An Act to Implement
Maine Legislature, Session 132, LD 2201
Committee Amendment CA_A_H981 (House)

COMMITTEE AMENDMENT '/^ " to H.P. 1480, L.D. 2201, "An Act to Implement
Certain Recommendations Related to the Regulatory Review and Approval of Certain
Health Care Transactions Involving Private Equity Companies, Hedge Funds or
Management Services Organizations 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"
Amend the bill in section 1 in c. 106 in §371 m subsection 2 in the last Une (page 1,
line 14 in L.D.) by inserting after the following: "18" the followmg: 'or a health care
provider or provider organization that provides only dental services'
Amend the bill in section 1 in c, 106 in §371 by striking out all of subsection 6 (page
2, lines I to 4 in L,D.) and inserting the following:
'6. Manaeemeiit services oreanization. "Manapement services oreanization" means
any oreamzation or entity owned or controlled by a private equity companyor hedge fund
that contracts with a health care provider or provider organization to perform manapement
or administrative services relating to. suuportme or facilitating the orovision of health care
services when the health care urovider or orovider oreanization is also owned or controlled
by the same private eguitv company or hedge fund.'
Amend the bill in section 1 in c. 106 in §371 by strikmg out all of subsection 10 (page
2, lines 18 and 19 in L.D.) and inserting the followmg:
'10. Private equity company. "Private equity comoany" means an entity that collects
caoital investments from individuals or entities and purchases, as a oarent entitv or throueh
another entity that the entity completely or tiartiallv owns or controls, a direct or indirect
ownership share of a health care orovider. provider organization or manaeement services
organization, except that "private equity company" does not include venture capital entities
exclusively funding start-ups or other early-stage businesses.'
Amend the bill in section 1 in c. 106 in §372 in subsection 1 by staking out all of
paragraph C (page 3, liaes 5 to 19 in L.D.) and inserting the following:
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COMMTTTEE AMENDMENT "ZJ^" to H.P. 1480, L.D. 2201
'C. All the infnrmation provided by the submitter as part of the notice under this
subsection is public unless the submitter requests that fee mformationbe designated as
confidential and the_deDartment_determmes that it contains proprietary information, in
which case it is confidential. The department may not disclose confidential
information that is obtained under Qus_ chapter mj-elation to a material change
transaction, except that the department may exchange confidential information with
the Office of Affordable Health Care. established under Title 5. section 3122.
subsection 1. necessary for the office to exercise its authority under this chapter and
may disclose information in accordance wifh subsection 3. paragraph D. For uurposes
of this section, oroorietary mformation means infonnation that is a trade secret or
production, commercial or financial information the disclosure of which would impair
the competitive position of the health care entity and would make available information
that is not otherwise public.'
Amend the bill in section 1 me. 106 in §372 in subsection 2 by inserting after paragraph
C the following:
'D. The department shall review a orooosed material change transaction under this
chapter concurrently with any review required pursuant to chapter 103 -A.'
Amend the bill in section 1 in c. 106 in §372 in subsection 3 in paragraph B by staking
out all of subparagraph (7) (page 5, lines 4 and 5 in L.D.) and insertmg the following:
(7) The impact of a real estate sale or lease agreement on the financial condition
of the health care entity and its ability to maintain natient care operations, includmg
the impact of a sale and leaseback arraneement if the main campus of the health
care entity is leased from a real estate investment tmst;
Amend the bill in section 1 in c. 106 in §372 m subsection 3 m paragraph B by insertmg
after subparagraph (9) the followmg;
(10) The debt-to-eamty ratio of the health_care entity follQwmg the transaction;
Amend the bill m section 1 in c. 106 iti §372 in subsection 3 in paragraph B by
renumbering the subparagraphs to read consecutively.
Amend the bill in section 1 in c. 106 in §372 in subsection 3 by striking out all of
paragraph D (page 5, lines 33 to 42 in L.D.) and inserting the following:
'D. _Propnetar/ information and documents obtained by the department and the Office
of Affordable Health Care under this chapter and the work product of the office is
confidential, except that the department and the office may disclose confidential
infQrmationor documents:
d) With the consent of the party that uroduced the information or documents: or
(2) To an expert or consultant-under contract with the State to review the urooosed
7 material change transaction, as lonp as the expert or consultant maintains the
8 confidentiality of the information or documents in accordance with this uaraeraph.'
