Rendering of planned Prince George's Regional Medical Center. (Prince George’s County government)

The Maryland Health Care Commission voted unanimously to approve plans for a proposed regional medical center in Prince George’s County, the final step in a prolonged regulatory process that began more than three years ago.

Commissioner Robert E. Moffit, who was assigned to review the proposal and this spring ordered officials to cut some costs, said the board had never seen a project as large or that involved as much taxpayer money.

The commission’s role is “to restrain excess capacity,” Moffit said, and to ensure the project is financially viable.

“I concluded . . . that there was a clear and compelling need for a replacement hospital in Prince George’s County,” Moffit said, “and its proposed location in Largo is an excellent choice.”

The $543 million project is a joint venture of Dimensions Healthcare Systems, which has run hospitals in Prince George’s for more than three decades, and the University of Maryland Medical System. More than $400 million in public funds will go to construction and hospital operations.

After the vote at the commission meeting in Baltimore, officials involved with the project broke into applause — an unusual gesture, but understandable, officials said.

“It’s a tremendous victory for Prince George’s County and Maryland,” said County Council member Mel Franklin (D-Upper Marlboro). “Everybody is thrilled. It’s been such a long time coming, and we are finally here.”

The regional medical center is supposed to anchor a revitalization of the county’s struggling health-care system so it can better serve residents, who have some of the highest rates of chronic disease in the state.

Finding a partner to operate the hospital and securing funding was a major priority for County Executive Rushern L. Baker III (D). The push for state support put him at odds at times with Gov. Larry Hogan (R), and the state’s Democratic-majority legislature eventually mandated annual subsidies.

Dimensions first submitted its application for a certificate of need — or permission to build the hospital — in 2013. But it wasn’t until April 2015 that regulators reviewed it.

Moffit noted Thursday that the project still faces significant challenges. One central question is whether an improved system can bring back patients who have abandoned county medical facilities in favor of better-ranked hospitals elsewhere.

“The long-term viability will be ultimately dependent on strong management,” Moffit said.

Project backers — including state and county elected officials — point to the progress made in the cardiac program at Prince George’s Hospital Center in Cheverly, which under the supervision of UMMS doctors achieved one of the highest ratings in the country for performance this year.

At the same time, the cost of care at that hospital, the second-busiest trauma center in the state, remains 12 percent higher than at similar hospitals elsewhere in Maryland, the commission said, in part to make up for the hospital’s large pool of indigent patients.

The state has committed $55 million in operating subsidies to the hospital system over the next few years and another $200 million for capital costs.

Moffit said he wanted to ensure the commission acted as a “sound steward” of public resources while reviewing the project.

In May, he asked project planners to modify the size and scope of the hospital, shaving $100 million from the estimated cost and reducing the bed count and square footage. Dimensions and UMMS reconfigured their plans, winning support from some onetime objectors, including Anne Arundel Medical Center.

Moffit also asked for clarification on what would happen to the long-troubled Dimensions organization once the hospital project was approved. Officials say UMMS will merge with Dimensions and become the regional medical center’s sole operator and owner.

“It’s super for the people of Prince George’s County,” said John Ashworth, senior vice president at UMMS. “I know the process was arduous and there were a lot of back-and-forths, but Moffit captured the essence of everything that we’ve been doing.”

A ceremonial groundbreaking will likely take place next spring or early summer, officials said. The projected opening date for the new hospital is 2020.