Connecticut Governor Ned Lamont recently signed Public Act No. 26-68 (“the Act”), which includes the elimination of the Office of Health Strategy (OHS) and reassignment of its statutory authority over the health care delivery system in Connecticut. The Act’s repeal of OHS’s enabling statute and the transfer of its authority to other state agencies are scheduled to take effect on July 1, 2026.

The Act allocates functions related to the oversight of health care in Connecticut previously assigned to OHS among several state agencies and offices, including the Department of Public Health (DPH), the Office of Policy and Management (OPM), the Department of Social Services (DSS) and the Office of the Healthcare Advocate (OHA). The impact of the dissolution of OHS and corresponding reshuffling of authority is summarized below.

Certificates of Need

Previously, OHS oversaw the Connecticut Certificate of Need (CON) program; however, under the Act the CON program will move to DPH. We have previously written about the Act’s changes to the CON program. Please see here for our analysis of the Act’s changes to the CON process, and here for our analysis of the new process for hospitals seeking to pause or terminate service lines.

For now, it is important for CON applicants and parties to understand that from July 1, 2026, until July 1, 2027, DPH will oversee the CON program in its current state until the newly established CON processes go into effect July 1, 2027.

Functions Moving to DPH

Aside from authority over the CON process, several notable functions previously vested in OHS shift to DPH:

  • Health Systems Planning Unit – The Act re-establishes the Health Systems Planning Unit within DPH, under the direction of the Commissioner of Public Health, rather than within OHS.
  • Nonprofit hospital transactions and related health care market reporting – The Act moves several hospital and group practice transactions and other reporting functions from OHS to DPH. For nonprofit hospital sales, all authority previously conferred to the Commissioner of Health Strategy is now granted to the Commissioner of Public Health. Hospital, hospital system, and group practice reporting also shifts to DPH, including written notices after certain transactions and health care entity annual reporting.
  • Health care facility oversight and reporting – DPH will now oversee all facility fee requirements, including hospital, health system, and hospital-based facility reporting requirements, and will hold enforcement authority arising from such reporting requirements.
  • Patient billing and financial assistance provisions – Hospitals must now report charity care and reduced-cost service policies to the Health Systems Planning Unit of DPH, and hospitals must provide detailed patient bills upon request of DPH or a patient.
  • Health data functions – Short-term acute care general and children’s hospitals will need to submit patient-identifiable inpatient discharge data and emergency department data to DPH, and outpatient surgical facilities and certain hospital outpatient surgery departments must submit such data to DPH.
  • Community Health Worker Advisory Body – DPH now has jurisdiction over the Community Health Worker Advisory Body.

Functions Moving to OPM

The Act transfers key health care data reporting authorities to OPM, including:

  • Core health information technology responsibilities – OPM will now oversee implementation and revision of the statewide health information technology plan, adoption of electronic data standards, oversight of the Statewide Health Information Exchange (discussed further below), and associated legislative committee reporting.
  • Statewide Health Information Exchange – The Act gives OPM administrative authority over the Statewide Health Information Exchange, known as Connie. The Secretary of OPM is responsible for designating and posting the systems, technologies, entities, and programs that constitute the exchange. OPM also receives authority to adopt regulations and implement interim policies and procedures for Connie, including public hearing and notice requirements.
  • State Health Information Technology Advisory Council – This council, tasked with policy recommendations for health information technology and exchange efforts, is reoriented to advise the Secretary of OPM and the health information technology officer.
  • All-payer claims database – OPM becomes the successor agency for the all-payer claims database program, now overseeing the planning, implementation, and administration of the all-payer claims database program, securing data collection and storage, auditing reporting entity data, and maintaining written administrative procedures in consultation with the Health Information Technology Advisory Council.
  • Consumer health information website – The Secretary of OPM receives responsibility for posting consumer-facing health cost and quality information, making specified lists of frequent services and procedures publicly available, and issuing reports on billed and allowed amounts and out-of-pocket costs.
  • Health care cost growth and quality benchmark authority – The Act redesignates the agency responsible for establishing the health care cost growth and health care quality benchmarks every five years to OPM. The Act also confers authority in OPM for monitoring and identifying entities exceeding benchmarks or failing targets and informing the public as such.

Functions Moving to DSS

The authorities reallocated to DSS include:

  • Hospital financial health reporting – Hospitals must submit semiannual financial health reports to the Commissioner of Social Services, rather than the Commissioner of Health Strategy. DSS may require additional information if a hospital reports two consecutive quarters of 60 days or less of cash on hand, and DSS must contact a hospital to offer assistance if a report reflects two consecutive quarters of 45 days or less of cash on hand.
  • Covered Connecticut and waiver-related provisions – The Commissioner of Social Services remains responsible for seeking Section 1115 waivers, but the Act removes the requirement for prior consultation with the Insurance Commissioner and OHS from that provision. The Act also permits DSS, rather than OHS, to seek Section 1332 waivers from the federal government.

Community Benefit Program Reporting Moves to OHA

The Act reassigns hospital community benefit program reporting, which includes hospitals’ community health needs assessments, implementation strategies, and annual reports, from OHS to OHA. Hospitals must submit community benefit reporting to OHA or to a designee selected by the Healthcare Advocate.

