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Editor’s Note: This week, we break from our usual format to offer insights roundup style.

Twenty statehouses, four big regulatory trends

By Allie Gross and Michael Hildebrand

3-minute read

In a presidential election year and amid our increasingly nationalized politics, it can be easy to miss the whirlwind of state legislature activity that has a significant impact on healthcare providers. As hospitals and health systems receive increased scrutiny from lawmakers, our team took a deep look at what was introduced, and ultimately passed, in statehouses across the country. Here are the key trends we discovered, in four buckets.

Tackling Transparency

  • Site-Neutral Payments: After backing off of harsher proposals, Maine passed a law requiring that hospitals clearly inform patients about facility fees through signage and websites. The state will also require medical bills to clearly identify the physical location where services were provided.
    • This won’t be the last we see of the facility fee issue. We can expect similar legislation to be brought forward next year in Maryland, which passed a bill requiring a state agency to study and make policy recommendations about hospital outpatient facility fees. And Indiana, Colorado and Connecticut tackled the fees last year.
  • No Surprises: Maine lawmakers got even more specific than the feds by requiring healthcare providers to clearly display to patients that they can request a “timely written estimate prior to receiving care and by defining what “timely” means. The state also prohibited collection actions against patients who were not provided good faith estimates.
  • Controlling Costs: Delaware passed a bill that creates the Diamond State Hospital Cost Review Board. A five-member panel will review the budgets of the state’s hospitals. This follows a similar initiative in Vermont.

CON Focus Continues

  • Certificate of Need continues to be a topic of debate across the country. Lawmakers in Georgia added CON exemptions for psychiatric and substance abuse inpatient programs, birthing centers and acute care hospitals in rural areas where similar facilities have recently closed.
  • States across the country exempted certain services and facilities from CON requirements – such as psych beds in Washington and Iowa. Nebraska exempted rehabilitation beds and acute care beds from CONs.
    • More to Come: Certificate of Need laws were targeted by many more states with proposed legislation, including Alabama, Alaska, Connecticut, Hawaii, Kentucky and Tennessee.

Curbing Consolidation

  • New Mexico enacted the Health Care Consolidation Oversight Act, requiring state review and approval of proposed hospital acquisitions and other changes in control of hospitals.
    • Another bill passed in Indiana requires healthcare mergers and acquisitions valued at more than $10 million be reported to the Attorney General at least 90 days in advance of the transaction.
  • Eyes on Private Equity: Maryland passed a measure directing the state to study the impact of PE firms on the state’s healthcare market, including looking at the payer mix at PE-owned physician groups and the impact on non-profit health systems to maintain access to care and keep doctors.

Gender-Affirming Care

  • Idaho passed legislation to prohibit gender-affirming care and pursue prison time for physicians who provide it, which was allowed by the U.S. Supreme Court.
  • Similar legislation passed in Ohio has been temporarily blocked by a local judge based on a legal challenge from the ACLU of Ohio.

What We’re Watching

We expect hospitals to continue facing scrutiny from state elected officials, and we know that lawmakers often look to their peers across the country for inspiration for new bills to introduce. We’re keeping an eye on trends in proposed legislation that we expect will be the subject of ongoing committee discussions and may be back next year when lawmakers return to their capitals. Examples include:

  • Even Fewer Surprises: States are building on the federal No Surprises Act to propose more stringent requirements on how hospitals share pricing information with patients and the public.
  • Community Benefits: Similarly, states are increasingly looking at harsher reporting requirements to ensure hospitals are earning their non-profit tax exemptions.

What’s Next

While we often breathe a sigh of relief while session is out, now is the time to ramp up your advocacy efforts. We recommend:

  • Proactively identifying your vulnerabilities
  • Strengthening existing relationships with key stakeholders and working to build new ones
  • Continuing to tell your community impact story

What Else?

What did we miss? What are you watching? Which areas of political/legislative activity do you think will have the biggest impact? Let us know at

This collection of laws was supported by trackers from the National Conference of State Legislatures and the National Academy for State Health Policy.