An Act to Enhance Transparency and Value in Substantial Health
Maine Legislature, Session 132, LD 1972
Committee: Health and Human Services
Sponsors: ZAGER
Amends: 22 MRSA §329, 22 MRSA §8710-A

Legislative Document
No. 1972
H.P. 1316
House of Representatives, May 13, 2025
An Act to Enhance Transparency and Value in Substantial Health 
Care Transactions by Changing the Review and Approval Process 
for Those Transactions
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative ZAGER of Portland.
Cosponsored by Representatives: BOYER of Cape Elizabeth, CLUCHEY of Bowdoinham, 
FOLEY of Wells, MORRIS of Turner.
Be it enacted by the People of the State of Maine as follows:
PART A
Sec. A-1.  22 MRSA §329, sub-§1, as amended by PL 2015, c. 453, §1, is further 
amended to read:
1.  Transfer of ownership; acquisition by lease, donation, transfer; acquisition of 
control of a nursing facility.  Any transfer of ownership or acquisition under lease or 
comparable arrangement or through donation or any acquisition of control of a health care 
nursing facility under lease, management agreement or comparable arrangement or through 
donation that would have required review if the transfer or acquisition had been by 
purchase, except in emergencies when that acquisition of control is at the direction of the 
department or except if the transfer of ownership or acquisition of control involves only 
entities or health care facilities that are direct or indirect subsidiaries of the same parent 
corporation, is between a parent corporation and its direct or indirect subsidiaries or is 
between entities or health care nursing facilities all under direct or indirect ownership of or 
ultimate control by the same parent corporation immediately prior to the transfer or 
acquisition;
PART B
Sec. B-1.  22 MRSA c. 106 is enacted to read:
CHAPTER 106
TRANSPARENCY AND VALUE IN HEALTH CARE TRANSACTIONS
§371. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1.  Acquisition.  "Acquisition" means the direct or indirect purchase in any manner of 
a material amount of the assets or operations of a health care entity.  "Acquisition" includes, 
but is not limited to, purchase by lease, transfer, exchange, option, receipt of a conveyance 
or creation of a joint venture or any other manner of purchase, such as by a health care 
system, private equity group, hedge fund, publicly traded company, real estate investment 
trust, management services organization, insurance carrier or any subsidiaries thereof. 
2.  Affiliate.  "Affiliate" means: 
A.  A person, entity or organization that directly, indirectly or through one or more 
intermediaries controls, is controlled by or is under common control or ownership with 
another person, entity or organization; 
B.  A person whose business is operated under a lease, management or operating 
agreement by another entity or a person substantially all of whose property is operated 
under a management or operating agreement with that other entity; 
C.  An entity that operates the business or substantially all the property of another entity 
under a lease, management or operating agreement; or
D.  Any out-of-state operations and corporate affiliates of an affiliate as defined in 
paragraph A, B or C, including significant equity investors, real estate investment trusts 
and management services organizations. 
3.  Arrangement.  "Arrangement" includes any agreement, association, partnership, 
joint venture, management services agreement, professional services agreement, health 
care staffing company agreement or other arrangement that results in a change of 
governance or change of control of a health care entity or a department, subdivision or 
subsidiary of a health care entity. 
4.  Carrier.  "Carrier" has the same meaning as in Title 24-A, section 4301-A, 
subsection 3.
5.  Change of control.  "Change of control" means an arrangement in which any other 
person, corporation or partnership or any other entity acquires direct or indirect control 
over the operations of a health care entity in whole or in substantial part. 
6.  Control.  "Control," including the terms "controlling," "controlled by" and "under 
common control with," means the direct or indirect power through ownership, contractual 
agreement or otherwise: 
A.  To vote 10% or more of any class of voting shares of a health care entity; or
B.  To direct the actions or policies of a health care entity. 
7.  Health care entity.  "Health care entity" means a health care provider, a health care 
facility or a provider organization.  "Health care entity" does not include a nursing facility 
as defined by section 328, subsection 18. 
