This bill strengthens oversight of health care facility spending by introducing several key provisions aimed at controlling healthcare costs and improving market transparency. The bill expands the Health Policy Commission’s authority to review and potentially block material changes in healthcare organizations, such as mergers, acquisitions, and expansions, by requiring providers to submit detailed notices at least 60 days before any significant operational or governance changes. Healthcare entities identified as exceeding cost growth benchmarks or having high relative prices will be required to file performance improvement plans, which must include specific strategies to reduce costs and meet statewide average pricing. The bill also mandates annual reviews of previously approved material changes to determine whether promised benefits like lower costs and improved quality have been realized. Additionally, the legislation introduces new requirements for secondary healthcare facilities, including obtaining separate licenses, negotiating contracts independently, and billing under unique provider identification numbers to promote competition and prevent anti-competitive practices. The bill gives the Health Policy Commission and the Attorney General expanded powers to investigate and potentially penalize healthcare entities that fail to meet cost containment goals, including the ability to reduce payments, require corrective action plans, or prohibit future structural changes.