Maine will require approval for certain investor health care takeovers

State health officials may approve, approve with conditions, or reject covered takeovers. The parties cannot complete a deal before officials issue their decision. Covered deals give a private equity firm, hedge fund, or covered management company majority ownership or operating control of a Maine health care business. Control includes power to influence policies or appoint or remove leaders. One deal or related deals can qualify. Nursing facilities and dental-only providers or provider groups are excluded. Independent provider groups with six or fewer providers and no ownership or control entities are exempt. Covered management companies must share the same private equity or hedge fund owner or controller as the provider they serve. Venture capital firms exclusively funding startups or other early-stage businesses are excluded. Notice must describe the deal and planned service changes. Officials must publish a summary, while business information they approve as confidential stays private. The law takes effect January 1, 2027. Businesses must give at least 180 days' notice before a planned deal. The initial review decision is due within 60 days of receiving complete notice.

State health officials must conduct deeper reviews of certain covered takeovers. Parties must pay filing fees and may be charged review costs. These rules apply to takeovers covered by the approval requirement. Reviewers may examine effects on patients, workers, competition, and the business's ability to keep providing care. Deeper review is required when transferred assets exceed $100 million, a deal reduces competition, or officials find it likely to substantially affect care costs, quality, fairness, or access. Review includes a public hearing or meeting in the health care business's county. Officials may request a cost and market review from the Office of Affordable Health Care. Initial nonrefundable filing fees range from $2,000 to $10,000. Officials may charge actual, reasonable, and direct review costs. The office's report deadline depends on parties answering information requests within 21 days or a mutually agreed later date. Missing or inadequate answers may extend review, lead to conditions, or result in rejection. From January 1, 2027, hearings or meetings are due within 90 days of the deeper-review decision. A requested cost and market report is due within 150 days of the request, if parties respond on time. The final decision is due within 60 days of receiving that report.

State health officials may check compliance and charge monitoring costs. The Attorney General may enforce takeover requirements and approval conditions. Officials may check compliance with covered takeover requirements. Scheduled follow-up reports apply to deals approved or approved with conditions after deeper review. Violating these takeover requirements, rules, or approval conditions carries an administrative penalty of $10,000 per day. Follow-up reports must show compliance with any conditions and examine cost trends and effects on patients, services, and workers. Officials may charge actual, reasonable, and direct monitoring costs. The Attorney General may seek court orders, damages, and legal costs. The law takes effect January 1, 2027. Follow-up reports are due one, two, and five years after a reviewed deal is completed, with later reports at intervals set by health officials.

Covered health care businesses must report their ownership and structure to the state's health data organization, which must publish annual reports. Reporting covers health care businesses whether or not an investment firm owns them. Reports identify their locations, business structure, and related businesses. Nursing facilities, dental-only providers or provider groups, and independent provider groups with six or fewer providers and no ownership or control entities are excluded. A controlled provider or provider group need not report separately if its controlling health care business includes it in its business chart and reports all required information for it. Health care facilities cannot use this exception. Hospitals must also identify affiliated providers and facilities. Reported ownership information is public, but business identification numbers and provider tax numbers that are Social Security numbers stay confidential. The law takes effect January 1, 2027. Businesses report once by July 1, 2027, and again when a covered takeover is completed. Annual public reports are due by January 1, 2029, and annually thereafter.