8.  Health care facility.  "Health care facility" means a licensed institution providing 
health care services or a health care setting, including, but not limited to, hospitals and 
other licensed inpatient facilities, health systems consisting of one or more health care 
entities that are jointly owned or managed, ambulatory surgical or treatment centers, 
residential treatment centers, diagnostic, laboratory and imaging centers, freestanding 
emergency facilities, outpatient clinics and rehabilitation and other therapeutic health 
settings. 
9.  Health care provider.  "Health care provider" means any person, corporation, 
partnership, governmental unit, state institution, medical practice or any other entity 
qualified or licensed under state law to perform or provide health care services to persons 
in the State. 
10.  Health care services.  "Health care services" means services and payments for the 
care, prevention, diagnosis, treatment, cure or relief of a medical, dental or behavioral 
health condition, illness, injury or disease, including, but not limited to: 
A.  Inpatient, outpatient, habilitative, rehabilitative, dental, palliative, therapeutic, 
supportive, home health or behavioral services provided by a health care entity; 
B.  Pharmacy services, either retail or specialty, and any drugs, medical devices or 
medical supplies; 
C.  Performance of functions to refer, arrange or coordinate care; 
D.  Equipment used such as durable medical equipment, diagnostic equipment, surgical 
devices or infusion equipment; or
E.  Technology associated with the provision of services or equipment in paragraphs A 
to D, such as telehealth, electronic health records, software, claims processing or 
utilization systems. 
11.  Health care staffing company.  "Health care staffing company" means a person, 
firm, corporation, partnership or other business entity engaged in the business of providing 
or procuring, for temporary employment or contracting by a health care facility, any health 
care personnel but does not include an individual who independently provides the 
individual's own services on a temporary basis to health care facilities as an employee or 
contractor. 
12.  Management services organization.  "Management services organization" means 
any organization or entity that contracts with a health care provider or provider organization 
to perform management or administrative services relating to, supporting or facilitating the 
provision of health care services. 
13.  Material change transaction.  "Material change transaction" means any of the 
following occurring during a single transaction or in a series of related transactions 
involving a health care entity within the State that has total assets or annual revenues, or 
anticipated annual revenues for new entities, of at least $10,000,000, including both in-
state and out-of-state assets and revenues or anticipated revenues: 
A.  A corporate merger including one or more health care entities; 
B.  An acquisition of one or more health care entities, including insolvent health care 
entities; 
C.  Any affiliation, arrangement or contract that results in a change of control for a 
health care entity; 
D.  The formation of a partnership, joint venture, accountable care organization, parent 
organization or management services organization for the purpose of administering 
contracts with carriers, 3rd-party administrators, pharmacy benefits managers or health 
care providers; 
E.  A sale, purchase, lease, affiliation or transfer of control of a board of directors or 
governing body of a health care entity; 
F.  A real estate sale or lease agreement involving a material amount of assets of a 
health care entity; or
G.  The closure of a health care facility or the closure, discontinuance or significant 
reduction of any essential health care service provided by a health care entity that is 
either a provider organization or a health care facility or any new contracts or clinical 
or contractual affiliations that will eliminate or significantly reduce essential health 
care services.  The department shall define by rule what constitutes a significant 
reduction and essential health care services for purposes of this chapter. 
"Material change transaction" does not include a clinical affiliation of health care entities 
formed solely for the purpose of collaborating on clinical trials; graduate medical education 
programs; the mere offer of employment to, or hiring of, a single physician; or situations 
in which the health care entity directly, or indirectly through one or more intermediaries, 
controls, is controlled by or is under common control with all other parties to the 
transaction, such as a corporate restructuring. 
14.  Medical practice.  "Medical practice" means a corporate entity or partnership 
organized for the purpose of practicing medicine and permitted to practice medicine in the 
State, including, but not limited to, partnerships, professional corporations, limited liability 
companies and limited liability partnerships. 
