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AB50-ASA2-AA8,250,15142. A description of the groups or individuals likely to be affected by the
15transaction.
AB50-ASA2-AA8,250,18163. Information about services currently provided by the health care entity,
17commitments by the health care entity to continue such services, and any services
18that will be reduced or eliminated.
AB50-ASA2-AA8,250,19194. Details about any public hearings and how to submit comments.
AB50-ASA2-AA8,250,22205. Any other information from the notice and other materials submitted by the
21health care entity that the attorney general or the department determines would be
22in the public interest, except for materials designated confidential under par. (c).
AB50-ASA2-AA8,251,223(e) For purposes of calculating time periods under this section, notice shall be

1considered received on the first business day after the department determines that
2notice is complete.
AB50-ASA2-AA8,251,43(2) Preliminary review. (a) Within 30 days after receiving notice as
4described in sub. (1), the department shall do one of the following:
AB50-ASA2-AA8,251,751. Approve the material change transaction and notify the health care entity
6in writing that a comprehensive review is not required for the material change
7transaction.
AB50-ASA2-AA8,251,1082. Approve the material change transaction subject to conditions set by the
9department and notify the health care entity in writing of the conditions under
10which the transaction may be completed.
AB50-ASA2-AA8,251,13113. Notify the health care entity in writing that the transaction is subject to a
12comprehensive review. The department may request additional information
13necessary to perform a comprehensive review under sub. (3).
AB50-ASA2-AA8,251,1514(b) Nothing in this section limits or infringes upon the existing authority of
15any state agency or the attorney general to review any transactions.
AB50-ASA2-AA8,251,1916(3) Comprehensive review process. (a) For purposes of this subsection,
17market power means possessing 30 percent or more market share in any line of
18service in the relevant geographic area or meeting other criteria that the
19department may define by rule.
AB50-ASA2-AA8,251,2120(b) A comprehensive review is required when any of the following apply to the
21material change transaction:
AB50-ASA2-AA8,251,23221. The transaction will result in the transfer of assets valued above $20
23million.
AB50-ASA2-AA8,252,2
12. The transaction occurs in a highly consolidated market for any line of
2services offered by any party to the material change transaction.
AB50-ASA2-AA8,252,433. The transaction will cause a significant change in market share such that
4any resulting health care entity possesses market power upon completion.
AB50-ASA2-AA8,252,754. The transaction will otherwise reduce competition, including effects of
6vertical or cross-market transactions among different product or geographic
7markets.
AB50-ASA2-AA8,252,985. Either party to the material change transaction possesses market power
9prior to the transaction.
AB50-ASA2-AA8,252,12106. The department, at its sole discretion, determines that the material change
11transaction is likely to have a material impact on the cost of, quality of, equity of, or
12access to health care services in any region in the state.
AB50-ASA2-AA8,252,1713(c) No later than 90 days after determining a material change transaction is
14subject to a comprehensive review, the department shall conduct the review and
15shall conduct one or more public hearings or public meetings, one of which shall be
16in the county in which the health care entity is located, to hear comments from
17interested parties.
AB50-ASA2-AA8,253,218(d) Not more than 90 days after determining that the material change
19transaction is subject to a comprehensive review under this subsection, the
20department shall produce a cost and market impact review report containing the
21findings and conclusions of the cost and market impact review, provided that the
22health care entity has complied with the requests for information or documents
23pursuant to this subsection within 21 days of the request or by a later date set by
24mutual agreement of the health care entity and the department. The cost and

1market impact review report shall be posted publicly and may not disclose
2confidential information.
AB50-ASA2-AA8,253,53(e) The cost and market impact review may examine factors relating to the
4proposed material change transaction, transacting parties, and their relative
5market position, including any of the following:
AB50-ASA2-AA8,253,761. The market share of each transacting party and the likely effects of the
7material change transaction on competition.
AB50-ASA2-AA8,253,1082. Any previous material change transaction involving any transacting party,
9including acquisitions or mergers of similar health care providers, whether or not in
10the same state.