The annual summary and analysis of community benefit program reporting is assigned to the Healthcare Advocate, who must post the summary and analysis on the OHA website and solicit stakeholder input through a public comment period. OHA uses that reporting and stakeholder input to identify additional stakeholders, determine how those stakeholders could assist in addressing community health needs, determine whether to make recommendations to DPH in developing the state health plan, and inform the statewide health care facilities and services plan.

Key Takeaways

Broadly, the above-discussed sections of the Act eliminate OHS as a statutory office and distribute its principal functions among multiple agencies. DPH becomes the key successor for the Health Systems Planning Unit, CON authority, nonprofit hospital transaction authority, and multiple health facility oversight functions. OPM becomes the key successor for statewide health information technology, the Statewide Health Information Exchange, the all-payer claims database, consumer health information tools, and benchmark programs. DSS becomes the successor for hospital financial health reporting and receives Covered Connecticut waiver authority. OHA becomes the successor for community benefit program reporting.

Despite administrative authority being distributed across multiple state agencies, the substantive reporting and administrative requirements for health care entities remain largely unchanged. Health care entities should be aware of the different agencies to which they must make reports and disclosures. We will continue to monitor implementation of these administrative changes.

Connecticut Governor Ned Lamont recently signed into law An Act Concerning Credit Cards and Health and Veterinary Care Services (PA 26-6; the Act). The Act restricts how health care providers may offer third-party financing products to patients and limits when health care providers can charge patients’ credit cards.  The Act is effective January 1, 2027.

The Act broadly applies to all Connecticut-licensed health care providers and facilities (including their employees, agents, and independent contractors) that provide health care services to patients in Connecticut. The term “health care services” is similarly broadly defined and includes hospital, medical, surgical, dental, vision, and pharmaceutical products and services.

The Act covers loans, lines of credit, and credit cards offered by third parties (“third-party financing”). Notably, third-party financing does not include lines of credit or loans offered by a health care provider where the health care provider is the creditor.

Under the Act, health care providers may not advertise, market, solicit, promote, or offer third-party financing to a patient by:

  1. Including the provider’s branding on any materials used to advertise, market, solicit, promote, offer, or extend the third-party financing;
  2. Giving patients access to software, internet addresses, hyperlinks, or QR codes maintained by a third party that offers third-party financing and includes provider branding;
  3. Offering third-party financing while the patient is under anesthesia or other sedation;
  4. Offering third-party financing while the health care provider is providing health care services to the patient or in any area of a facility that is used to provide health care services, except in limited circumstances; or
  5. Completing or submitting a third-party financing application on behalf of a patient.

Once the Act is effective, health care providers are also prohibited from receiving financial incentives in exchange for advertising, marketing, soliciting, promoting, or offering any third-party financing.

The Act includes a notable provision that prohibits a health care provider from charging a third-party financing account “for the cost of a health care service or … any portion of the cost of such service, before the date on which such service is provided to the patient,” unless the provider has already incurred costs related to the service prior to the date of service. This section appears to limit the ability of providers to charge patient credit cards in advance of a date of service, a relatively common practice in regard to self-pay patients or those receiving cosmetic or elective procedures.

The Act also prohibits health care providers charging a third-party financing account for products ancillary to a health care service, unless the patient receives a separate receipt identifying the ancillary product and separately consents in writing to the product. If a patient does purchase an ancillary product with third-party financing, health care providers must offer a 30-day return and refund option, except in limited circumstances, such as damage to the product or customization.

To the extent a health care provider decides to discuss third-party financing with patients outside of the restrictions set forth above, the provider must provide patients with a detailed disclosure as specifically set forth in Section 1(c)(1) of the Act (PA 26-6). Among other things, the disclosure explains third-party financing, that it is optional and encourages patients to carefully review the terms of the third-party financing.

Any violations of the Act will be an unfair and deceptive trade practice under Connecticut law.

Health care provider relationships with third-party financing vendors may need adjustments in order to comply with the Act, specifically related to how providers are promoting those third-party financing products, along with a review of policies and procedures related to credit card processing. Health care providers would be well served to review financing-related signage, update financing disclosure and consent documents, examine patient-facing materials, scripts, and vendor arrangements before January 1, 2027, and provide appropriate training to staff. We expect practices in violation of the Act will face increased scrutiny from Connecticut regulators given the legislature’s opposition to co-branded health care financing products.

On May 27, 2026, Connecticut Governor Ned Lamont signed “An Act Concerning Return of Health Care Provider Payments” (PA 26-56). As of January 1, 2027, PA 26-56 shortens the time period during which commercial health insurers can look to cancel, deny, or recoup certain payments to providers, and creates statutory timeframes in which health insurers must respond to provider appeals of such cancelations, denials, or recoupments.