15.  Pharmacy benefits manager.  "Pharmacy benefits manager" has the same 
meaning as in Title 24-A, section 4347, subsection 17.
16.  Provider organization.  "Provider organization" means any corporation, 
partnership, business trust, association or organized group of persons that is in the business 
of health care delivery or management, whether incorporated or not, that represents one or 
more health care providers in contracting with carriers for the payment of health care 
services.  "Provider organization" includes, but is not limited to, physician organizations, 
physician-hospital organizations, independent practice associations, health care provider 
networks, accountable care organizations and management services organizations and any 
other organization that contracts with carriers for payment for health care services. 
§372.  Review of proposed material change transactions
1.  Notice.  This subsection governs notice regarding material change transactions. 
A.  A health care entity shall, before completing any material change transaction, file 
written notice with the department not fewer than 180 days before the date of the 
proposed material change transaction. 
B.  Written notice under paragraph A must contain the information the department 
determines necessary.  The health care entity may include any additional information 
supporting the written notice of the material change transaction.  Notice is complete 
when the department determines that all required information has been received. 
C.  All the information provided by the submitter as part of the notice under this 
subsection must be treated as a public record unless the submitter designates documents 
or information as confidential when submitting the notice and the department concurs 
with the designation in accordance with a process specified by rule.  Information that 
is otherwise publicly available, or that has not been confidentially maintained by the 
source, must be considered public information.  The department shall maintain the 
confidentiality of all confidential information that is obtained in relation 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 any information to an expert or consultant under contract with the 
department as long as the expert or consultant is bound by the same confidentiality 
requirements as the department.  The confidential information and documents are not 
public records and are exempt from the provisions of Title 1, chapter 13. 
D.  Within 10 days of receiving written notice of a material change transaction, the 
department shall post on its publicly accessible website information about the material 
change transaction, including: 
(1)  A summary of the proposed transaction, including the identities of the parties 
to the transaction; 
(2)  An explanation of the groups or individuals likely to be affected by the 
transaction; 
(3)  Information about services currently provided by the health care entity, 
commitments made by the health care entity to continue such services and any 
services to be reduced or eliminated; 
(4)  Details about any public hearings and how to submit comments; and
(5)  Any other information from the notice and other materials submitted by the 
health care entity that the department determines would be in the public interest, 
except for materials designated confidential under paragraph C. 
E.  For purposes of calculating time periods pursuant to this subsection, notice is 
considered received on the first business day after the department determines that 
notice is complete. 
2.  Preliminary review.  This subsection governs preliminary reviews of material 
change transactions. 
A.  Within 60 days after receiving a notice described in subsection 1, the department, 
in consultation with the Office of Affordable Health Care, shall: 
(1)  Approve the material change transaction and notify the health care entity in 
writing that a comprehensive review is not required for the material change 
transaction; 
(2)  Approve the material change transaction subject to conditions set by the 
department and notify the health care entity in writing of the conditions under 
which the material change transaction may be completed; or
(3)  Notify the health care entity in writing that the transaction is subject to a 
comprehensive review.  The department may request additional information 
necessary to perform a comprehensive review under subsection 3. 
B.  A comprehensive review under subsection 3 is required when any of the following 
applies to the material change transaction: 
(1)  The material change transaction will result in the transfer of assets valued over 
$100,000,000; 
(2)  The material change transaction will lessen competition, including through the 
effects of vertical or cross-market transactions among different product or 
geographic markets; and
(3)  The department, at its sole discretion, determines that the material change 
transaction is likely to have a material impact on the cost, quality or equity of or 
access to health care services in any region in the State. 
C.  This section does not limit or infringe upon the existing authority of any state 
agency, including the Department of Health and Human Services, the Department of 
Professional and Financial Regulation and the Department of the Attorney General, to 
review any transactions. 
3.  Comprehensive review process.  This subsection governs the comprehensive 
review process for material change transactions. 
