*ES0119.1*
April 1, 2025
ENGROSSED
SENATE BILL No. 119
_____
DIGEST OF SB 119 (Updated April 1, 2025 10:38 am - DI 147)
Citations Affected: IC 4-6; IC 16-21.
Synopsis: Certificate of public advantage. Prohibits the submission of
an application for a certificate of public advantage (application) after
May 13, 2025. Changes the time frame in which the Indiana
department of health has to review and make a determination on an
application filed during a specified time frame.
Effective: Upon passage.
Charbonneau, Johnson T,
Randolph Lonnie M
(HOUSE SPONSORS — BARRETT, HEATON, BAIRD, PFAFF)
January 8, 2025, read first time and referred to Committee on Health and Provider
Services.
February 13, 2025, reported favorably — Do Pass.
February 19, 2025, read second time, amended, ordered engrossed.
February 20, 2025, engrossed. Read third time, passed. Yeas 49, nays 0.
HOUSE ACTION
March 3, 2025, read first time and referred to Committee on Public Health.
April 1, 2025, amended, reported — Do Pass.
ES 119—LS 6493/DI 104 April 1, 2025
First Regular Session of the 124th General Assembly (2025)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2024 Regular Session of the General Assembly.
ENGROSSED
SENATE BILL No. 119
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 4-6-3-3, AS AMENDED BY P.L.198-2021,
2 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 UPON PASSAGE]: Sec. 3. (a) If the attorney general has reasonable
4 cause to believe that a person may be in possession, custody, or control
5 of documentary material, or may have knowledge of a fact that is
6 relevant to an investigation conducted to determine if a person is or has
7 been engaged in a violation of IC 4-6-9, IC 4-6-10, IC 13-14-10,
8 IC 13-14-12, IC 13-24-2, IC 13-30-4, IC 13-30-5, IC 13-30-8,
9 IC 16-21-15, IC 23-7-8, IC 24-1-2, IC 24-5-0.5, IC 24-5-7, IC 24-5-8,
10 IC 24-9, IC 25-1-7, IC 27-1-37-8, IC 32-34-1.5, or any other statute
11 enforced by the attorney general or is or has been engaged in a criminal
12 violation of IC 13, only the attorney general may issue in writing, and
13 cause to be served upon the person or the person's representative or
14 agent, an investigative demand that requires that the person served do
15 any combination of the following:
16 (1) Produce the documentary material for inspection and copying
17 or reproduction.
ES 119—LS 6493/DI 104 2
1 (2) Answer under oath and in writing written interrogatories.
2 (3) Appear and testify under oath before the attorney general or
3 the attorney general's duly authorized representative.
4 (b) The office of the attorney general may consult with the
5 Indiana department of health in the review of an application for a
6 certificate of public advantage under IC 16-21-15.
7 SECTION 2. IC 16-21-15-3, AS AMENDED BY P.L.62-2022,
8 SECTION 4, AND P.L.143-2022, SECTION 43, IS AMENDED TO
9 READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 3. (a)
10 Any hospital entering into a merger agreement with another hospital
11 may submit an application to the state department for a certificate of
12 public advantage to govern the merger agreement in the manner
13 prescribed by the state department. However, a hospital may not submit
14 an application under this chapter after July 1, 2026. May 13, 2025.
15 (b) The application for a certificate of public advantage must
16 include the following:
17 (1) A written copy of the merger agreement.
18 (2) A written description of the nature and scope of the merger.
19 (c) Any documentation submitted under this section with the
20 application that is deemed to be proprietary information shall be clearly
21 identified as proprietary information and a copy of the application with
22 the proprietary information redacted for public records must be
23 submitted by the applicant.
24 (d) An applicant must also file a complete copy of the application
25 for a certificate of public advantage with:
26 (1) the office of the secretary of family and social services in a
27 manner prescribed by the office of the secretary; and
28 (2) the office of the attorney general in a manner prescribed by the
29 office of the attorney general.
30 (e) The state department shall assess a filing fee for an application
31 for a certificate of public advantage that is reasonably sufficient to fully
32 fund the costs of the review of the application and ongoing supervision
33 if the application is granted, including any fees for consultants and
34 experts. The state department may not spend any money on the
35 implementation of this chapter until the state department has received
36 a filed application and received the filing fee.
37 (f) If the state department incurs costs of the review of the
38 application and administration of the program that exceed the
39 application fee collected, the applicant for a certificate of public
40 advantage shall pay the reasonable charges incurred by the state
41 department, as determined by the state department.
42 (g) The reasonable costs of services concerning the program:
ES 119—LS 6493/DI 104 3
1 (1) include the cost of fees for consultants and experts; and
2 (2) must be commensurate with the usual compensation for like
3 services.