As industry trends, federal policy changes, and financial pressures increase the frequency of disputes between health care providers and commercial health insurers (payors), PA 26-56 seeks to address areas of contention between providers and payors involving the timing and process of recoupment demands and appeals. The changes are as follows:

  • Currently, a managed care organization or preferred provider network is prohibited from canceling, denying, or demanding the return of payment for authorized covered services, due to an administrative or eligibility error, more than 18 months after receiving the clean claim, and Connecticut laws are silent as to the applicable timeline for such cancellations, denials or demands when made by other payor types issuing individual or group health insurance policies. The Act shortens that timeframe to 12 months for managed care organizations and preferred provider networks and also creates an analogous prohibition on any insurer, health care center, fraternal benefit society, hospital service corporation, medical service corporation, or other entity delivering, issuing for delivery, renewing, amending or continuing, an individual or group health insurance policy from canceling, denying, or demanding the return of payment for an authorized covered services due to an administrative or eligibility error, more than 12 months after receiving the clean claim.
  • In the event a provider appeals such a demand from a payor, current law does not specify a modality for the appeal. Under PA 26-56, a payor must establish and offer an electronic appeals process, but can also offer additional methods. This Act requires payors to respond to an appeal and issue a determination within 30 business days of receipt, and establishes that the failure to meet this deadline results in the appeal being construed in the provider’s favor.
  • PA 26-56 clarifies that the existing 30-day advanced notice of payment cancellation requirement must be sent by either certified mail return receipt requested, email to an address specifically designated by the provider, or through a secure electronic provider portal or clearing house used for claims communication.

While the changes are limited, they address an area of common contention in the negotiation of commercial health insurance reimbursement agreements and will offer both providers and payors a degree of increased certainty in the timeframes around recoupments and appeals.

On May 27, 2026, Connecticut Governor Ned Lamont signed into law Public Act 26-22, “An Act Concerning Hospital Sale-Leaseback Agreements and Attestations Concerning Lack of Private Equity Control of the Hospital and Control of or Interference with the Professional Judgment and Clinical Decisions of Certain Health Care Providers” (PA 26-22). PA 26-22 prohibits Connecticut hospitals from entering into “sale-leaseback transactions” and requires them to submit annual attestations disclaiming certain private equity interests in or authority over the hospital.

First, PA 26-22 prohibits Connecticut hospitals entering into sale-leaseback transactions, which are defined as any transaction where a “hospital enters into an agreement with a person or another entity to sell and lease back hospital-owned real property that constitutes the main campus of a hospital.” For purposes of this prohibition, PA 26-22 defines a hospital’s main campus as the “licensed premises within which the majority of inpatient beds are located.” Accordingly, PA 26-22 restricts the ability of a hospital to enter into a sale-leaseback arrangement involving its campus but does not apply to off-campus hospital-owned locations. For purposes of PA 26-22, a “private equity entity” is defined as “any entity that collects capital investments from individuals or entities and purchases, as a parent company or through another entity that the entity completely or partially owns or controls, a direct or indirect ownership share of a hospital.”

Second, PA 26-22 establishes a new attestation requirement requiring hospitals to disclaim private equity involvement in their ownership, governance, and operations. Beginning on February 15, 2027, and annually thereafter, each hospital in Connecticut must submit an attestation to the Commissioner of Public Health’s Office that no private equity entity:

  • Has a controlling interest (meaning “direct or indirect power to direct the management and policies of the main campus of a hospital, whether through ownership of voting securities, contract or other means”) in the hospital.
  • Has ultimate governance control and authority over any hospital asset or activity of the main campus of the hospital, including without limitation any clinical, operational, managerial, financial, or human resources matter.
  • Is permitted to control or direct any procedure or policy that would interfere with professional judgment or clinical decisions of authorized clinicians, including time spent with patients, number of patients seen, time spent on triage or admission evaluations, time periods for patient discharge, clinical decision making including related to observation status or palliative care, diagnostic testing, or coding determinations in the medical record.

Failure to comply with the attestation requirement will result in a civil penalty of up to $2,000 per violation. However, PA 26-22 also clarifies that it does not prohibit hospitals or their affiliates from investing in joint ventures or entering into clinical services contracts with physicians, nor is it intended to interfere with a hospital coordinating with its parent health care system.

The Act demonstrates a continued focus by Connecticut on private equity business arrangements involving hospitals in the wake of notable bankruptcy and reorganization matters involving private equity-owned health systems in Connecticut and neighboring states. It remains to be seen how the ownership/control attestation and heightened scrutiny provided for by PA 26-22 will impact private equity investment in health care in Connecticut.

On May 14, 2026, Connecticut Governor Ned Lamont signed Public Act No. 26-13, “An Act Concerning Various Revisions to the Public Health Statutes” (the “Act”) into law. The Act contains numerous revisions to State public health and health care laws, and several provisions deserve close attention from health care organizations, including hospitals and health systems, campus clinics, behavioral health providers, EMS providers, nurse’s aides, dentists, and other licensed professionals. We summarize key changes under the Act below.

New Flexibility for Campus Clinics (§1)

Effective October 1, 2026, an infirmary operated by an educational institution may provide care not only to enrolled students, faculty, and employees, but also to dependent family members of those groups when the family members are enrolled in the institution’s health plan.

This change may be significant for colleges, universities, and other educational institutions that operate infirmaries and sponsor health plans covering dependents. Under prior law, these infirmaries were generally limited to evaluating and treating routine health problems, and in some cases providing short-term overnight accommodations, only for students, faculty, and employees.

Increased Regulatory Focus on Managed Residential Communities (§2)

Effective July 1, 2026, the Act requires the Commissioner of Public Health to establish a working group to advise DPH on managed residential communities where assisted living services agencies provide assisted living services to residents. The working group must also evaluate whether DPH licensure of those managed residential communities would help DPH and the communities improve residents’ health, safety, and overall well-being. The working group must include representatives from managed residential communities, assisted living services agencies, residents receiving assisted living services in managed residential communities, relatives of those residents, and an association of aging services organizations in Connecticut. Organizations that operate managed residential communities or contract with assisted living services agencies should monitor the working group’s recommendations because they may influence future licensure or regulatory oversight of these communities, which are already subject to a number of regulatory regimes in Connecticut depending upon the specific services each community provides.