A.  No later than 90 days after determining a material change transaction is subject to 
a comprehensive review pursuant to subsection 2, paragraph B, the department shall 
conduct one or more public hearings or public meetings, one of which must be in the 
county in which the health care entity is located, to hear comments from interested 
parties. 
B.  At the department's request, the Office of Affordable Health Care shall review the 
material change transaction's cost and market impact.  The review may examine factors 
relating to the proposed transaction and the transacting parties and their relative market 
positions, including, but not limited to: 
(1)  The quality of the services provided by any health care provider party to the 
transaction, including patient experience; 
(2)  Consumer concerns, including, but not limited to, complaints or other 
allegations that the health care provider or provider organization has engaged in 
any unfair method of competition or any unfair or deceptive act or practice; 
(3)  The role of the transacting parties in serving at-risk, underserved and 
government payer patient populations; 
(4)  The prices charged by either of the transacting parties for health care services, 
including their relative prices compared to others' prices for the same health care 
services in the same geographic area;
(5)  The cost and cost trends of the health care entity in comparison to total health 
care expenditures statewide; 
(6)  The impact of the transaction on the clinical workforce, including wages, 
working conditions, staffing levels, supply, patient access and continuity of 
patient-care relationships; 
(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 patient care operations; 
(8)  The market share of any transacting party and the likely effects of the 
transaction on competition; 
(9)  Any previous transaction involving either transacting party, including, but not 
limited to, acquisitions or mergers of similar health care providers, whether or not 
in the same state; 
(10)  The availability and accessibility of health care services similar to those 
provided, or proposed to be provided, through the health care provider or provider 
organization within its primary service areas and dispersed service areas; 
(11)  The impact of the material change transaction on competing options for the 
delivery of health care services within the health care provider's or provider 
organization's primary service areas and dispersed service areas; 
(12)  The role of the transacting parties in providing low-margin or negative-
margin services within their respective primary service areas and dispersed service 
areas; 
(13)  The parties' compliance with prior conditions and legal requirements related 
to competitive conduct, including without limitation compliance with reporting 
requirements regarding health care entity ownership and control under Title 22, 
section 8710-A and compliance with the laws and regulations of other states in 
which the parties operate; 
(14)  In the case of a proposed closure or discontinuance of a health care facility or 
any essential health care services, the impact of the closure or discontinuance on 
health care services access, outcomes, costs and equity for those in the health care 
facility's service area and the health care facility's plan for ensuring equitable 
access, quality, affordability and availability of essential health care services 
within the service area; and
(15)  Any other factors that the Office of Affordable Health Care determines to be 
in the public interest. 
C.  The department and the Office of Affordable Health Care may request additional 
information or documents from the transacting parties necessary to conduct the review 
of the material change transaction's cost and market impact.  Failure to respond or 
insufficient responses to requests for information by transacting parties may result in 
the extension of the deadline for the office to complete the review or the imposition of 
conditions for approval or the disapproval of the material change transaction under 
subsection 4. 
D.  The department and the Office of Affordable Health Care shall keep confidential 
all nonpublic information and documents obtained under this section and may not 
disclose the confidential information or documents to any person without the consent 
of the party that produced the confidential information or documents, except that the 
department and the office may disclose any information to an expert or consultant 
under contract with the State to review the proposed material change transaction as 
long as the expert or consultant is bound by the same confidentiality requirements as 
the department and the office.  The confidential information and documents and work 
product of the Office of Affordable Health Care are not public records and are exempt 
from Title 1, chapter 13. 
E.  The department or the office may, in its sole discretion: 
(1)  Contract with, consult and receive advice from any state agency, including 
other offices of the Department of Health and Human Services, the Department of 
Professional and Financial Regulation, the Maine Health Data Organization 
established in section 8703, the Maine Quality Forum established in Title 24-A, 
section 6951 or any other state agency, on those terms and conditions that the 
department or the office considers appropriate; and
(2)  Contract with experts or consultants to assist in reviewing the proposed 
material change transaction. 
