(1) The department shall issue a certificate of public advantage for a cooperative agreement if it determines that the applicants have demonstrated by clear and convincing evidence that the likely benefits resulting from the agreement outweigh any disadvantages attributable to a reduction in competition that may result from the agreement.
(2) In evaluating the potential benefits of a cooperative agreement, the department shall consider whether one or more of the following benefits may result from the cooperative agreement:
(a) Enhancement of the quality of health care facility care and provider care provided to Nebraska citizens;
(b) Preservation of health care facilities, including those in other states, in geographical proximity to the communities traditionally served by such facilities;
(c) Gains in the cost efficiency of services provided by the health care facilities or providers involved or by other health care facilities or providers in this state;
(d) Improvements in the utilization of health care facility resources and equipment;
(e) Avoidance of duplication of health care facility resources;
(f) Enhancement, maintenance, or preservation of competition for the services or goods involved; and
(g) Mitigation of adverse environmental impact or enhancement of positive environmental impact.
(3) The department's evaluation of any disadvantages attributable to any reduction in competition likely to result from the agreement may include, but need not be limited to, the following factors:
(a) The extent of any likely adverse impact on the ability of health maintenance organizations, preferred provider organizations, managed health care service agents, or other health care payors to negotiate advantageous payment and service arrangements with health care facilities or providers;
(b) The extent of any reduction in competition among health care facilities or providers or other persons furnishing goods or services to or in competition with health care facilities that is likely to result directly or indirectly from the cooperative agreement;
(c) The extent of any likely adverse impact on patients in the quality, availability, and price of health care services; and
(d) The availability of arrangements that are less restrictive to competition and achieve the same benefits or a more favorable balance of benefits over disadvantages attributable to any reduction in competition likely to result from the agreement.