Section 9954 - Performance improvement plans(a) Beginning in 2026, if the Board determines that a hospital's actual annual cost growth has exceeded the spending benchmark, the Board shall send the hospital notice of that finding and may require the hospital to submit a performance improvement plan within 45 days.(b) The Board shall promulgate additional regulations and written guidance about the performance improvement plan process, including discretionary factors that the Board may consider in deciding whether or not a performance improvement plan is required, taking into account a hospital's financial condition, any ongoing strategies or investments that the healthcare entity is implementing to improve patient access and quality, future long-term efficiency, population growth in the hospital service area, and such other factors as the Board may determine to be relevant.(c) A proposed performance improvement plan submitted by a hospital must identify the causes of the hospital's cost growth and must include specific strategies, adjustments, and action steps the hospital proposes to implement to improve cost performance. The proposed performance improvement plan must include specific identifiable and measurable expected outcomes and a timetable for implementation. The timetable for a performance improvement plan may not exceed 12 months.(d) If the Board determines that the performance improvement plan is unacceptable or incomplete, the Board shall provide written guidance explaining the criteria that have not been met and may provide an additional time period, up to 30 calendar days, for resubmission. If the hospital and the Board are unable to agree to a performance improvement plan, the Board may require the hospital to submit to the budget approval process under § 9955 of this title.(e) If the Board determines that the performance improvement plan is acceptable, the Board shall notify the hospital of the approval of the plan. A hospital implementing an approved performance improvement plan may be subject to additional reporting requirements and compliance monitoring, at the discretion of the Board.(f) At the conclusion of the timetable established in the performance improvement plan, or at an earlier time determined by the Board, the hospital shall report to the Board regarding the progress or outcome of the performance improvement plan. If the Board finds that the performance improvement plan has not been successful, the Board may do one of the following:(1) Extend the implementation timetable of the existing performance improvement plan.(2) Require the hospital to submit a new performance improvement plan.(3) Require the hospital to participate in the budget approval process under § 9955 of this title.(g) When determining whether to approve a performance improvement plan or an amendment thereto under this section the Board shall consider whether the proposal will be effective in achieving the factors set forth under § 9955(c) of this title.Added by Laws 2023, ch. 270,s 2, eff. 6/13/2024.Section 4 of the 2024 amending legislation provides that "Sections 1 and 2 of this Act are effective upon enactment, and hospitals, in accordance with regulations and guidance promulgated by the Board, are required to begin submission of budget information under § 9953 of Title 16 in 2025 for the 2026 budget year. The Board may require the submission of more than 1 year of historical financial information in its initial year of operation. The Board may not require the submission of a performance improvement plan under § 9954 of Title 16 until 2026."