Notwithstanding Title 5, chapter 155 or any other provision of law to the contrary, 
agreements and contracts entered into pursuant to this chapter are not subject to the 
competitive bid requirements of the Chief Procurement Officer. 
F.  Not more than 150 days after receiving the request under paragraph B, the Office 
of Affordable Health Care shall produce a report on its review of the material change 
transaction's cost and market impact report containing the findings and conclusions of 
the review as long as the health care entity has complied with the requests for 
information or documents pursuant to this section within 21 days of the request or by 
a later date set by mutual agreement of the health care entity and the office.  The report 
must be posted publicly and may not disclose confidential information. 
G.  The department may charge costs to the transacting parties for all actual, reasonable 
and direct costs incurred in reviewing, evaluating and making the determination 
referred to in this section, including, without limitation, administrative costs, costs 
incurred by the Office of Affordable Health Care and costs of contracted experts or 
consultants. 
4.  Approval authority.  This subsection governs the department's approval authority. 
A.  The department may approve, conditionally approve or disapprove of any material 
change transaction for which the department receives notice under subsection 1.  Any 
conditions imposed pursuant to this section must specify a time period for compliance, 
an expiration date or that the condition applies indefinitely. 
B.  The department shall inform the health care entity of the determination under 
paragraph A within 60 days of notice under subsection 1 or, in the case of 
comprehensive review, within 60 days of the department's receiving the report of the 
completed review of the material change transaction's cost and market impact from the 
Office of Affordable Health Care.  A proposed material change transaction may not be 
completed before the department has informed the health care entity of the 
determination. 
C.  In making the determination pursuant to paragraph A, the department may consider 
any factors that the department considers relevant, including, but not limited to, the 
likely impact, as described in the cost and market impact review report when 
applicable, of the material change transaction on: 
(1)  Health care costs, prices and affordability; 
(2)  The availability or accessibility of health care services to the affected 
individuals and groups; 
(3)  The potential effects of the transaction on health outcomes, quality, access, 
equity or workforce for residents of this State or the potential loss or change in 
access to essential health care services; 
(4)  Health care provider cost trends and containment of total state health care 
spending; 
(5)  Access to health care services in medically underserved areas; 
(6)  Rectifying historical problems and contemporary factors contributing to a lack 
of health equity or access to health care services; 
(7)  The functioning and competitiveness of the markets for health care and health 
insurance; 
(8)  Whether the transaction is contrary to or violates any applicable law, including, 
without limitation, state antitrust laws, laws restricting the corporate practice of 
medicine and consumer protection laws; 
(9)  Whether the benefits of the transaction are likely to outweigh the 
anticompetitive effects from the transaction; and
(10)  Whether the transaction is in the public interest. 
D.  This subsection does not limit or alter any authority of the Attorney General or any 
state agency to enforce any other law, including state or federal antitrust law, or to 
review nonprofit transactions.
5.  Post-transaction oversight.  This subsection governs post-transaction oversight. 
A.  This paragraph governs enforcement by the Attorney General. 
(1)  The Attorney General may subpoena any records necessary to enforce any 
provisions of this chapter or to investigate suspected violations of any provisions 
of this chapter or any conditions imposed by conditional approval pursuant to 
subsection 4. 
(2)  The Attorney General may enforce any requirement of this chapter and any 
conditions imposed by a conditional approval pursuant to subsection 4 to the fullest 
extent provided by law, including damages.  In addition to any legal remedies the 
Attorney General may have, the Attorney General is entitled to specific 
performance, injunctive relief and other equitable remedies a court considers 
appropriate for any violation or imminent violation of any requirement of this 
chapter or breach of any of the conditions and is entitled to recover attorney's fees 
and costs incurred in remedying each violation. 
(3)  This subsection does not narrow, abrogate or otherwise alter the authority of 
the Attorney General to prosecute violations of antitrust or consumer protection 
requirements. 
