States are taking healthcare consolidation into their own hands.
From banning private equity interference in clinical decisions to expanding attorney general review of mergers and pausing hospital acquisitions, lawmakers across the country are reshaping how deals get done, and who ultimately controls care delivery.
For ASCs, physicians and health systems, the implications are significant: these policies will influence ownership models, referral patterns, competition and expansion opportunities for years to come.
Here’s how five states are approaching healthcare consolidation:
- California bars private equity interference in clinical decision-making: California enacted a law prohibiting private equity firms, hedge funds and their affiliates from interfering, contractually or otherwise, with healthcare professionals’ clinical judgment, including decisions involving diagnostic tests, treatment options, patient volume and referrals.
The law also blocks these entities from controlling medical records, provider hiring and firing, payer contract terms, billing and coding, and equipment selection. It restricts certain noncompete and nondisparagement clauses in management agreements. Notably, the final version does not include a previously proposed mandatory state pre-approval requirement for PE-backed healthcare transactions.
- Oregon tightens restrictions on corporate control of medical practices: Oregon enacted one of the nation’s strictest corporate practice of medicine laws in June 2025, requiring physicians to hold at least a 51% ownership stake in most practices and limiting corporate and management service organization decision-making authority.
The law also bans physician noncompete agreements and gives practices three years to comply, reflecting growing state scrutiny as independent practice ownership by hospitals and corporate entities continues to rise.
- Colorado proposes sweeping expansion of healthcare deal oversight: A bill introduced in the Colorado legislature would create a new standalone notification and review authority for healthcare transactions, including deals that do not trigger federal antitrust review.
The proposal would authorize the attorney general to delay or prohibit transactions that may reduce competition or harm consumer welfare and would apply broadly to hospitals, ASCs, behavioral health providers, urgent care centers and PBMs. It defines “material change transactions” to include ownership or control changes, consolidation and certain joint payer negotiations and would require at least 60 days’ notice before closing.
- Pennsylvania moves to expand oversight of healthcare consolidation: The Pennsylvania House passed legislation that would give the state attorney general greater authority to review and potentially block healthcare mergers and acquisitions.
The bill would also prohibit private equity-backed healthcare sale-leaseback arrangements and require organizations to disclose financial and operational details before finalizing major deals. The legislation was introduced following Prospect Medical Holdings’ decision to close Upland, Pa.-based Crozer Health, which lawmakers said left Delaware County with reduced access to local care.
- North Carolina’s CON laws continue to influence consolidation and ASC expansion: Certificate-of-need laws remain a major flashpoint in North Carolina’s competitive healthcare market, with repeal plans paused following recent court action.
In December 2025, a trial court upheld the constitutionality of the state’s CON laws, rejecting arguments that they create monopolies for incumbent providers. The state’s supreme court also declined to hear Asheville, N.C.-based Mission Health’s challenge to Altamonte Springs, Fla.-based AdventHealth’s planned hospital project. North Carolina has also implemented interim exemptions allowing ASCs in counties with populations over 125,000 to expand without CON approval.
