Mergers, acquisitions and other consolidation deals are reshaping who owns and controls health care providers in Colorado, and lawmakers want closer scrutiny of those transactions. SB 26-041, introduced this session, would require advance notice to the attorney general and give state regulators time to assess a deal’s potential impact.
The measure reflects growing concern over access, cost and quality of care. Supporters say the bill is about information, not interference; others warn the added layer could impede health care operations and chill investment.
A ‘Radar System’ for Health Care
The bill is part of a nationwide effort by states “to study and scrutinize health care consolidation,” said health care attorney John Saran, a partner with Holland & Knight. “State legislators have been asking, ‘What are the effects of health care consolidation on our state?’”
Besides Colorado, the following states have proposed related legislation this year:
- Transaction reporting (similar to Colorado): Indiana, Washington, Rhode Island, Maine, Vermont, Pennsylvania, Hawaii, Illinois, Maryland, Connecticut
- Corporate practice of medicine restrictions: New Mexico, Maine, Vermont, Washington
- Legislative study of health care consolidation: Virginia
- Prohibition on dental insurer ownership of practices: Arizona
Federal oversight under the Hart-Scott-Rodino Act captures only the largest transactions. SB 26-041 aims to fill in the gaps: “States have started to build out their radar systems through statutes,” Saran said.
In 2025, 30 bills related to health care transaction were introduced in 20 states, with seven states enacting laws. Colorado paused its 2025 proposed bill on health care consolidations and instead passed a general mini-HSR, the Uniform Antitrust Pre-Merger Notification Act, with the promise to revisit the original bill after conversations with stakeholders, including hospital associations and physician groups. SB 26-041 is that result.
“You see bipartisan interest now,” Saran said.
Most state bills governing health care transactions and passed last year or earlier require advance notice or disclosure, with Oregon requiring regulator consent. “You give the regulator a chance to review, ask questions, request additional information,” Saran said. “It all goes towards understanding access to care, cost and quality.”
Broad Scope Across Provider Types
Colorado’s proposal is broad, capturing hospitals, ambulatory surgery centers, provider practices with seven or more clinicians, imaging and behavioral health facilities and pharmacy benefit managers. “Some states only focus on hospitals or specific medical practices, but Colorado wants to see the full picture,” Saran said.
The bill excludes transactions under $10 million and facilities with fewer than $5 million in net patient revenue.
Concerns About Access and Oversight
While SB 26-041’s sponsors emphasize transparency, the Colorado Hospital Association argues the proposal could disrupt patient access and hospital operations.
According to CHA, many transactions and partnerships, including contracting affiliations and management arrangements, are designed not to consolidate market power but to maintain services, stabilize staffing and coordinate care across a provider network. CHA warns that requiring review of such activities could delay or derail time-sensitive decisions essential for patient access, particularly in emergency care, obstetrics and behavioral health.
The association also disapproves of the bill’s standards, suggesting concepts such as “consumer harm” and “public interest” could introduce unpredictable legal interpretations that undermine planning and innovation. CHA contends these undefined terms could leave hospitals unable to assess compliance risk.
60-Day Notice and Enforcement
SB 26-041 requires parties to notify the Colorado attorney general 60 days before closing on a transaction. The notice is not a consent requirement but provides time for review.
Saran highlighted the practical considerations of giving notice: “Imagine a national transaction that includes Colorado. You would have to hold the entire deal out of caution for a state requirement, which could be burdensome for investors or large platforms.”
The bill’s wide net could create difficulties as well. “Given the broad definitions of transactions and provider types, the AG’s office could be inundated with filings,” he said. “The $10 million exclusion helps, but the 60-day notice could delay smaller transactions that don’t trigger federal review, which might dissuade investment.”
The bill allows the attorney general to seek injunctive relief for noncompliance. “That’s actual teeth,” Saran said. “It’s real enforcement, not just advisory.”
Unlike a federal merger review, SB 26-041 does not require evidence of competitive harm. “It’s based on who the provider is and the size of the transaction,” Saran explained. “This puts more transactions on the radar and gives the state time to exercise authorities it already has.”
Looking Ahead
SB 26-041 positions Colorado as one of several state leaders in health care consolidation oversight, as Colorado shows its willingness to move forward without federal action. “It’s a balance,” Saran said. “If done well, this can give the state meaningful insight while maintaining a functional market.”
To track SB 26-041, visit State Bill.