SB45,1140,24 11. The parties’ compliance with prior conditions and legal requirements related to competitive conduct, including compliance with s. 150.994, reporting requirements regarding health care entity ownership and control under s. 150.996, or restrictions on anticompetitive contracting provisions.

SB45,1141,3 12. The impact of the material change transaction on the clinical workforce, including wages, staffing levels, supply, patient access, and continuity of patient- care relationships.

SB45,1141,6 13. The impact of a real estate sale or lease agreement on the financial condition of any health care entity party and its ability to maintain patient care operations.

SB45,1141,11 14. In the case of a proposed closure or discontinuance of a health care facility or any essential health services, the impact of the closure on health care access, outcomes, costs, and equity for those in the health care facility’s service area and the health care facility’s plan for ensuring equitable access, quality, affordability, and availability of essential health services within the service area.

SB45,1141,13 15. Any other factors that the department determines, by rules promulgated by the department, to be in the public interest.

SB45,1141,19 (f) The department may request additional information or documents from the transacting parties necessary to conduct a cost and market impact review. Failure to respond or insufficient responses to requests for information by transacting parties may result in the extension of the deadline for the department to complete the cost and market impact review, the imposition of conditions for approval, or the disapproval of the material change transaction.

SB45,1142,5 (g) The department shall keep confidential all nonpublic information and documents obtained under this subsection and may not disclose the confidential information or documents to any person without the consent of the party that produced the confidential information or documents, except that the department may disclose any information to an expert or consultant under contract with the department to review the proposed transaction, provided that the expert or consultant is bound by the same confidentiality requirements as the department. The confidential information and documents and work product of the department may not be treated as public records and shall be exempt from inspection or copying under s. 19.35.

SB45,1142,6 (h) The department may, in its sole discretion:

SB45,1142,9 1. Contract with, consult, and receive advice from any state agency on those terms and conditions that the department determines are appropriate with regard to reviewing a proposed material change transaction.

SB45,1142,11 2. Contract with experts or consultants to assist in reviewing a proposed material change transaction.

SB45,1142,16 (i) The department shall be entitled to charge costs to or receive reimbursement from the transacting parties for all actual, reasonable, direct costs incurred in reviewing, evaluating, and making the determination referred to in this subsection, including administrative costs and costs of contracted experts or consultants in par. (h).

SB45,1142,21 (4) Approval authority. (a) The department may at its discretion approve, conditionally approve, or disapprove of any material change transaction for which the department receives notice under sub. (1). Any conditions imposed under this subsection shall specify a time period for compliance, an expiration date, or that the condition applies indefinitely.

SB45,1143,2 (b) The department shall inform the health care entity of the determination within 30 days of notice under sub. (2), or in the case of comprehensive review, within 60 days of the completion of the cost and market impact review. No proposed material change transaction may be completed before the department has informed the health care entity of the determination.

SB45,1143,5 (c) In making the determination under this subsection, the department may consider any factors that the department determines to be relevant, including any of the following:

SB45,1143,7 1. The likely impact, as described in the cost and market impact review report, where applicable, of the material change transaction on any of the following:

SB45,1143,8 a. Health care costs, prices, and affordability.

SB45,1143,10 b. The availability or accessibility of health care services to the affected community.

SB45,1143,12 c. Health care provider cost trends and containment of total state health care spending.

SB45,1143,13 d. Access to services in medically underserved areas.

SB45,1143,15 e. Rectifying historical and contemporary factors contributing to a lack of health equities or access to services.

SB45,1143,17 f. The functioning and competitiveness of the markets for health care and health insurance.

SB45,1143,19 g. The potential effects of the material change transaction on health outcomes, quality, access, equity, or workforce for residents of this state.

SB45,1143,20 h. The potential loss of or change in access to essential services.

SB45,1143,23 2. Whether the material change transaction is contrary to or violates any applicable law, including state antitrust laws, laws restricting the corporate practice of medicine, or consumer protection laws.

SB45,1144,2 3. Whether the benefits of the transaction are likely to outweigh any anticompetitive effect from the transaction.

SB45,1144,3 4. Whether the transaction is in the public interest.

SB45,1144,6 (d) This subsection does not limit or alter any existing authority of the attorney general or any state agency to enforce any other law, including state or federal antitrust law, or to review nonprofit transactions.

SB45,1144,10 (5) Post-transaction oversight. (a) Enforcement by the attorney general. 1. The attorney general may subpoena any records necessary to enforce any provisions of this section or to investigate suspected violations of any provisions of this section or any conditions imposed by conditional approval pursuant to sub. (4).

SB45,1144,18 2. The attorney general may enforce any requirement of this section and any conditions imposed by a conditional approval pursuant to sub. (4) to the fullest extent provided by law, including damages. In addition to any legal remedies the attorney general may have, the attorney general shall be entitled to specific performance, injunctive relief, and other equitable remedies a court deems appropriate for any violations or imminent violation of any requirement of this section or breach of any of the conditions and shall be entitled to recover its attorney fees and costs incurred in remedying each violation.