Consolidation among healthcare providers continues to be a significant contributor to high healthcare prices while also having questionable effects on the quality of and access to health care. States across the country have utilized various legal authorities to address hospital and health system mergers, acquisitions, and other consolidating transactions and the potential harm these transactions can bring. In attempting to balance multiple, and sometimes competing priorities, state officials who are tasked with reviewing and deciding whether to permit a transaction to proceed, have often utilized their authority to conditionally approve transactions. By conditionally approving transactions, transactions are allowed to proceed but with requirements and restrictions on their behavior post-transaction. This key issue page examines conditional approvals imposed under certificate of need programs, attorney general oversight through nonprofit and antitrust laws, and oversight authority granted to other state agencies such as state departments of health.

For more information, read the Frontiers in Public Health paper “Considerations for state-imposed conditions on healthcare provider transactions” for an overview of state healthcare transaction conditional approval authority, a taxonomy of state-imposed conditions, and considerations and recommendations for states in imposing conditions for the effective use of conditions.

State Conditional Approval Authority

Conditional Approval Cases