B.  This paragraph governs enforcement by the department. 
(1)  The department may audit the books, documents, records and data of any entity 
that is subject to a conditional approval under subsection 4 to monitor compliance 
with the conditions. 
(2)  Any entity that violates any provision of this chapter, any rules adopted 
pursuant to this chapter or any condition imposed pursuant to a conditional 
approval under subsection 4 is subject to an administrative penalty of $10,000 per 
day for any violation of this chapter.  The department may hold these funds in a 
special revenue account that may be used only to support material change 
transaction reviews, such as for hiring expert analysts on a short-term consulting 
basis. 
(3)  The department may refer any entity to the Attorney General to review for 
enforcement of any noncompliance with this chapter and any conditions imposed 
by conditional approval pursuant to subsection 4. 
(4)  In order to monitor effectively ongoing compliance with the terms and 
conditions of any material change transaction subject to prior notice, approval or 
conditional approval under this chapter, the department may, in its sole discretion, 
conduct a review or audit and may contract with experts and consultants to assist 
in this regard. 
(5)  One year, 2 years and 5 years following the completion of the material change 
transaction approved or conditionally approved by the department after a 
comprehensive review under subsection 3, and at future intervals determined at the 
discretion of the department, the health care entity or the person, corporation or 
partnership or any other entity that acquired direct or indirect control over the 
health care entity shall submit reports to the department that: 
(a) Demonstrate compliance with conditions placed on the transaction, if any; 
(b) Analyze cost trends and cost growth trends of the parties to the transactions; 
and
(c) Analyze any changes or effects of the transaction on patient access, 
availability of services, workforce, quality or equity. 
C.  The department is entitled to charge costs to the transacting parties for all actual, 
reasonable and direct costs incurred in monitoring ongoing compliance with the terms 
and conditions of the material change transaction, including contractor and 
administrative costs. 
6.  Assessment.  The department shall adopt rules setting minimum and maximum 
filing fees under this chapter.  Initial fees may not be less than $1,000 nor more than $5,000.  
In addition to rules regarding filing fees, the department shall adopt rules to establish 
reasonable and necessary fees to carry out the provisions of this chapter.  The department 
shall also assess an annual fee equal to one five-thousandth of 1% of all premiums earned 
in the prior year on all health insurers and health maintenance organizations operating in 
the State and all insurers writing employee benefit excess insurance as described in Title 
24-A, section 707, subsection 1, paragraph C-1 in the State.  The department may, at its 
sole discretion, waive this assessment for carriers with less than $25,000,000 in annual 
earned premium.  When filing written notice pursuant to subsection 1, paragraph A, the 
health care entity shall pay a nonrefundable filing fee pursuant to this subsection.  All fees 
received by the department under this subsection must be placed in a separate, nonlapsing 
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.  
§373.  Rulemaking
The department may, after notice and hearing pursuant to Title 5, chapter 375, 
subchapter 2, adopt rules to carry out this chapter.  Rules adopted pursuant to this section 
are routine technical rules pursuant to Title 5, chapter 375, subchapter 2-A.
PART C
Sec. C-1.  22 MRSA §8710-A is enacted to read:
§8710-A.  Ownership and control of health care entities
1.  Definitions.  For the purposes of this section, unless the context otherwise indicates, 
all terms have the same meanings as under section 371.