New Patient Notice Requirements for Medical Records Retention and Access (§4)

As of January 1, 2027, health care providers in Connecticut must notify each patient in writing, at initial intake, about the laws governing how long the provider must maintain patient medical records and how the patient may request copies of those records.

Providers should therefore review intake packets, electronic registration workflows, patient portal messaging, and medical records request policies to confirm that they give patients the required written notice at initial intake. As a reminder, under Connecticut law, providers are generally required to maintain medical records for not less than seven years (for individual providers) and not less than 10 years (for hospitals), but in certain circumstances and for certain types of records shorter or longer retention periods may apply (and longer retention may nonetheless be advisable in light of certain statutes of limitations extending to 10+ years).

Additional Data for Community Health Needs Assessments (§11)

Effective October 1, 2026, when conducting a community health needs assessment, the Act requires hospitals to consider including the nutritional needs of community members with diabetes and congestive heart failure. To the extent federal law permits, hospitals must include those nutritional needs in the hospital’s community health needs assessment.

Before starting the next community health needs assessment, hospitals should evaluate whether existing community health data, population health analytics, community benefit materials, or care management information identify nutrition-related needs among community members with diabetes or congestive heart failure.

Hospitals Get New Opioid Treatment Bridge Tools (§12)

Beginning January 1, 2027, the Act permits hospitals to administer buprenorphine or methadone to a patient who presents to the emergency department with symptoms of opioid use disorder without admitting the patient solely for that purpose. The hospital may do so only when (i) such administration is clinically indicated, and (ii) the patient consents.

At discharge, the Act also permits hospitals to offer the patient a prescription for, or supply of, an opioid antagonist, such as naloxone hydrochloride or another similarly acting and equally safe FDA-approved drug for overdose treatment. If the patient accepts, the hospital may provide the prescription or dispense the opioid antagonist. Hospitals may also refer the patient to one or more community providers or opioid treatment programs that can provide continuity in buprenorphine prescribing or methadone administration. If a hospital administers buprenorphine, the hospital must provide a bridging prescription for buprenorphine for the anticipated period while the patient awaits treatment from the referred community provider, if permitted by federal law (e.g., the Controlled Substances Act). Finally, the Act directs that if a hospital administers or dispenses methadone to a patient as permitted by the Act, the hospital must provide a last-dose letter for the patient to give to the local opioid treatment program to which the hospital refers the patient. A “last-dose letter” is a formal, sealed document confirming the exact date, time, and amount of the last methadone dose administered to the patient.

Student Safety Plans Get a Secure Pathway to Schools (§19)

Beginning April 1, 2027, health care providers that prepare a safety plan for a minor following receipt of inpatient behavior health care treatment for at least 12 consecutive days are required to review the safety plan with the minor patient, if the provider believes review is medically appropriate. The provider must also ask whether the minor patient or minor patient’s parent or legally authorized representative consents to sharing the safety plan with the minor patient’s school, and must obtain written consent before transmitting the safety plan to the school (from the patient’s parent or legal representative, or from the minor patient if the patient is 16 years or older). If the required consent is given, the health care provider must transmit the safety plan to the minor’s school district or school using a secure messaging system or another HIPAA-compliant form and manner.

The Act defines a safety plan as a written document created collaboratively between a health care provider and patient that outlines coping strategies, activities, and support networks the patient can access to prevent or manage a potential mental health crisis.

The Act also connects this safety-plan framework to Connecticut’s statewide health information exchange, known as Connie, by making it a goal of the exchange to provide secure messaging organizational accounts to school districts or schools for receiving minor patient safety plans, and to provide access to those organizational accounts for designated employees at no cost.

Notably, the Act also expressly provides that it does not require health care providers to release information to parents or legal representatives of a minor patient “if, pursuant to state or federal law, a minor patient may withhold such information” from a parent or legal representative.  The Act gives, as examples of such information that may be subject to heightened protections, “information regarding pregnancy, abortion, contraceptives, human immunodeficiency virus or other sexually transmitted disease testing or treatment, mental health treatment or any other area of care that a health care provider has promised a minor patient that the health care provider will keep confidential…”  This last cited criterion is particularly notable because it potentially raises the question of whether the Act could be construed as a state law giving heightened protection to any types of health information related to a minor patient if the provider “promise[s]” to keep it confidential.

Nurse’s Aide Oversight Expands (§23)

The Act makes several changes related to the oversight of the practice of a nurse’s aide that take effect October 1, 2027.

The Act revises the definition of “nurse’s aide” to include a registered nurse’s aide who provides nursing or nursing-related services through employment or contract with an “institution.” This change expands DPH’s nurse’s aide registry to cover nurse’s aides working with any DPH-licensed health care institution, not only nursing homes. Individuals who are otherwise licensed or certified by DPH as health professionals and individuals who volunteer to provide those services without monetary compensation remain excluded from the definition of “nurse’s aide.”

