On May 6, 2025, Indiana Governor Mike Braun signed Indiana HB 1666 into law. This new law grants Indiana's attorney general authority to investigate market concentration of health care entities, modifies existing requirements for notifying the state about certain health care transactions, and introduces additional reporting obligations regarding ownership interests for hospitals, certain other health care entities, insurers, third party administrators (TPAs) and pharmacy benefit managers (PBMs) operating in Indiana.
History of HB 1666
Originally, HB 1666 sought to grant the attorney general power to approve or deny certain transactions involving private equity partnerships, regardless of the total assets of the parties. However, as signed into law, HB 1666 does not mandate attorney general approval for health care transactions. For further details on the original version of HB 1666, refer to our previous alert published January 31, 2025.
Carve-Out to Current Health Care Transactions Notice Law in Indiana for Practitioners
HB 1666 modifies Indiana's existing health care transaction notice requirements. Indiana health care entities involved in mergers or acquisitions with another health care entity must notify the state if the total assets involved are $10 million or more.
Under the existing notice requirements, the term "health care entity" includes the following:
- Any organization or business that provides diagnostic, medical, surgical, dental treatment, or rehabilitative care.
- Certain insurers.
- Health maintenance organizations (HMOs).
- PBMs.
- Administrators (as defined in Ind. Code § 27-1-25-1).
- A private equity partnership, regardless of where the private equity partnership is located, seeking to enter into a merger or acquisition with an entity described in (1) through (5).
Effective July 1, 2025, HB 1666 changes the law to carve out practices owned by physicians who actively practice in that entity by excluding from the definition of "health care entity" any health care providers that are majority owned (or will be majority owned after the merger or acquisition) by licensed Indiana practitioners who routinely provide care in their owned practices.
Attorney General's Power to Investigate Market Concentration
Effective July 1, 2025, the attorney general will have the authority to investigate market concentration within health care entities. As part of this investigation, the attorney general may issue civil investigative demands to a health care entity. Any nonpublic information obtained during an investigation will remain confidential.
Required Reporting of Ownership Stakes for Certain Entities
The law establishes additional reporting requirements for ownership stakes in hospitals, certain other health care entities, insurers, TPAs, and PBMs doing business in Indiana:
- Hospitals: Effective July 1, 2025, as part of its annual fiscal reporting to the state department, an Indiana hospital must now include in its report the name, certain other identifying information (e.g., business website, address, NPI, TIN etc.), and ownership stake of any person or entity with the following ownership interest in the hospital: (1) a 5% or more ownership interest, or, if the person is a practitioner of the hospital, any ownership interest; (2) a controlling interest; or (3) an interest as a "private equity partner." The term "private equity partner" is not defined. Failure to report ownership information can result in $1,000 per diem fines.
- Insurers, TPAs, and PBMs: Effective July 1, 2025 and annually thereafter, these entities are required to report to the Department of Insurance the same type of identifying information regarding any person or entity with (1) an ownership interest of at least 5%; (2) a controlling interest; or (3) an interest as a private equity partner (not defined), in addition to the obligation to report other identifying information. Failure to report ownership information can result in $1,000 per diem fines and/or disciplinary action.
- Certain Other Health Care Entities: Effective January 1, 2026, with certain exceptions, most other health care entities (e.g., laboratories, imaging centers) must report every two years to the Secretary of State the name, certain other identifying information, and ownership stake of each person or entity with: (1) 5% or more ownership interest, or, if the person is a practitioner of the health care entity, any ownership interest; (2), a controlling interest; or (3) interest as a "private equity partner" (not defined) in the entity. Reports must also indicate whether the health care entity is a Medicaid provider and, if so, whether the entity accepted Medicaid recipients during a majority of the preceding two calendar years. A "health care entity" means any organization or business providing health care services (i.e., any diagnostic, medical, surgical, dental treatment or rehabilitative treatment for the purposes of preventing, alleviating, curing or healing human illness or injury), but specifically excludes entities that already have reporting obligations as outlined above (i.e., hospitals, insurers, TPA, PBMs) and any person or entity that does not accept commercial payor reimbursement. HB 1666 does not add fines for failure to report for these categories of health care entities.
This new law is part of an ongoing national trend toward increased state oversight of health care transactions and investments.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