4 SECTION 3. IC 16-21-15-4, AS AMENDED BY P.L.11-2023,
5 SECTION 58, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
6 UPON PASSAGE]: Sec. 4. (a) The state department, in consultation
7 with the office of the secretary of family and social services, shall
8 review an application for a certificate of public advantage and the
9 documentation filed under section 3 of this chapter to determine
10 whether there is clear evidence that the proposed merger agreement:
11 (1) would benefit the population's health outcomes, health care
12 access, and quality of health care; and
13 (2) meets the standards described in this section.
14 (b) The state department shall consider in the review of the
15 application and documentation the effect of the merger agreement on
16 the following:
17 (1) The quality and price of hospital and health care services
18 provided to Indiana residents, including the demonstration of
19 population health improvement of the region serviced and the
20 extent to which medically underserved populations have access
21 to and are projected to use the proposed services.
22 (2) The preservation of sufficient health care services within the
23 geographic area to ensure public access to acute care.
24 (3) The cost efficiency of services, resources, and equipment
25 provided or used by the hospitals that are a party to the merger
26 agreement, including avoidance of duplication of services to
27 better meet the needs of the community.
28 (4) The ability of health care payors to negotiate payments and
29 service agreements with hospitals proposed to be merged under
30 the merger agreement.
31 (5) Employment.
32 (6) Economic impact.
33 (c) The state department shall grant the certification if the state
34 department determines in the review of the application and
35 documentation that, under the totality of the circumstances, the
36 following apply:
37 (1) There is clear evidence that the proposed merger would
38 benefit the population's health outcomes, health care access, and
39 quality of care in the county.
40 (2) The likely benefits resulting from the proposed merger
41 agreement outweigh any disadvantages attributable to a potential
42 reduction in competition that may result from the proposed
ES 119—LS 6493/DI 104 4
1 merger.
2 The holder of a certificate of public advantage issued by the state
3 department under this chapter receives immunity from claims made
4 pursuant to federal or state antitrust laws for the duration of the
5 certificate.
6 (d) The state department has must review and make a
7 determination on an application filed under this chapter not later
8 than:
9 (1) one hundred twenty (120) days from the filing of the
10 application; or
11 (2) November 9, 2025, for an application filed under this
12 chapter between January 1, 2025, through May 13, 2025.
13 to review and make a determination on the application.
14 (e) The state department's determination on whether to grant the
15 application must:
16 (1) be in writing;
17 (2) specify the basis for the determination; and
18 (3) be provided to the applicant on the date of the determination.
19 (e) (f) The state department may include terms or conditions of
20 compliance with the issuance of a certificate of public advantage under
21 this chapter.
22 (f) (g) The state department shall maintain records of all of the
23 applications filed under this chapter, including records of any terms or
24 conditions of issuing a certificate of public advantage that are imposed
25 by the state department.
26 (g) (h) The office of the attorney general may, at any time after an
27 application is filed under this chapter and before the state department
28 makes a determination on the application, require by civil investigative
29 demand the attendance of witnesses and the production of documents
30 for purposes of investigating whether the merger agreement satisfies
31 the requirements of this chapter. Any documents produced or testimony
32 given under this subsection are subject to confidentiality if the
33 information is deemed proprietary information. The attorney general
34 may seek compliance with the issuance of a civil investigative demand
35 with the appropriate district court of the county in which the merger is
36 to occur.
37 SECTION 4. An emergency is declared for this act.
ES 119—LS 6493/DI 104 5
COMMITTEE REPORT
Mr. President: The Senate Committee on Health and Provider
Services, to which was referred Senate Bill No. 119, has had the same
under consideration and begs leave to report the same back to the
Senate with the recommendation that said bill DO PASS.
(Reference is to SB 119 as introduced.)
CHARBONNEAU, Chairperson
Committee Vote: Yeas 7, Nays 4
_____
SENATE MOTION
Mr. President: I move that Senate Bill 119 be amended to read as
follows:
Replace the effective date in SECTION 1 with "[EFFECTIVE
UPON PASSAGE]".
Page 1, line 3, after "3." insert "(a)".
Page 1, line 9, reset in roman "IC 16-21-15,".
Page 2, delete lines 4 through 13, begin a new paragraph and insert:
"(b) The office of the attorney general may consult with the
Indiana department of health in the review of an application for a
certificate of public advantage under IC 16-21-15.
SECTION 2. IC 16-21-15-3, AS AMENDED BY P.L.62-2022,
SECTION 4, AND P.L.143-2022, SECTION 43, IS AMENDED TO
READ AS FOLLOWS [EFFECTIVE UPON PASSAGE]: Sec. 3. (a)
Any hospital entering into a merger agreement with another hospital
may submit an application to the state department for a certificate of
public advantage to govern the merger agreement in the manner
prescribed by the state department. However, a hospital may not submit
an application under this chapter after July 1, 2026. February 15,
2025.
(b) The application for a certificate of public advantage must
include the following:
(1) A written copy of the merger agreement.
(2) A written description of the nature and scope of the merger.
