NC S532

Requires hospital entities to provide written notice to the State Auditor, Attorney General, and State Treasurer before entering into transactions involving 50% or more of assets or control valued at $5 million or more, triggering a 60-90 day review period during which the transaction cannot be consummated

Mandates public hearings within 30 days of notice and newspaper publication in affected counties, with parties required to address expected impacts on healthcare cost, availability, accessibility, and quality

Authorizes the three state officials to object to transactions and file court actions seeking injunctive relief, with the burden of proving by clear and convincing evidence that the transaction would cause significant harm to healthcare competition or violate fiduciary duties

Imposes civil penalties of up to $50,000 per board member and chief financial officer for violations, increasing to $1 million for wanton disregard, and renders non-compliant transactions null and void with denial of hospital license renewals

Requires acquiring entities to submit annual compliance reports and provide 120 days' written notice before changing financial assistance policies for uninsured or underinsured patients, effective December 1, 2025