Amend the bill in section 1 in c. 106 in §372 by striking out all of subsection 6 (page
8, lines 30 to 44 m L.D.) and inserting the following:
'6. Assessment. The department shall adopt rules setting mimmum and maximum
filing fees under this chapter. Initial fees may not be less than $2.000 nor more than
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COMMFTTEE AMENDMENT 't\ " to H.P. 1480, L.D. 2201
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$10.000. In addition to rules reeardme filine fees. the department shall adoDt mles to
establish reasonable and necessary fees to carry out the provisions of this chapter. When
filing written notice pursuant to subsection 1, paragraBhA, thehealthcare entitv shall pav
a nonrefundable filing fee oursuant to this subsection. All fees received bv the deDartment
under this subsection must be placed in a separate. nonlaosine account to be used in
accordance with this chapter. The department shall hold these funds in a special revenue
account that may be used only to support staff positions and other expenses necessary to
administer this section,
7. Exemption. Notwithstanding any other provision of this chapter to the contrary.
this section does not apply to an independent provider oreamzation. without any ownership
or control entities, consisting of 6 orjeweM^
change transaction.'
Amend the bill in section 1 in c. 106 in §373 in the first indented paragraph in the last
line (page 9, line 4 m L.D.) by striking out the following: "routine technical" and insertmg
the following: 'major substantive'
Amend the bill in section 2 in §8710-A by striking out all of subsection 2 (page 9, lines
20 to 39 and page 10, lines 1 to 25 in L.D.) and inserting the following:
'2. Reportine of ownership and control of health care entities. A health care entity
shall report to the oreanization once no later than July 1. 2027 and subsequently upon the
comuletion of a material change transaction involvtna the health care entity in a form and
manner required by the oreamzation the following mformation:
A. The leeal name of the health care entitv:
B, The busmess_address of the h_ealth care entito
C. Locations of operations of the health care entity:
D^_The busmess_Mentification_mmibCT^ of the}iGa\th cwe^^
includine:
(1) Taxpayer identification number;
(2} National r>rovider identifier;
f3') Employer identification number: and
0 (4) United States Department of Health and Human Services. Centers for Medicare
and Medicaid Services certification number;
E. The name and contact information of a representative of the health care entity:
F. A current oreanizational chart showine the business structure of the health care
entity, includine affiliates and subsidiaries: and
G, For a health care entity that is a hospital:
(1) The affiliated health care providers identified by name. license type. specialty.
7 national provider identifier and any other applicable identification number
described in paragraph D; the address of the principal practice location: and
whether the affiliated health care provider is emuloved or contracted by the health
care entity: and
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COMMITTEE AMENDMENT "f^ " to H.P. 1480, L.D. 2201
(T) The name and address of affiliated health care facilities bv license number,
license type and capacity in each mai or service area.
Amend the bill in section 2 in §8710-A in subsection 3 by striking out all of paragraph
A (page 10, lines 28 to 31 in L.D.) and inserting the following:
'A, A health care entity that is an independent provider oraanization, without any
ownershiu or control entities. consistme of 6 or fewer individual providers: and'
Amend the bill in section 2 in §8710-A in subsection 3 in paragraph B in the 3rd line
(page 10, line 34 in L.D.) by striking out the following: "paragraph G" and inserting the
following: 'paragraph F'
Amend the bill m section 2 in §8710-A m subsection 4 in paragraph A in the 3rd line
(page 11, line 1 in L.D.) by insertmg after the following: "social security number" the
followiag: 'and any business identification number of a health care entity listed in
subsection 2. paraeraoh D'
Amend the bill in section 2 in §8710-A in subsection 4 by striking out all of paragraph
B (page 11, lines 3 to 15 in L.D.) and inserting the following:
IB. No later than January 1, 2029 and annually thereafter, the organization shall post
on a publicly accessible website a report with respect to the orevious one-vear oeriod.
including:
d) The number of health care entities reporting for that previous one-year period.
disaeereeated by the business sfructurc of ea_ch_sDecified health care entity:
.(2) The name. address and business structure of any health care entity;
f3) Any chanee in ownershiu or control for each health care entity:
(4) _In accordance with paraRraph A, any chanee in the tax identificatiQn number
of a health care entity: and
(5} As awlicable in accordance with subsection 2. paragraph G. the name. address.
tax identification number and business structure of affiliates and subsidiaries of a
health care entity that is a hospital, including the business type and the tax
identification number of each.