The Act expands DPH’s authority to receive, investigate, and prosecute complaints against individuals who provide services as nurse’s aides in any DPH-licensed institution. The grounds for complaint include illegal, incompetent, or negligent conduct in the provision of nursing or nursing-related services; abuse of a resident, patient or client; neglect of a resident, patient, or client; misappropriation of resident, patient, or client property; and fraud or deceit in obtaining or attempting to obtain registration as a nurse’s aide. The Act defines “abuse” and “neglect” by reference to 42 CFR § 483.5, which sets out the Centers for Medicare & Medicaid Services definitions for long-term care facilities.

DPH may now summarily suspend a nurse’s aide’s ability to practice before final adjudication of a complaint or during the appeals process if DPH finds that the nurse’s aide would pose a clear and immediate danger to public health and safety if allowed to continue practicing. DPH may also discipline a nurse’s aide by revoking or suspending a credential; censuring the violator; issuing a letter of reprimand; placing the nurse’s aide on probationary status; or imposing a civil penalty of up to $25,000.

Finally, the Act updates terminology under the nurse’s aide training requirements by replacing references to “residents” and “residents’ rights” with “patients” and “patients’ rights.”

Connecticut Moves Toward EMS Licensure Portability (§28)

Effective October 1, 2026, Connecticut adopts the Recognition of Emergency Medical Services Personnel Licensure Interstate Compact, but the state will not actually enter the compact earlier than one year after Massachusetts, New York, or Rhode Island enacts it. The compact is designed to enhance access to EMS services by facilitating day-to-day movement of EMS personnel across state lines and allowing state EMS offices to provide immediate legal recognition to EMS personnel licensed in another member state.

At a high level, the compact applies to EMS personnel such as EMTs, advanced EMTs, and paramedics. The compact may be relevant for EMS organizations and health systems with multistate emergency services operations because it creates a framework for qualifying EMS personnel licensed in one member state to practice in another member state under the compact’s privilege to practice model. Because Connecticut’s participation cannot begin until at least one year after Massachusetts, New York, or Rhode Island enacts the compact, EMS organizations should monitor neighboring-state adoption before treating the compact as operational in Connecticut.

Dentists Enter the Cosmetic Injection Space (§34)

Effective October 1, 2026, the Act allows Connecticut-licensed dentists to administer cosmetic injections to a patient’s face if the dentist satisfies specified training and insurance requirements. A “cosmetic injection” is defined under the Act as a nonsurgical procedure involving the injection of a substance, including botulinum toxin or dermal filler, to alter or enhance a person’s physical appearance.

To qualify, the dentist must successfully complete in-person, hands-on training in the administration of cosmetic injections through a continuing education provider or program approved by the Commissioner of Public Health or accredited by a national professional accrediting body. The dentist must also maintain professional liability insurance that covers cosmetic injection procedures. Additionally, dentists may not delegate cosmetic injections to dental hygienists, dental assistants, or other auxiliary personnel.

The Act still imposes limits on the type of cosmetic procedures dentists are allowed to perform. Dentists cannot administer injections into the tear trough, infraorbital hollow, eyelids, medial canthal region, or other orbit-adjacent soft tissue for periocular volumization or under-eye hollow correction. The Act also does not authorize dentists to administer injections into the forehead, glabella, or eyebrows for improved cosmesis.

The Act, however, does allow dentists to administer a neuromodulator to the lateral canthal region, including for treatment of lateral canthal rhytids (a/k/a, crow’s feet). It also permits injections for management of orofacial pain, temporomandibular disorders, or other oromandibular conditions, or dermal filler to the malar, zygomatic, or midface region when the primary intended treatment site is the cheek or midface and the injection site remains inferior to the infraorbital rim.

Key Takeaways from the Act

  • Health care providers should prepare to give patients written medical records retention and access notices at initial intake by January 1, 2027.
  • Managed residential communities, assisted living services agencies, and senior living campus operators should monitor the DPH working group’s recommendations and the commissioner’s February 1, 2027 report to the Public Health Committee, and consider opportunities for their representatives to participate as part of the working group.
  • Hospitals should review their community health needs assessment processes to determine whether available data warrant including nutritional needs for community members with diabetes and congestive heart failure.
  • Hospitals should review emergency department opioid use disorder protocols before January 1, 2027, including buprenorphine and methadone administration, opioid antagonist offers, referrals, bridging prescriptions, and last-dose letters.
  • Educational institutions that operate infirmaries should evaluate whether their clinical operations and health plan arrangements will extend services to dependent family members enrolled in the institution’s health plan, and consider how that will impact other operations and compliance programs (including records protections and processes under FERPA and/or HIPAA).
  • Hospitals and pediatric behavioral health providers should assess how they will obtain consent, transmit safety plans securely, and coordinate with schools when a minor patient receives at least twelve consecutive days of inpatient behavioral health care treatment.
  • Institutions that employ or contract with nurse’s aides should prepare for the October 1, 2027 expansion of DPH’s registry, complaint, discipline, and training framework.
  • EMS providers and organizations with cross-border operations should monitor whether Massachusetts, New York, or Rhode Island enacts the EMS compact because Connecticut’s participation cannot begin earlier than one year after one of those states does so.
  • Dentists that want to administer cosmetic injections should assess training, professional liability insurance, site-of-service limits, nondelegation requirements, and any future DPH regulations.

