In a disclosure that hinted that further transactions, state health care officials received notifications Tuesday in connection with the proposed sale of Stewardship Health Inc. and the contracting Steward Health Care Network to OptumCare, a subsidiary of UnitedHealth Group.

Stewardship Health Inc. is the parent of Stewardship Health Medical Group Inc., which employs primary care physicians and other clinicians across nine states, according to the Health Policy Commission.

"This is a significant proposed change involving two large medical providers, both in Massachusetts and nationally, with important implications for the delivery and cost of health care across Massachusetts," HPC Director David Seltz said. "Details of the proposal will be reviewed by the HPC to examine potential impacts on health care costs, quality, access, and equity. The sale cannot be completed until after the HPC’s review and any concurrent review by state or federal antitrust authorities."

Once all required information has been provided about the sale, the HPC will have 30 days to assess potential impacts of the transaction, according to the agency. If the sale is anticipated to have a significant impact on health care costs and market functioning, the HPC can initiate a full Cost and Market Impact Review, an option that it has often not pursued in the past.

Steward's financial problems have received widespread attention in recent weeks and the outlook for its Massachusetts assets remains cloudy. The HPC said that transactions involving the sale of Steward’s eight Massachusetts hospitals would also require review by the agency, and review by the Determination of Need program at the Department of Public Health.

In its new notice of material change, Steward Operations Holdings LLC, in response to a question about other material changes anticipated in the next 12 months, wrote: "Steward anticipates providing Notices of Material Change regarding transactions concerning certain of its acute care hospitals and other provider operations in the next 12 months."