Senate Bill 16: Preserving Competition in Health Care Act

• Requires hospital entities to notify the North Carolina Attorney General in writing before entering into transactions involving the sale, transfer, lease, or change of control of hospital assets or operations, with written certification that hospital governing boards have been provided the full statute.

• Establishes a 90-day review period (extendable up to 60 additional days) for the Attorney General to evaluate proposed transactions, during which parties cannot consummate the transaction, based on criteria including fair market value, competitive effects, cost and quality of healthcare services, and compliance with antitrust laws.

• Mandates hospital entities publish notice of proposed transactions in newspapers across affected counties within 5 days of notifying the Attorney General and conduct at least one public hearing within 30 days in a convenient location to discuss transaction impacts on healthcare costs, availability, accessibility, quality, and community benefits.

• Authorizes the Attorney General to object to transactions and file court actions seeking injunctive relief, with different burden-of-proof standards for nonprofit/publicly owned entities versus for-profit entities, and allows the Attorney General to recover up to $50,000 in review costs from the acquiring entity.

• Requires post-transaction monitoring by an independent health care access monitor for at least 3 years (extendable to 10 years) to assess effects on healthcare access, price, and quality, with authority to unwind transactions or alter control if monitoring reveals significant deleterious anticompetitive effects, effective December 1, 2023.