An Act to Implement Certain Changes in the Certificate of Need
Maine Legislature, Session 132, LD 2190
Committee: Health Coverage, Insurance and Financial Services
Amends: 22 MRSA §328, 22 MRSA §331, 22 MRSA §335

Legislative Document
No. 2190
H.P. 1471
House of Representatives, February 3, 2026
An Act to Implement Certain Changes in the Certificate of Need 
Laws Recommended by the Commission to Evaluate the Scope of 
Regulatory Review and Oversight over Health Care Transactions 
That Impact the Delivery of Health Care Services in the State
Reported by Representative MATHIESON of Kittery for the Joint Standing Committee on 
Health Coverage, Insurance and Financial Services pursuant to Resolve 2025, chapter 106, 
section 8.
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed pursuant to Joint Rule 218.
ROBERT B. HUNT
Clerk
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §328, sub-§23-A is enacted to read:
23-A.  Private equity company.  "Private equity company" means an entity whether 
or not publicly traded that collects capital investments from individuals or entities. 
Sec. 2.  22 MRSA §328, sub-§24-A is enacted to read:
24-A.  Real estate investment trust.  "Real estate investment trust" has the same 
meaning as in the United States Internal Revenue Code of 1986, Section 856. 
Sec. 3.  22 MRSA §331, sub-§1, ¶A-1 is enacted to read:
A-1.  There is a change in the ownership structure or operational control of a health 
care facility involving a private equity company or real estate investment trust;
Sec. 4.  22 MRSA §335, sub-§1, ¶F, as amended by PL 2023, c. 343, §3, is further 
amended to read:
F.  In the case of a nursing facility project that proposes to add new nursing facility 
beds to the inventory of nursing facility beds within the State, is consistent with the 
nursing facility MaineCare funding pool and other applicable provisions of sections 
333‑A and 334‑A; and
Sec. 5.  22 MRSA §335, sub-§1, ¶G, as enacted by PL 2023, c. 343, §4, is amended 
by amending subparagraph (2) to read:
(2)  After considering all reasonable alternatives, that access to other health care 
services will be substantially reduced if the project is not approved.; and
Sec. 6.  22 MRSA §335, sub-§1, ¶H is enacted to read:
H.  Does not negatively affect the affordability and accessibility of health care services 
for all residents of the State. 
Sec. 7.  22 MRSA §335, sub-§5-A, ¶H, as amended by PL 2023, c. 343, §5, is 
further amended to read:
H.  Except with regard to a project related to nursing facility services, a written 
assessment by the Director of the Maine Center for Disease Control and Prevention of 
the impact of the project on the health of persons living in the State, including without 
limitation an assessment of the impact of the project on access to, geographic proximity 
of, timeliness of and quality of any family planning services, as defined in section 1902, 
subsection 4, and any abortion services; and
Sec. 8.  22 MRSA §335, sub-§5-A, ¶I, as amended by PL 2013, c. 424, Pt. B, §9, 
is further amended to read:
I.  Except with regard to a project related to nursing facility services, or a project that 
qualifies for a simplified review process under section 336, a written assessment by the 
Superintendent of Insurance of the impact of the project on the cost of insurance in the 
region and the State when required by the commissioner.  The superintendent may 
request additional information from the applicant for the purpose of reviewing the 
application.  Any such request must be transmitted through the department and 
becomes part of the official record. The applicant shall respond to the request within 
days.  Any such response must be transmitted through the department and becomes 
part of the official record.  The inability of the superintendent to complete the review 
of the application due to the failure of the applicant to respond timely must be noted in 
the superintendent's assessment filed with the department and may be cause for the 
commissioner to deny approval of the project.; and 
Sec. 9.  22 MRSA §335, sub-§5-A, ¶J is enacted to read:
J.  With regard to a project that involves a transfer of ownership or acquisition of 
control of a health care facility pursuant to section 329, subsection 1, an analysis by 
the staff of the department of the extent to which the applicant's ownership structure 
involves a private equity company or real estate investment trust and the impact of that 
ownership structure on the ability of the applicant to meet the conditions set forth in 
subsection 1 and subsection 7.  The department shall contract with a consultant funded 
by the applicant to review and investigate the prior activities and conduct of any private 
equity company or real estate investment trust associated with the project and may also 
consult with the Attorney General to complete the analysis required by this paragraph.
SUMMARY
This bill is reported out by the Joint Standing Committee on Health Coverage, 
Insurance and Financial Services pursuant to Resolve 2025, chapter 106 to implement a 
recommendation from the Commission to Evaluate the Scope of Regulatory Review and 
Oversight over Health Care Transactions That Impact the Delivery of Health Care Services 
in the State.  The joint standing committee has not taken a position on the substance of this 
bill.  By reporting this bill out, the joint standing committee is not suggesting and does not 
intend to suggest that it agrees or disagrees with any aspect of this bill; instead, the joint 
standing committee is reporting the bill out for the sole purpose of having a bill printed that 
can be referred to a joint standing committee for an appropriate public hearing and 
subsequent processing in the normal course.  The joint standing committee is taking this 
action to ensure clarity and transparency in the legislative review of the proposals contained 
in the bill.
This bill expands the criteria considered during a review under the certificate of need 
laws to include consideration of a project's impact on affordability and accessibility of 
health care for all Maine residents.  
The bill also expands the scope of review under the certificate of need laws when there 
is a change in ownership or control of a health care facility to require a review and analysis 
of the extent to which the applicant's ownership structure involves a private equity company 
or real estate investment trust.  The bill requires the Department of Health and Human 
Services to contract with a consultant funded by the applicant to review and investigate the 
prior activities and conduct of the private equity company or real estate investment trust 
and authorizes the department to consult with the Attorney General.  Finally, the bill 
broadens the authority of the department to conduct subsequent reviews of an applicant for 
a certificate of need when there is a change in ownership or control of a health care facility.