AB50-ASA2-AA8,253,13113. The prices charged by each transacting party for services, including their
12relative prices compared to others prices for the same services in the same
13geographic area.
AB50-ASA2-AA8,253,15144. The quality of the services provided by any health care provider party to
15the material change transaction, including patient experience.
AB50-ASA2-AA8,253,17165. The cost and cost trends of any health care entity party in comparison to
17total health care expenditures statewide.
AB50-ASA2-AA8,253,20186. The availability and accessibility of services similar to those provided, or
19proposed to be provided, through any health care provider or provider organization
20party within its primary service areas and dispersed service areas.
AB50-ASA2-AA8,253,23217. The impact of the material change transaction on competing options for the
22delivery of health care services within the primary service areas and dispersed
23service areas of the transacting parties.
AB50-ASA2-AA8,254,2
18. The role of the transacting parties in serving at-risk, underserved, and
2government-payer patient populations.
AB50-ASA2-AA8,254,439. The role of the transacting parties in providing low-margin or negative-
4margin services within its primary service areas and dispersed service areas.
AB50-ASA2-AA8,254,7510. Consumer concerns, including complaints or other allegations that any
6provider or provider organization party has engaged in any unfair method of
7competition or any unfair or deceptive act or practice.
AB50-ASA2-AA8,254,11811. The parties compliance with prior conditions and legal requirements
9related to competitive conduct, including compliance with s. 150.994, reporting
10requirements regarding health care entity ownership and control under s. 150.996,
11or restrictions on anticompetitive contracting provisions.
AB50-ASA2-AA8,254,141212. The impact of the material change transaction on the clinical workforce,
13including wages, staffing levels, supply, patient access, and continuity of patient-
14care relationships.
AB50-ASA2-AA8,254,171513. The impact of a real estate sale or lease agreement on the financial
16condition of any health care entity party and its ability to maintain patient care
17operations.
AB50-ASA2-AA8,254,221814. In the case of a proposed closure or discontinuance of a health care facility
19or any essential health services, the impact of the closure on health care access,
20outcomes, costs, and equity for those in the health care facilitys service area and
21the health care facilitys plan for ensuring equitable access, quality, affordability,
22and availability of essential health services within the service area.
AB50-ASA2-AA8,254,242315. Any other factors that the department determines, by rules promulgated
24by the department, to be in the public interest.
AB50-ASA2-AA8,255,6
1(f) The department may request additional information or documents from
2the transacting parties necessary to conduct a cost and market impact review.
3Failure to respond or insufficient responses to requests for information by
4transacting parties may result in the extension of the deadline for the department
5to complete the cost and market impact review, the imposition of conditions for
6approval, or the disapproval of the material change transaction.
AB50-ASA2-AA8,255,167(g) The department shall keep confidential all nonpublic information and
8documents obtained under this subsection and may not disclose the confidential
9information or documents to any person without the consent of the party that
10produced the confidential information or documents, except that the department
11may disclose any information to an expert or consultant under contract with the
12department to review the proposed transaction, provided that the expert or
13consultant is bound by the same confidentiality requirements as the department.
14The confidential information and documents and work product of the department
15may not be treated as public records and shall be exempt from inspection or copying
16under s. 19.35.
AB50-ASA2-AA8,255,1717(h) The department may, in its sole discretion:
AB50-ASA2-AA8,255,20181. Contract with, consult, and receive advice from any state agency on those
19terms and conditions that the department determines are appropriate with regard
20to reviewing a proposed material change transaction.
AB50-ASA2-AA8,255,22212. Contract with experts or consultants to assist in reviewing a proposed
22material change transaction.
AB50-ASA2-AA8,256,323(i) The department shall be entitled to charge costs to or receive
24reimbursement from the transacting parties for all actual, reasonable, direct costs

1incurred in reviewing, evaluating, and making the determination referred to in this
2subsection, including administrative costs and costs of contracted experts or
3consultants in par. (h).