On May 26, 2026, Connecticut Governor Ned Lamont signed a bill overhauling the state’s Certificate of Need (CON) program which, among other things, eliminates the current CON approval requirement for a hospital to terminate services. A new process for hospitals to provide notice of service suspensions and terminations is part of the State’s budget bill, Public Act No. 26-68 (the “Act”). This new process is highlighted below and will take effect starting July 1, 2027. For our analysis of the Act’s changes to the CON process, please see here. 

Current CON Requirement for Hospital Service Terminations

Currently, hospitals must obtain CON approval of the termination of a service, which applies where the hospital ceases providing a service for more than 180 days over a two-year period. This CON requirement has led to challenges for the health care organizations due to the current CON decision factors not expressly contemplating terminations, and the fact that “services” is not defined in the CON statutes or regulations.

New Process for Hospital Service Line Terminations – Starting July 1, 2027

The Act establishes a new process for hospital service line terminations (including pauses of 90+ days), and in doing so gets rid of the current 180-day termination standard as well as the current requirement to obtain CON approval to terminate a hospital service.

Short-Term Service Pauses; Definition of Service Lines Subject to the New Process

Under the Act, hospitals are permitted to temporarily pause service lines for up to 90 days without any notice or approval.  Importantly, the Act also specifies that “service line” refers to “a category of inpatient and outpatient services” but does not include services provided by an emergency department.

Service Line Termination Notice Requirement

If a hospital intends to pause a service line for more than 90 days, or elects to terminate the service line, the hospital must provide 90 days’ advance notice to the following state agencies:

  • The Department of Public Health’s (DPH) CON program;
  • Office of the Attorney General;
  • Department of Social Services;
  • Office of the Healthcare Advocate; and
  • If the termination relates to behavioral health or substance use disorder services, to the Department of Mental Health and Addiction Services and the Behavioral Health Advocate.

The service termination notice must include:

  •  A description of the service(s) to be terminated;
  • Utilization rates;
  • Anticipated impact on the primary service area;
  • An account of all community planning that has and will take place;
  • The proposed effective date of the termination, as well as the anticipated resumption date (if applicable for certain pauses of service lines); and
  • Any other information required by the Director of the CON program established under the Act.

In the event 90 days’ notice is impracticable due to circumstances outside of the hospital’s control, the hospital is obligated to provide notice as soon as practicable and no later than 14 days following the start of an unanticipated cessation of a service line.

Public Hearing

Following submission of the notice, the service termination (or 90+ day pause) proposal will be subject to a mandatory public hearing. The hearing will review the impact on the hospital’s primary service area, and plans for ensuring continued access to high-quality affordable health care in that area. The hearing record and any public comments will be provided to the CON panel, consisting of the Commissioners of DPH and DSS and the Secretary of the Office of Policy Management (the “CON Panel”), which it will use to aid in its review of the plan for ensuring access further described below.

Service Line Access Plan

Following the provision of notice of the termination (or long-term pause) of a service line, a hospital is required to submit a plan for ensuring continued access to the services following the pause or termination of the service (“Access Plan”). The Access Plan must be submitted at least 60 days prior to the effective date of service line termination (or as soon as practicable and within 14 days of the cessation where due to an unplanned event outside of the hospital’s control).

The Access Plan must include:

  • Prior service line utilization;
  • The locations and service capacity of alternative sites of the services;
  • Travel times to such alternative sites;
  • A transportation needs assessment and plan for meeting any such needs;
  • A protocol detailing mechanisms to maintain continuity of care for affected patients; and
  • A protocol for providing notice to affected patients in the primary service area of the service line termination (or pause), which includes information on alternative sites, and how affected patients can receive assistance from the hospital to obtain the services and preserve continuity of care.

The CON program will then review the Access Plan and determine if it ensures continued access to the service. The CON program will review and provide written recommendations regarding the approval, modification, or imposition of conditions on the Access Plan within ten days. The CON Panel will then hold a meeting regarding the Access Plan within ten days, and the hospital can provide comments on the recommendations at any time prior to the meeting. Within ten days after the meeting, the CON Panel will approve, require modifications, or add conditions to the proposed Access Plan. 

The CON Panel’s decision on the Access Plan constitutes a final decision subject to review and procedural rights afforded to contested cases under the Uniform Administrative Procedures Act. The CON program will maintain oversight of the final approved Access Plan, and the Act grants the CON program authority to impose performance improvement plans on hospitals and to seek civil penalties for noncompliance.

On May 2, 2026, the Connecticut Legislature approved the overhaul of the state’s Certificate of Need (CON) program as part of its appropriations bill for the fiscal year ending June 30, 2027, Public Act No. 26-68 (“the Act”).

The Act significantly revises all aspects of the CON program and process, including most notably by eliminating the independent Office of Health Strategy (OHS) that had overseen CONs since 2018, and returning oversight for CON largely to the State Department of Public Health (DPH). The Act is the culmination of years of debate over the CON process, and the Governor is expected to sign the Act in the near future. 

Various sections of the Act take effect October 1, 2026, with the new CON process fully taking effect July 1, 2027. Below is a summary of the major elements of the new CON process and how they differ from the current process.

