The bill creates a new chapter in Title 70 RCW establishing a state review process for certain health care business transactions (purchases, mergers, joint ventures) involving health care entities when those transactions may affect access to specified "protected health care services" (defined in the bill to include reproductive services covered by the 1991 Reproductive Privacy Act, death with dignity services, and gender-affirming health care). It gives the Washington State Department of Health authority to review applications and to approve, approve with conditions or modifications, or disapprove transactions under standards set in the bill, and it amends RCW 43.370.030 to require ongoing analysis of availability of the covered services in the statewide health resources strategy. The act creates procedural requirements for applicants and the department: parties must file an application at least 60 days before the transaction’s effective date; the department must check completeness within 15 working days, publish notice and provide public notice and hearings soon after a completed application is filed, and issue a final written determination within 60 days (transactions are deemed approved if the department fails to decide in 60 days). Applications and supporting documents are public records; the department must charge an application fee to cover costs; conditions imposed must be related, reasonable, and not impose undue financial burden; affected entities have a right to an adjudicative proceeding under chapter 34.05 RCW; the attorney general may seek an injunction against transactions required to be reviewed that are not approved or are approved with conditions; annual compliance reports by parties to approved transactions are required for up to three years; and the department must produce a statewide access report by December 1, 2026, updated at least every two years. The act takes effect December 1, 2026, applies to transactions with effective dates on or after that date, and section 9 takes effect July 1, 2026. The provided materials include definitions for terms like "community health care services," "health care entity," "provider," and "provider organization," and require consultation with the attorney general and affected health districts. Important details are missing from the extracted text: the full list of specific factors and standards the department must apply (section 6) is incomplete, the precise procedures or limits for the attorney general’s enforcement role beyond the injunction authority are not set out here, and the exact new chapter and section numbering in Title 70 RCW and the full amended RCW language are not provided.

If enacted, health systems, hospitals, provider organizations, and insurance holding companies that plan mergers, purchases, or joint ventures will likely face a new state review that can delay or change transactions. They must file an application at least 60 days before a deal takes effect, pay a fee to cover the Department of Health’s costs, publicly disclose supporting documents, participate in hearings, and be prepared to show how the deal will not reduce access to reproductive care, death-with-dignity services, or gender-affirming care. Deals could be approved with conditions, blocked, or subject to a court injunction by the attorney general if not approved, and parties to approved deals must provide annual compliance reports for up to three years, so transactions will carry added compliance costs, public scrutiny, and legal risk. The Department of Health will need staff, rules, and possibly outside experts to meet tight review timelines and to produce a statewide access report by December 1, 2026 (and every two years after), but it can charge applicants for implementation costs. Health districts will be consulted and exposed to more public input about local service availability. Important details about which transactions are covered and the full list of factors the department must weigh are not included in the provided text, so the exact scope of coverage and the criteria that will determine approvals or required conditions remain uncertain.