Healthcare Transactions Laws – An Interactive Map

Healthcare transactions, including private equity healthcare transactions, are under review from both federal and state regulators and legislators. In particular, new state competition, quality, access and cost laws are creating additional requirements on healthcare entities considering new transactions, from private-equity backed entities to management services organizations. These laws and regulations are highlighted below and discussed in greater detail in our podcast series, which also offers ways to mitigate their impact.  

These laws require the review of health care transactions that historically fell outside of review by the states under existing facility licensure, certificate of need, non-profit and insurance laws.
* See additional failed legislation below.
This page was last updated on July 2, 2024. While we will endeavor to keep this page up to date with the most recent changes in state regulation of health care transactions, we note that this is a rapidly evolving area, and our map may not in real time capture the latest legislative and regulatory updates.

Legislation

  • California: As of April 1, 2024, health care entities must notify the Office of Health Care Affordability (“OHCA”) of proposed material change transactions at least 90 days prior to closing. From there, OHCA will either i) within 45 days, issue a waiver to a cost and market impact review (“CMIR”), or ii) within 60 days, notify parties of its decision to conduct a CMIR, which could extend the review period to over eight months. OHCA issued regulations in December 2023 that further clarify the entities and transactions subject to review, details regarding comprehensive reviews, and other details of the notice process. OHCA will start accepting notices on January 1, 2024. Cal. Health & Saf. Code § 127500 et seq; 22 CCR 97431 et seq.
  • Connecticut: The state Attorney General requires 30-day pre-closing notice of any material change transaction involving health care group practices, hospitals or hospital systems. If the Attorney General determines that the transaction will adversely impact competition, it may open a deeper inquiry or seek to postpone the transaction. While no strict timeline is given, transaction review may take up to, or greater than, 200 days after the notice is received. Conn. Gen. Stat. § 19a-486i.
  • Illinois: As of January 1, 2024, Illinois requires health care facilities and provider organizations to provide 30-day pre-closing notice to the state Attorney General’s Office of any merger, acquisition or contracting affiliation between two or more health care facilities or provider organizations. Illinois’ review process applies to all applicable in-state entities, and out-of-state entities with sufficient patient revenue in Illinois. While transaction “approval” is not explicitly required, the Attorney General has discretion to open an investigation and challenge conduct the Attorney General deems anti-competitive. A link to the healthcare transaction notice form can be found here740 Ill. Comp. Stat. 10/7.2a.
  • California: Proposed legislation in California would require private equity groups and hedge funds to (i) provide 90 days pre-closing notice to and obtain consent from the Attorney General prior to a change of control or an acquisition of a health care facility or provider group, and (ii) provide pre-closing notice to the Attorney General of a change of control or an acquisition of either a nonphysician provider with a gross annual revenue of more than $4,000,0000, or a provider with gross annual revenue between $4,000,000-25,000,000. Transactions subject to the Attorney General review requirements of this bill would be exempted from the Office of Health Care Affordability’s notice and review process. The legislation also provides for additional restrictions on a private equity or hedge fund’s ability to control or contract with certain health care entities, including a prohibition on interfering with professional judgment or exercising certain types of control over physician, psychiatric, and/or dental practices. See AB 3129 (as amended on June 19, 2024).
  • Connecticut: Proposed legislation in Connecticut would require, by January 1, 2025, that the Office of Health Strategies develop a plan concerning private equity ownership of Connecticut-licensed health care facilities, including (1) assessing whether a certificate of need should be required for a private equity firms’ acquisition of a health care facility; and (2) recommending requirements for the disclosure of information by a health care facility that has private equity ownership. See HB 5319.
  • Massachusetts: Proposed legislation in Massachusetts would expand the current review process by the Attorney General, the Center for Health Information and Analysis, and the Health Policy Commission (“HPC”), to more clearly capture transactions involving a “significant equity investor” that result in a change of ownership of a provider, provider organization or a carrier. “Significant equity investor” is defined to include (i) any private equity companies with a financial interest in a provider or provider organization, or (ii) other investors with a 10% or more direct or indirect interest in such organizations. The proposed bill also includes a number of other changes to enhance the state’s enforcement capacity under the review process, including by allowing the state to scrutinize the size and market share of any corporate affiliates or significant equity investors, and creating a presumption of unfair competition if a transaction is likely to result in a dominant market share or increase prices. See HB 4643.
  • California: Proposed legislation requiring certain health care entities entering into transactions resulting in a material change with a value of at least $15,000,000 to submit pre-closing notice and obtain approval from the Attorney General failed in 2024. See AB 1091.
  • Florida: Proposed legislation requiring health care entities to submit pre-closing notice to the state Attorney General’s Office of certain transactions failed in 2020 and 2021. See H.B. 711; S.B. 1064.
  • Maine: Proposed legislation requiring health care entities to submit pre-closing notice of certain health transactions and obtain approval from the state Attorney General’s Office failed in 2023. See H.B. 894.