230HB0864PN0840 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(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-C
ACQUISITION OF HEALTH CARE FACILITIES
20230HB0864PN0840 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Section 801-C. 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
any of the following:
(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
20230HB0864PN0840 - 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
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.
"Department." The Department of Health of the Commonwealth.
"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-C. 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:
20230HB0864PN0840 - 6 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(1) The name of the hospital or hospital system being
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,
20230HB0864PN0840 - 7 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
outpatient visits and emergency visits.
(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:
20230HB0864PN0840 - 8 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(i) Admission policies.
(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-
20230HB0864PN0840 - 9 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
affirming 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 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.
20230HB0864PN0840 - 10 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(D) Collective bargaining agreements.
(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:
20230HB0864PN0840 - 11 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(i) The need that the population presently has for
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
20230HB0864PN0840 - 12 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
that is the subject of the acquisition is located.
(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-C. Completed applications.
(a) Completeness.--The department shall determine if an
application in accordance with section 802-C 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.
20230HB0864PN0840 - 13 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(b) Receipt.--A completed application shall be deemed
received on the date when all the information required by
section 802-C 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-C. Public hearings.
(a) Hearing requirements.--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. The
following apply:
20230HB0864PN0840 - 14 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(1) At the hearings, anyone may file written comments
and exhibits or appear and make a statement.
(2) 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-C, 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-C, 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-C, 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.
20230HB0864PN0840 - 15 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(B) At the public entrance and on the bulletin
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-C(b), the department
shall conduct an additional public hearing to ensure adequate
public comment regarding the proposed change.
Section 805-C. Health care impact statements.
(a) Authorization.--The department shall engage an
independent contractor to prepare an independent health care
20230HB0864PN0840 - 16 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
impact statement for any acquisition that satisfies any of the
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
20230HB0864PN0840 - 17 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
system has historically funded or operated.
(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-C.
(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-C. Duties of department.
(a) Determination.--The department shall review the
completed application and, within 45 days of the last public
20230HB0864PN0840 - 18 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
hearing held under section 804-C, shall determine whether the
acquisition meets the requirements for approval in section 807-
C. 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-C 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-C.
(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
20230HB0864PN0840 - 19 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
contract with and provide reasonable reimbursement to qualified
persons to assist in determining whether the requirements of
section 807-C have been met.
(g) Rules and regulations.--The department may adopt rules
and regulations necessary to implement this chapter.
Section 807-C. 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
20230HB0864PN0840 - 20 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
acquisition are committed to providing health care to the
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-C. 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-C. Reports.
(a) Compliance.--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. The following apply:
(1) 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.
(2) 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.
20230HB0864PN0840 - 21 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(c) Reimbursement.--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. The following apply:
(1) The department may bill the acquiring person or any
successor for the costs incurred.
(2) The acquiring person or successor billed by the
department under paragraph (1) shall promptly pay for the
costs incurred.
(3) If the acquiring person or successor fails to pay
the costs incurred within 30 days, the department may assess
a civil fine.
(d) Hearing.--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-C, including the acquiring person or
successor not complying with any conditions imposed by the
department under section 806-C, the department shall hold a
hearing upon 10 days' notice to the affected parties. The
following apply:
(1) 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.
(2) 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-C,
the department may:
(i) Revoke or suspend the license issued to the
acquiring person or successor or impose civil fines until
20230HB0864PN0840 - 22 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
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-C.
Section 810-C. Duties of Attorney General.
(a) Duties.--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-C. 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. The following apply:
(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.
20230HB0864PN0840 - 23 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
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-C. 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 January 1, 2024.
20230HB0864PN0840 - 24 -
1
2
3
4
5
6
7
8
9
10
11