Creation of CON Panel within DPH

The Act establishes a new CON program within DPH (referred to herein as the “CON Program”), which will be overseen by a three-person panel consisting of the respective Commissioners of DPH and the Department of Social Services (DSS), as well as the Secretary of the Office of Policy and Management (OPM) (the “CON Panel”).

After July 1, 2027, the Panel’s CON Program responsibilities will notably include:

  • Issuing rulings and final decisions on all CON applications;
  • Issuing civil penalties and cease and desist orders associated with CON applications, CON decisions/settlements, and related CON Program laws and regulations;
  • Approving CON Program policies and procedures, including the promulgation of CON regulations;
  • Reviewing and approving hospital plans for continued access to care during service terminations (in connection with the new process for hospital terminations of service established by the Act, which we reference below and will describe in further detail in a forthcoming post); and
  • Assuming existing obligations of OHS in connection with the review of proposed sales of nonprofit hospitals to for-profit purchasers under Conn. Gen. Stat. § 19a-486a.

 The CON Panel will meet monthly to address matters related to CON Program applications and other business, as further described below.

Changes to CON Program Definitions and When a CON is Required

Importantly, the Act (i) revises certain key defined terms that impact the applicability of the CON Program, and (ii) streamlines certain current CON categories and CON exemptions while reducing instances in which a CON is required. 

Among other changes, the Act makes the following updates affecting CON definitions and requirements:

Changes of Ownership or Control Subject to CON Review

  • Currently, the defined term intended to capture change of ownership-type transactions requiring CON approval is “transfer of ownership” which refers to a “transfer that impacts or changes the governance or controlling body of a health care facility, institution or large group practice, including, but not limited to, all affiliations, mergers or any sale or transfer of net assets of a health care facility.”
    • Going forward, the defined term is updated to “change of ownership or control” which is more broadly applicable to “any change in the ownership or beneficial ownership or the change of control of an entity, including (A) a corporate merger, (B) an acquisition of one or more entities by direct or indirect purchase in any manner of not less than twenty-five per cent of the assets, equity or voting shares of a health care facility, (C) a transfer of control of a board of directors or governing body, or (D) a real estate sale or lease agreement involving not less than twenty per cent of the total assets of a hospital.”
    • Importantly, this new defined term establishes a 25% threshold for asset / equity / voting interest acquisitions for a transaction that could require CON Program review, as well as certain real estate transactions involving hospitals.

Applicability of CON Laws to Hospital Satellites

  • The Act expands the current definition of a “health care facility” subject to CON requirements with respect to a hospital to indicate that the term “hospital” is “including any satellite location” under the hospital’s license, as well as an outpatient surgical facility established by a hospital. This defined term expansion is notable because it potentially brings the closure of a hospital satellite location within the new process for hospital service terminations, but could also be construed to potentially require CON review of the establishment of new hospital satellites.

New Process for Terminations

  • Consistent with the new process for hospital service terminations (which will no longer require full CON review and approval as described further below), the Act’s new CON defined terms remove the current definition of a “termination of service” which had referred to “the cessation of any services for a combined total of greater than one hundred eighty days within any consecutive two-year period.”

Behavioral Health and Substance Use Disorder Exception

  • The Act notably replaces the longstanding current exception to CON requirements for nonprofit facilities and providers (other than hospitals) holding state contracts for certain services, to now establish an exception to CON requirements for all facilities, institutions, and providers that are nonprofit (or operated by the State) and that solely provide behavioral health or substance use disorder treatment services.

CON Exception for 10-Mile Facility Relocations

  • Currently, health care facilities seeking to relocate are required to submit a CON Determination to OHS and demonstrate that the proposed relocation will not impact the patient population or payor mix of the facility.
    • The Act includes a new CON exception, permitting all facility relocations within the same town or within 10 miles of the facility’s current location, as long as the relocation does not result in a substantial change to the facility’s payor mix or patient population.

Large Group Practice Notification Process

  • The Act establishes a new mandatory notice process applicable to certain changes of ownership or control of a large group practice that are otherwise carved out from full CON review under the Act (e.g., due to the acquirer being a physician).
    • Under the Act, the acquiring person or entity must give DPH at least 30 days’ advance notice prior to closing of the transaction involving the large group practice, and include in such notice certain information required by DPH (including names, medical specialties, addresses, and any entities providing management services, in connection with the transaction).

The Act’s New CON Application Process

Application Submission

The Act creates an entirely new CON application process, described below:

  • CON applications will need to be submitted on a monthly rolling deadline, with submission dates on the 15th of each month.
  • At least 21 days prior to submission, the applicant(s) must provide the CON Program a notice for posting on its website with a description of the applicant, any known parties, a description of the proposal, and a reference to the applicable law requiring a CON.
  • If the application is not submitted within 90 days of the notice, a new notice must be submitted.
  • Importantly, any person wishing to request party or intervenor status with respect to an application must file notice of such intent, including whether the person seeks a hearing on the application, within 20 days after the applicant’s notice of intent to file is posted on the CON Program’s website. The Panel will appoint a hearing officer to decide if intervenor or party status shall be granted, consistent with the Connecticut Uniform Administrative Procedures Act. The CON applicant will have five days to file an objection to the intervenor and the office must issue a decision within 15 days.
    • This is a significant change to the current process, which allows intervenor and party petitions much later in the process.

