MD SB494

Repeals the certificate of need exemption for health care facility mergers, requiring mergers to undergo the same regulatory review as other major health care transactions

Establishes a new "material change transaction" notification and review process for health care entities with at least $10 million in assets or annual revenues, covering mergers, acquisitions, affiliations, joint ventures, and real estate transactions

Requires health care entities to provide 90 days advance notice to the Maryland Health Care Commission and the public before completing material change transactions

Authorizes the Executive Director to conduct public interest reviews within 30 days of notice, with final approval, conditional approval, or denial decisions due within 60 days, considering impacts on market competition, health care costs, quality, equity, and access

Defines "market power" as 30% or more market share in any service line and authorizes civil penalties up to 1% of transaction value for violations, with effective date of October 1, 2026