2.  Reporting of ownership and control of health care entities.  A health care entity 
shall report to the organization on an annual basis and upon the completion of a material 
change transaction involving the health care entity in a form and manner required by the 
organization the following information: 
A.  Legal name of health care entity; 
B.  Business address of health care entity; 
C.  Locations of operations; 
D.  Business identification numbers of the health care entity, as applicable, including: 
(1)  Taxpayer identification number; 
(2)  National provider identifier; 
(3)  Employer identification number; and
(4)  United States Department of Health and Human Services, Centers for Medicare 
and Medicaid Services certification number; 
E.  Name and contact information of a representative of the health care entity; 
F.  The name, business address, business identification numbers listed in paragraph D 
and federal tax classification for each person or entity that, with respect to the relevant 
health care entity: 
(1)  Has an ownership or investment interest; 
(2)  Has a controlling interest; 
(3)  Is a management services organization; or
(4)  Is a significant equity investor; 
G.  A current organizational chart showing the business structure of the health care 
entity, including: 
(1)  Any entity listed in paragraph F; 
(2)  Affiliates, including entities that control or are under common control as the 
health care entity; and
(3)  Subsidiaries; 
H.  For a health care entity that is a health care provider or a health care facility: 
(1)  The affiliated health care providers identified by name, license type, specialty, 
national provider identifier and other applicable identification number described in 
paragraph D; the address of the principal practice location; and whether the health 
care provider is employed or contracted by the health care entity; and
(2)  The name and address of affiliated health care facilities by license number, 
license type and capacity in each major service area; 
I.  The names, national provider identifiers, if applicable, and compensation of the 
members of the governing board or board of directors or similar governance body for 
the health care entity; any entity that is owned or controlled by, affiliated with or under 
common control with the health care entity; and any entity described in paragraph F; 
and
J.  Payor mix information for the reporting year by:
(1)  The number of services provided and percent of total services provided by 
payor category; and 
(2)  The percent of total patient service revenue by payor category.
3.  Exceptions.  The following health care entities are exempt from the reporting 
requirements under subsection 2: 
A.  A health care entity that is an independent provider organization, without any 
ownership or control entities, consisting of 5 or fewer physicians, except that if such a 
health care entity experiences a material change transaction under chapter 106, the 
health care entity is subject to reporting pursuant to chapter 106; and
B.  A health care provider or provider organization that is owned or controlled by 
another health care entity, if the health care provider or provider organization is shown 
in the organizational chart submitted under subsection 2, paragraph G and the 
controlling health care entity reports all the information required under subsection 2 on 
behalf of the controlled or owned entity, except that health care facilities are not subject 
to this exception. 
4.  Sharing of ownership information to improve transparency.  This subsection 
governs the sharing of ownership information to improve transparency. 
A.  Information provided under this subsection is public information and may not be 
considered confidential, proprietary or a trade secret, except that any individual health 
care provider's taxpayer identification number that is also their social security number 
is confidential. 
B.  Not later than July 1, 2027 and annually thereafter, the organization shall post on a 
publicly accessible website a report with respect to the previous one-year period, 
including: 
(1)  The number of health care entities reporting for that previous one-year period, 
disaggregated by the business structure of each specified health care entity; 
(2)  The name, address and business structure of any entity with an ownership or 
controlling interest in a health care entity; 
(3)  Any change in ownership or control for each health care entity; 
(4)  Any change in the tax identification number of a health care entity; and
(5)  As applicable, the name, address, tax identification number and business 
structure of other affiliates that are under common control with, subsidiaries of or 
management services entities of the health care entity, including the business type 
and the tax identification number of each. 
C.  The organization may share information reported under this section with the Office 
of Affordable Health Care, Attorney General, other state agencies and other state 
officials to reduce or avoid duplication in reporting requirements or to facilitate 
oversight or enforcement pursuant to the laws of the State, except that any tax 
identification numbers that are individual social security numbers may be shared only 
with other state agencies or other state officials that agree to maintain the 
confidentiality of such information.  
PART D
Sec. D-1.  Effective date. This Act takes effect January 1, 2026.
SUMMARY
This bill enacts law governing consequential transactions, such as transfers of 
ownership or control, among health care entities, including health care providers, health 
care facilities, provider organizations, pharmacy benefits managers and carriers.  It 
establishes a preliminary and comprehensive review process carried out by the Department 
of Health and Human Services in consultation with the Office of Affordable Health Care 
and provides for post-transaction oversight.  It creates provisions governing reporting on 
the ownership and control of health care entities upon the completion of a transaction.  It 
also makes the provisions take effect January 1, 2026.