1. (a) Subject to approval as provided in this article, entities and individuals may engage in data sharing, collaborating, and providing shared services to carry out the states policy provided in this article. Such activities may include, but are not limited to:

   1. (1) Joint purchasing and contracting;
   2. (2) Shared clinical, administrative, and support services;
   3. (3) Coordinated staffing arrangements;
   4. (4) Joint quality improvement initiatives;
   5. (5) Shared technology platforms;
   6. (6) Joint negotiations with payors, suppliers, and vendors;
   7. (7) Coordinated service line development; and
   8. (8) Shared facilities, equipment, and infrastructure.
2. (b) Notwithstanding any language or provision to the contrary, joint negotiations with a health benefit plan or health insurer, as those terms are defined in Section 27-45A-3; an employee welfare benefit plan, as defined in 29 U.S.C. § 1002(1); a plan that pays or reimburses for health care services pursuant to Chapter 25A of Title 16, Chapter 29 of Title 36, or Chapter 91A of Title 11; or the administrator of any such plan is not included and is hereby expressly prohibited from approval by the agency as an allowed activity pursuant to this article.
3. (c) Prior to engaging in activities provided in subsection (a), an entity or individual shall obtain a valid certificate authorizing such activities issued by the State Health Planning and Development Agency, acting through its executive director.

4. (d) An applicant shall describe with reasonable particularity:

   1. (1) The parties to the engagement;
   2. (2) The nature and scope of the proposed activities;
   3. (3) The anticipated effects of engagement, including any expected impact on competition; and
   4. (4) Any other information requested by the State Health Planning and Development Agency.
5. (e) In addition to the requirements of subsection (c), the applicant shall certify that the engagement is in good faith and is reasonably necessary to further the state’s policy set forth in this article.

6. (f) The State Health Planning and Development Agency may issue a certificate if it determines that the activities are reasonably necessary to further the state’s policy set forth in this article and the benefits of the proposed activities outweigh foreseeable anticompetitive effects. In making this determination, the State Health Planning and Development Agency may consider the effects of the proposed engagement on:

   1. (1) The quality of hospital and related care provided to rural Alabama citizens;
   2. (2) The continued availability of hospital facilities in close geographical proximity to the rural communities they serve;
   3. (3) Potential cost efficiencies in the services provided by the applicant and other individuals and entities involved in the proposed engagement;
   4. (4) The efficient use of rural health care resources and equipment, including the avoidance of duplication of resources and equipment;
   5. (5) Improvements in health outcomes in the region impacted by the proposed engagement;
   6. (6) Access to care for medically underserved rural populations and the extent to which these populations are likely to benefit from the proposed activities;
   7. (7) The ability of rural health care payors to negotiate appropriate payment and service arrangements with rural health care providers;
   8. (8) Competition among rural health care providers and others providing goods or services to, or competing with, such providers;
   9. (9) The quality, availability, and price of health care services for rural Alabama citizens; and
   10. (10) Whether other alternatives could reasonably achieve the same or greater public health benefits with fewer anticompetitive effects.
7. (g) A certificate issued under this section shall not become effective unless and until it is reviewed and approved in writing by the Governor or the Governor’s designee. The Governor may approve, in whole or in part, disapprove, or return the certificate for further consideration, and may impose conditions consistent with the purposes of this article.

(Act 2026-522, §3.)