(1) In evaluating the potential benefits of a cooperative agreement, merger or consolidation, the department shall consider whether one or more of the following benefits may result from it:

(a) enhancement of the quality of health care provided to residents of Montana;

(b) preservation of health care facilities in geographical proximity to the communities traditionally served by those facilities;

(c) gains in the cost efficiency of services provided by the health care facilities or physicians involved;

(d) savings to health care consumers resulting from anticipated cost efficiencies;

(e) improvements in the utilization of health services and equipment;

(f) provision of services that would not otherwise be available;

(g) avoidance of duplication of health care resources; or

(h) any other manifestation of lower health care costs or of improved access to health care or higher quality health care as a result of the agreement or transaction.

(2) In evaluating any disadvantages likely to result from the agreement or transaction, the department may consider the following factors:

(a) adverse impact on quality, availability, or cost of health care services to consumers;

(b) adverse impact on the ability of health care payers to negotiate optimal payment and service arrangements with health care providers;

(c) reduction in competition among health care providers or other persons furnishing goods or services to, or in competition with, health care facilities or physicians that is likely to result directly or indirectly from the cooperative agreement, merger or consolidation; and

(d) the availability of arrangements less restrictive to competition that achieve the same benefits.

(3) In making determinations as to availability of or access to health care, the department may consider:

(a) the extent to which the utilization of needed health care services or products by the population to be served by the agreement or transaction is likely to increase or decrease;

(b) the extent to which the proposed agreement or transaction is likely to make available a new and needed service or product to al certain geographic area;

(c) the extent to which the proposed agreement or transaction is likely to otherwise make health care services or products more financially or geographically available to persons who need them; and

(d) any other factors bearing upon the availability of or access to health care.

(4) In making determinations as to quality, the department may consider the extent to which the proposed agreement or transaction is likely to:

(a) decrease morbidity and mortality;

(b) result in faster convalescence;

(c) result in fewer, or shorter, hospital stays without detriment to the patient's health;

(d) permit providers to attain needed experience or frequency of treatment, likely to lead to better outcomes;

(e) result in lower complication rates;

(f) result in shorter patient waiting periods;

(g) increase consumer satisfaction; and

(h) have any other features likely to improve or reduce the quality of health care.

(5) The department may condition approval on a modification of all or part of the proposed agreement or transaction to eliminate any restriction on competition that is not reasonably related to the goals of reducing costs or improving access to health care or quality of health care. The department may also establish terms and conditions for approval that are reasonably necessary to protect against abuses of private economic power, to ensure that the agreement or transaction is appropriately supervised and regulated by the state, or otherwise determined appropriate to best achieve lower health care costs, improved access to health care or higher quality health care.

(6) A certificate of public advantage will not be awarded in connection with an agreement involving a health maintenance organization unless the transaction has, been approved by the commissioner of insurance as required by Title 33, chapter 31, MCA.

(7) The department shall maintain on file all cooperative, merger and consolidation agreements for which a certificate of public advantage remains in effect.   Any party to a cooperative agreement or transaction who terminates the agreement shall file a notice of termination with the department within 30 days after termination.