WA SB5704

Requires hospitals, hospital systems, and provider organizations to submit written notice to the Health Care Authority and Attorney General at least 90 days before mergers, acquisitions, or contracting affiliations

Mandates material change transactions maintain or improve community access to affordable health care services including emergency, primary, reproductive, gender-affirming, and end-of-life care for at least five years post-transaction

Establishes a two-tier review process: preliminary review by the Health Care Authority with public hearing, followed by comprehensive review including access, affordability, quality, and equity assessment for larger transactions

Authorizes the Attorney General to approve, approve with conditions, or deny transactions, with civil penalties up to 10% of transaction value for non-compliance with notice requirements

Requires five years of post-transaction monitoring and annual reporting, with enforcement authority including civil fines up to 1% of transaction value per day for ongoing non-compliance