RI S2492

Healthcare entities with at least $10 million in assets or annual revenues must provide written notice to the Attorney General and Department of Health at least 180 days before any material change transaction, including mergers, acquisitions, joint ventures, real estate sales, or facility closures.

Within 30 days of receiving complete notice, regulators must approve the transaction, approve with conditions, or designate it for comprehensive review if it may significantly affect competition, prices, quality, access, workforce, or health equity.

Comprehensive review requires public hearings and a Cost and Market Impact Review (CMIR) within 90 days, examining factors such as market share, pricing effects, service access, patient outcomes, and impacts on underserved populations.

Transaction parties bear the burden of proving by clear and convincing evidence that the deal will not reduce competition, increase costs, or harm access, quality, or equity.

Noncompliance carries civil penalties of $10,000 per day, and regulators may require ongoing monitoring of approved transactions and recover all review costs from the parties.