AB50-ASA2-AA8,256,84(4) Approval authority. (a) The department may at its discretion approve,
5conditionally approve, or disapprove of any material change transaction for which
6the department receives notice under sub. (1). Any conditions imposed under this
7subsection shall specify a time period for compliance, an expiration date, or that the
8condition applies indefinitely.
AB50-ASA2-AA8,256,139(b) The department shall inform the health care entity of the determination
10within 30 days of notice under sub. (2), or in the case of comprehensive review,
11within 60 days of the completion of the cost and market impact review. No proposed
12material change transaction may be completed before the department has informed
13the health care entity of the determination.
AB50-ASA2-AA8,256,1614(c) In making the determination under this subsection, the department may
15consider any factors that the department determines to be relevant, including any
16of the following:
AB50-ASA2-AA8,256,18171. The likely impact, as described in the cost and market impact review report,
18where applicable, of the material change transaction on any of the following:
AB50-ASA2-AA8,256,1919a. Health care costs, prices, and affordability.
AB50-ASA2-AA8,256,2120b. The availability or accessibility of health care services to the affected
21community.
AB50-ASA2-AA8,256,2322c. Health care provider cost trends and containment of total state health care
23spending.
AB50-ASA2-AA8,256,2424d. Access to services in medically underserved areas.
AB50-ASA2-AA8,257,2
1e. Rectifying historical and contemporary factors contributing to a lack of
2health equities or access to services.
AB50-ASA2-AA8,257,43f. The functioning and competitiveness of the markets for health care and
4health insurance.
AB50-ASA2-AA8,257,65g. The potential effects of the material change transaction on health
6outcomes, quality, access, equity, or workforce for residents of this state.
AB50-ASA2-AA8,257,77h. The potential loss of or change in access to essential services.
AB50-ASA2-AA8,257,1082. Whether the material change transaction is contrary to or violates any
9applicable law, including state antitrust laws, laws restricting the corporate
10practice of medicine, or consumer protection laws.
AB50-ASA2-AA8,257,12113. Whether the benefits of the transaction are likely to outweigh any
12anticompetitive effect from the transaction.
AB50-ASA2-AA8,257,13134. Whether the transaction is in the public interest.
AB50-ASA2-AA8,257,1614(d) This subsection does not limit or alter any existing authority of the
15attorney general or any state agency to enforce any other law, including state or
16federal antitrust law, or to review nonprofit transactions.
AB50-ASA2-AA8,257,2017(5) Post-transaction oversight. (a) Enforcement by the attorney general.
181. The attorney general may subpoena any records necessary to enforce any
19provisions of this section or to investigate suspected violations of any provisions of
20this section or any conditions imposed by conditional approval pursuant to sub. (4).
AB50-ASA2-AA8,258,4212. The attorney general may enforce any requirement of this section and any
22conditions imposed by a conditional approval pursuant to sub. (4) to the fullest
23extent provided by law, including damages. In addition to any legal remedies the
24attorney general may have, the attorney general shall be entitled to specific

1performance, injunctive relief, and other equitable remedies a court deems
2appropriate for any violations or imminent violation of any requirement of this
3section or breach of any of the conditions and shall be entitled to recover its attorney
4fees and costs incurred in remedying each violation.
AB50-ASA2-AA8,258,1053. In addition to the remedies set forth in subd. 2., any person who violates
6this section or of any conditions imposed pursuant to a conditional approval under
7sub. (4) is subject to a forfeiture of $10,000 per day, which the attorney general may
8seek to recover by action on behalf of the state. The attorney general may also
9rescind or deny approval for any other past, pending, or future material change
10transactions involving the health care entity or an affiliate.
AB50-ASA2-AA8,258,13114. Nothing in this paragraph shall narrow, abrogate, or otherwise alter the
12authority of the attorney general to prosecute violations of antitrust or consumer
13protection requirements.
AB50-ASA2-AA8,258,1614(b) Enforcement by the department. 1. The department may audit the books,
15documents, records, and data of any entity that is subject to a conditional approval
16under sub. (4) to monitor compliance with the conditions.