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section
0 number to read consecutively.
SUMMARY
This amendment makes the following changes to the bill, which establishes a process
for notice, review and approval of transactions when a private equity company, hedge fund
or management services organization acquires a majority ownership interest in a health
care entity or when a private equity company, hedge fund or management services
organization takes operational control over a health care entity.
1. It amends the definition of "health care entity" to exclude a health care provider or
8 provider organization that provides only dental services, which has the effect of exempting
material change transactions involving dental practices from the review process established
in the bill.
Page4-132LR3022(02)
COMMITTEE AMENDMENT
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COMMnTEE AMENDMENT "H-" to H.P. 1480, L.D. 2201
2. It exempts material change transactions involving independent provider practices of
6 or fewer individual providers from the review process,
3. It clarifies the definition of "management services organization" to provide that a
management services organization subject to the requirements of the bill must be owned
by a private equity company or hedge fund and provide contracted services to a health care
provider or provider organization owned or controlled by the same private equity company
or hedge fund.
4, It amends the definition of "private equity company" to be consistent with the
definition used in similar laws in other states.
5. It provides that proprietary information provided to the Department of Health and
Human Services and the Office of Affordable Health Care during the material change
transaction review process is confidential and may be disclosed only if certain conditions
are met.
6. It clarifies that the material change transaction review process is concurrent wifh any
review required under the certificate of need laws ,
7. It requires the comprehensive review process of a material change transaction to
include consideration of the impact on the fmancial condition of a health care entity if the
transaction involves a sale and leaseback of the main campus of the health care entity from
a real estate investment tmst and consideration of the health care entity's debt to equity
ratio following the transaction,
8. It removes the assessment on health insurance carriers and doubles the range of filing
fees authorized to be imposed by the department by mle on health care entities subject to
the review process.
9. It designates any mles adopted to implement the provisions of the bill as major
substantive and subject to legislative review and approval before final adoption.
10. It changes the reporting requirements for health care entities to the Maine Health
Data Organization from an annual requirement to a one-time report no later than July 1,
2027, It retains the requirement in the bill to require a report to be made subsequently upon
completion of a material change transaction.
11. It eliminates certam reporting requirements, including requirements to report
names, business addresses and tax identification numbers of certain persons with respect
to a health care entity; requirements to report compensation of governing board members;
and requirements to report payor mix information. It also limits the reporting of certain
information about affiliated health care providers and health care facilities to hospitals only.
12. It provides that business identification numbers provided by a health care entity
reporting to the Maine Health Data Organization are confidential if those numbers are not
otherwise publicly available.
13. It expands the exemption from the reporting requirements for independent provider
practices from practices with 5 or fewer providers to providers with 6 or fewer providers.
FISCAL NOTE REQUIRED
(See attached)
COMMIHEE AMENDMENT
Approved: 04/02/26
LRL.
LD 2201 LR 3022(02)
An Act to Implement Certain Recommendations Related to the Regulatory Review and Approval of
Certain Health Care Transactions Involving Private Equity Companies, Hedge Funds or IVIanagement
Services Organizations 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
Fiscal Note for Bill as Amended by Committee Amendment '1y x
Committee: Health Coverage, Insurance and Financial Services
Fiscal Note Required: Yes
Fiscal Note
Minor cost increase - General Fund
Fiscal Detail and Notes
Any additional costs to the Department of Health and Human Services and the Maine Health Data Organization to
implement the provisions of this bill are expected to be minor and can be absorbed within existing budgeted resources.
LR3022(02) - Fiscal Note - Page 1 of 1