accountability act of 2026.

(a) For purposes of this section:

(1) "Applicant" means the birthing center submitting an application pursuant to subsection

(d) of this section.

(2) "Birthing center" means any freestanding birthing center licensed under chapter 17 of

title 23, and any birthing unit, maternity unit, perinatal unit, or labor-and-delivery service operated

by a hospital or healthcare facility.

(3) "Closure" means the permanent cessation of all birthing services at a birthing center.

(4) "Closure application" means the application required by subsection (d) of this section.

(5) "Discontinuation of services" means the cessation of any prenatal, perinatal,

postpartum, or birthing-related service or program offered by a birthing center without complete

closure of the facility.

(6) "Significant reduction" or "significantly reduced" means:

(i) A reduction of twenty-five percent (25%) or more in capacity or annual volume;

(vi) Other licensed birthing centers in the affected community and the distance of those

facilities to the applicant's birthing center.

(2) A detailed evaluation of:

(i) Annual deliveries, prenatal visits, postpartum care, and newborn services;

(ii) Impact on high-risk pregnancies, low-income families, and Medicaid members;

(iii) EMS transport impacts; and

(iv) Projected changes in maternal morbidity and newborn outcomes.

(3) A patient transition plan, including:

(i) Protocols for laboring patient transfers;

(ii) EMS and hospital coordination;

(iii) Continuity plans for prenatal patients beyond twenty (20) weeks gestation;

(iv) Transfer agreements with receiving hospitals or birthing centers; and

(v) Protocols for the storage of and access to medical records.

(4) Workforce plan, including detailed descriptions of:

(i) Staffing levels;

(ii) Proposed layoff or reassignment plans; and

(iii) Transition plans for licensed midwives, doulas, nurses, and obstetric clinicians.

(5) Financial justification, certified by a certified public accountant, including:

(i) Five (5) years of audited financial statements for the birthing center and operating

hospital, if applicable, parent health system, and all controlled affiliates, subsidiaries, and

management entities;

(ii) Detailed service-level financials, including, revenues, expenses, and margins, volume

trends, overhead allocation methodology, and documentation of any staffing cuts, resource

reductions, or underinvestment contributing to financial decline;

(iii) Five (5) year forward projection, including, break-even analyses, capital investment

needs, labor costs, and sensitivity analyses for multiple scenarios; and

(iv) Parent system financial capacity review, including, reserves and unrestricted funds,

cash on hand, investments and endowment holdings, executive compensation, and intercompany

transfers or management fees.

(6) Comparative analysis of at least three (3) alternatives to closure including, but not

limited to, shared staffing models, partnerships with community providers or regional systems,

cross-subsidization by the parent system, and/or redesign or modernization; and

(7) The applicant's controlling officers shall certify that neither the birthing center nor

parent system engaged in actions that materially contributed to financial instability including, but

not limited to, understaffing, reduction of capital investment, curtailment of marketing or referral

pathways, diversion of patients, and/or failure to pursue available external funding.

(e) The director of the department of health shall deny a closure application that fails to

satisfy the requirements of this section.

(f) An independent expert, selected by the department of health and paid for by the

applicant, shall evaluate sustainability, feasible restructuring alternatives, and pathways to avoid

closure or significant reduction of services.

(g)(1) Within sixty (60) days of receiving the notice required by subsection (c) of this

section, the director of the department of health shall hold a public hearing. The applicant's

controlling officers shall attend the public hearing and members of the public shall be permitted to

participate and offer testimony; the director of the department of health shall provide twenty-one

(21) days written notice on the department of health's website of the date, time, and location of the

public hearing.

(2) Within thirty (30) days of receiving a closure application that satisfies the requirements

of subsection (d) of this section, the director of the department of health shall hold a public hearing.

The applicant's controlling officers shall attend the public hearing and members of the public shall

be permitted to participate and offer testimony; the director of the department of health shall

provide twenty-one (21) days written notice on the department of health's website of the date, time,

and location of the public hearing.

(h) The director of the department of health shall not approve an application submitted

pursuant to subsection (d) of this section unless the applicant demonstrates, by clear and convincing

evidence, that:

(1) The birthing center cannot reasonably be sustained through restructuring, alternative

staffing models, or system-level financial support;

(2) No feasible alternatives exist that would maintain safe and accessible birthing services;

(3) Closure shall not exacerbate maternal, newborn, racial, economic, or geographic

disparities; and

(4) Adequate, timely, and safe birthing access shall remain for the affected population.

(i) Notwithstanding any other provision in the general laws, the director of the department

of health shall have the sole authority to review all applications submitted under this section and

shall issue a written decision within ninety (90) days of the public hearing that follows the

applicant's submission of the completed closure application. The decision of the director of the

department of health shall approve, deny, or approve with conditions, the closure application.

(j) The department of health shall not amend a facility license issued pursuant to chapter

17 of title 23 to remove a birthing center unless the requirements of this section have been fulfilled.

(k) Failure to comply with the requirements of this section shall subject the entity required

to comply with the provisions of this section to civil penalties not to exceed twenty-five thousand

dollars ($25,000) per violation. Each day of noncompliance shall constitute a separate violation.

(l) The department of health shall adopt rules and regulations to implement and enforce the

provisions of this section.

SECTION 13. Title 27 of the General Laws entitled "INSURANCE" is hereby amended

by adding thereto the following chapter:

CHAPTER 84

PHARMACY BENEFIT MANAGER TRANSPARENCY REPORTING AND STUDY ACT