AB50-ASA2-AA8,258,20172. Any entity that violates any provision of this section, any rules adopted
18pursuant thereto, or any condition imposed pursuant to a conditional approval
19under sub. (4) shall be subject to a forfeiture of $10,000 per day for any violation of
20this section.
AB50-ASA2-AA8,258,23213. The department may refer any entity to the attorney general to review for
22enforcement of any noncompliance with this section and any conditions imposed by
23conditional approval pursuant to sub. (4).
AB50-ASA2-AA8,259,424(c) Monitoring. In order to effectively monitor ongoing compliance with the

1terms and conditions of any material change transaction subject to prior notice,
2approval, or conditional approval under sub. (4), the department may, in its sole
3discretion, conduct a review or audit and may contract with experts and
4consultants to assist in this regard.
AB50-ASA2-AA8,259,115(d) Reporting. One year, 2 years, and 5 years following the completion of the
6material change transaction approved or conditionally approved by the department
7after a comprehensive review under sub. (3), and upon future intervals determined
8at the discretion of the department, the health care entity or any person,
9corporation, partnership, or other entity that acquired direct or indirect control over
10the health care entity shall submit reports to the department that do all of the
11following:
AB50-ASA2-AA8,259,13121. Demonstrate compliance with conditions placed on the material change
13transaction, if any.
AB50-ASA2-AA8,259,14142. Analyze cost trends and cost growth trends of the transacting parties.
AB50-ASA2-AA8,259,16153. Analyze any changes or effects of the material change transaction on
16patient access, availability of services, workforce, quality, or equity.
AB50-ASA2-AA8,259,2017(e) Costs. The department shall be entitled to charge costs to the transacting
18parties for all actual, reasonable, and direct costs incurred in monitoring ongoing
19compliance with the terms and conditions of the sale or transfer of assets, including
20contractor and administrative costs.
AB50-ASA2-AA8,259,2121(6) Rules. The department may promulgate rules to implement this section.
AB50-ASA2-AA8,40322Section 403. 150.994 of the statutes is created to read:
AB50-ASA2-AA8,260,223150.994 Corporate practice of medicine. The corporate practice of

1medicine is prohibited. The department shall promulgate rules to define what
2conduct constitutes the corporate practice of medicine for purposes of this section.
AB50-ASA2-AA8,4043Section 404. 150.996 of the statutes is created to read:
AB50-ASA2-AA8,260,94150.996 Transparency in ownership and control of health care
5entities. (1) Reporting of ownership and control. Each health care entity
6shall report to the department on an annual basis and upon the consummation of a
7material change transaction involving the entity as set forth in s. 150.992, in a form
8and manner required by the department, all of the following information, as
9applicable:
AB50-ASA2-AA8,260,1010(a) Legal name of entity.
AB50-ASA2-AA8,260,1111(b) Business address of entity.
AB50-ASA2-AA8,260,1212(c) Locations of operations.
AB50-ASA2-AA8,260,1413(d) Business identification numbers of the entity, as applicable, including all
14of the following:
AB50-ASA2-AA8,260,15151. Taxpayer identification number.
AB50-ASA2-AA8,260,16162. National provider identifier.
AB50-ASA2-AA8,260,17173. Employer identification number.
AB50-ASA2-AA8,260,18184. Centers for Medicare and Medicaid Services certification number.
AB50-ASA2-AA8,260,19195. National Association of Insurance Commissioners identification number.
AB50-ASA2-AA8,260,21206. A personal identification number associated with a license issued by the
21commissioner of insurance.
AB50-ASA2-AA8,260,23227. Pharmacy benefit manager identification number associated with a license
23or registration of the pharmacy benefit manager in this state.
AB50-ASA2-AA8,260,2424(e) Name and contact information of a representative of the entity.
AB50-ASA2-AA8,261,4
1(f) The name, business address, and business identification numbers listed in
2par. (d) for each person or entity that, with respect to the relevant health care
3entity, has an ownership or investment interest, has a controlling interest, is a
4management services organization, or is a significant equity investor.
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