(c) Any documentation submitted under this section with the
application that is deemed to be proprietary information shall be clearly
identified as proprietary information and a copy of the application with
the proprietary information redacted for public records must be
ES 119—LS 6493/DI 104 6
submitted by the applicant.
(d) An applicant must also file a complete copy of the application
for a certificate of public advantage with:
(1) the office of the secretary of family and social services in a
manner prescribed by the office of the secretary; and
(2) the office of the attorney general in a manner prescribed by the
office of the attorney general.
(e) The state department shall assess a filing fee for an application
for a certificate of public advantage that is reasonably sufficient to fully
fund the costs of the review of the application and ongoing supervision
if the application is granted, including any fees for consultants and
experts. The state department may not spend any money on the
implementation of this chapter until the state department has received
a filed application and received the filing fee.
(f) If the state department incurs costs of the review of the
application and administration of the program that exceed the
application fee collected, the applicant for a certificate of public
advantage shall pay the reasonable charges incurred by the state
department, as determined by the state department.
(g) The reasonable costs of services concerning the program:
(1) include the cost of fees for consultants and experts; and
(2) must be commensurate with the usual compensation for like
services.
SECTION 3. IC 16-21-15-4, AS AMENDED BY P.L.11-2023,
SECTION 58, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
UPON PASSAGE]: Sec. 4. (a) The state department, in consultation
with the office of the secretary of family and social services, shall
review an application for a certificate of public advantage and the
documentation filed under section 3 of this chapter to determine
whether there is clear evidence that the proposed merger agreement:
(1) would benefit the population's health outcomes, health care
access, and quality of health care; and
(2) meets the standards described in this section.
(b) The state department shall consider in the review of the
application and documentation the effect of the merger agreement on
the following:
(1) The quality and price of hospital and health care services
provided to Indiana residents, including the demonstration of
population health improvement of the region serviced and the
extent to which medically underserved populations have access
to and are projected to use the proposed services.
(2) The preservation of sufficient health care services within the
ES 119—LS 6493/DI 104 7
geographic area to ensure public access to acute care.
(3) The cost efficiency of services, resources, and equipment
provided or used by the hospitals that are a party to the merger
agreement, including avoidance of duplication of services to
better meet the needs of the community.
(4) The ability of health care payors to negotiate payments and
service agreements with hospitals proposed to be merged under
the merger agreement.
(5) Employment.
(6) Economic impact.
(c) The state department shall grant the certification if the state
department determines in the review of the application and
documentation that, under the totality of the circumstances, the
following apply:
(1) There is clear evidence that the proposed merger would
benefit the population's health outcomes, health care access, and
quality of care in the county.
(2) The likely benefits resulting from the proposed merger
agreement outweigh any disadvantages attributable to a potential
reduction in competition that may result from the proposed
merger.
The holder of a certificate of public advantage issued by the state
department under this chapter receives immunity from claims made
pursuant to federal or state antitrust laws for the duration of the
certificate.
(d) The state department has must review and make a
determination on an application filed under this chapter not later
than:
(1) one hundred twenty (120) days from the filing of the
application; or
(2) for an application filed under this chapter between
January 1, 2025, through February 15, 2025, August 13, 2025.
to review and make a determination on the application.
(e) The state department's determination on whether to grant the
application must:
(1) be in writing;
(2) specify the basis for the determination; and
(3) be provided to the applicant on the date of the determination.
(e) (f) The state department may include terms or conditions of
compliance with the issuance of a certificate of public advantage under
this chapter.
(f) (g) The state department shall maintain records of all of the
ES 119—LS 6493/DI 104 8
applications filed under this chapter, including records of any terms or
conditions of issuing a certificate of public advantage that are imposed
by the state department.
(g) (h) The office of the attorney general may, at any time after an
application is filed under this chapter and before the state department
makes a determination on the application, require by civil investigative
demand the attendance of witnesses and the production of documents
for purposes of investigating whether the merger agreement satisfies
the requirements of this chapter. Any documents produced or testimony
given under this subsection are subject to confidentiality if the
information is deemed proprietary information. The attorney general
may seek compliance with the issuance of a civil investigative demand
with the appropriate district court of the county in which the merger is
to occur.
SECTION 4. An emergency is declared for this act.".
Renumber all SECTIONS consecutively.
(Reference is to SB 119 as printed February 14, 2025.)
CHARBONNEAU
_____
COMMITTEE REPORT
Mr. Speaker: Your Committee on Public Health, to which was
referred Senate Bill 119, has had the same under consideration and
begs leave to report the same back to the House with the
recommendation that said bill be amended as follows:
Page 2, line 14, delete "February 15," and insert "May 13,".
Page 4, line 12, after "(2)" insert "November 9, 2025,".
Page 4, line 13, delete "February 15, 2025, August 13, 2025." and
insert "May 13, 2025.".
and when so amended that said bill do pass.
(Reference is to SB 119 as reprinted February 20, 2025.)
BARRETT
Committee Vote: yeas 10, nays 1.
ES 119—LS 6493/DI 104