Application Review and Staff Report

Following submission of an application:

  • The CON Program must notify the applicant of whether there is deemed complete status within 15 days of the deadline.
  • If an application is deemed incomplete, the CON Program will provide a list of elements of the application inadequately addressed within five days and permit resubmission of a revised application during the next application window ending on the 15th day, or other subsequent application window.

Once deemed complete, the CON Program will review and provide a report on the application and how it meets the new CON factors (described below). This report must be issued at least 10 days prior to any public hearing and in no event later than 90 days after the application is deemed complete. In compiling the report, the CON Program may ask for additional information but is not permitted to do so in a manner that would delay review timelines. The CON Program can supplement the CON application record with additional reports and evidence no later than 75 days after the application is deemed compete, and the CON Program will give the applicant(s) 10 days to respond to such evidence, which will be included in the record.

CON Hearings

Within 90 days of the application being deemed complete, the CON Program will hold a hearing on all CONs, unless the applicant waives this right.

The applicant may waive the right to a hearing within 30 days of the application being deemed complete if the applicant is the only party and no other person or entity has been granted intervenor status. Such waiver will also constitute a waiver of the applicant’s right to appeal a final decision under the CT Administrative Procedures Act; i.e., by waiving the hearing, the CON becomes an “uncontested case” under the Administrative Procedures Act which reduces the applicant’s procedural rights to challenge an unfavorable decision.

If a hearing is held, the following post-hearing process will then occur leading to a final decision:

TimelineEvent
10 days after adjournment of hearingThe hearing record closes. If no hearing is held the record will close 10 days after issuance of the report.
60 days after hearing record closes, or if the hearing right is waived, 150 days after the application is deemed completeThe hearing officer transmits the hearing record and a proposed final decision to the Panel for review at the Panel’s next monthly meeting. If the proposed final decision imposes conditions, the hearing officer will meet with the applicant five days before transmitting to the Panel.
Within 14 days of publication of proposed final decisionThe applicant may file written briefs and request oral argument on the proposed final decision.
Panel’s next monthly meeting following receipt of the proposed final decisionThe Panel will review the proposed final decision and has the authority to impose any conditions on approval that are permitted by law. By majority vote, the Panel will either approve, modify, remand for further development of the record and consideration at their next meeting, or send to settlement negotiations.
Immediately upon a majority vote by the Panel to approve a proposed final decisionThe approved proposed final decision becomes automatically converted to a final decision.
Within 30 days of a vote by the Panel to modify a proposed final decisionThe proposed final decision shall be modified consistent with the Panel’s modifications and then published as a final decision.
At the next monthly meeting of the Panel following a vote to further develop the record or engage in settlement negotiationsThe Panel reviews and votes upon the updated record or proposed settlement.

Once the Panel issues a final decision, it is subject to appeal under the CT Administrative Procedures Act, similar to the current process, and subject to whether the applicant(s) waived the right to a hearing (and thus potentially waived the right to appeal any final decision).

CON Review Criteria

The Act establishes new CON factors which will govern the Panel’s review of all CON applications. The Panel will determine by a preponderance of evidence standard whether the application demonstrates the proposal is in the public interest. The Panel will specifically consider whether the proposal:

  • Promotes the delivery of high quality care in the applicant’s primary service area;
  • Promotes access to health care services, including for Medicaid beneficiaries, in the primary service area;
  • Promotes the delivery of cost-effective care in the applicant’s primary service area;
  • Promotes the financial stability of the health care system, including whether the proposal is financially feasible to implement and whether the applicant has any prior evidence of financial mismanagement or misconduct;
  • Demonstrates a clear public need; and
  • Would result in the unnecessary duplication of services.

The Act thus streamlines the CON review factors (of which there are currently 12, with a number rarely applicable to CON reviews), to focus on access, need, quality, and cost.

As is the case under the current law, the Panel may engage a consultant to review the proposal with costs passed onto the applicant capped at $100,000. The applicant will have the right to withdraw any application before incurring consulting fees.

Expedited CON Review

The Act requires the establishment of an expedited CON review process for certain categories. These categories are:

  • Relocations of more than 10 miles and outside of the current town of operation;
  • Increases of inpatient or outpatient hospital beds;
  • Acquisition of CT, MRI, PET, or PET-CT scanners by any person, physician, provider, or hospital;
  • Increases of two or three operating rooms within a three-year period by an outpatient surgical facility or short-term acute care general hospital; or
  • any other category the DPH commissioner designates in regulations.

Requests for expedited review will begin on January 1, 2028. Applications must be submitted under the same deadlines as the standard process, but include the expedited request. The CON Program will inform the applicant within 15 days whether an application qualifies for the expedited process. Notably, the decision of whether to hold a hearing as part of an expedited review becomes permissive at the Panel’s discretion. If an application is deemed eligible for expedited review, a proposed final decision will be issued within 60 days of the application being deemed complete, and the application will be considered at the next monthly meeting of the Panel. If an application is determined not to be eligible for expedited review, the application reverts to the (new) standard CON Program process described above.

Enforcement Powers

The Act grants authority to the Panel to investigate CON violations, including by administering oaths and taking testimony, subpoenaing witnesses and documents, and issuing civil penalties. As is the case currently, civil penalties may be issued when a person or health care facility negligently undertakes an activity without a required CON approval or fails to comply with a CON decision’s terms or conditions or a panel-approved agreed settlement. Such penalties are also permissible for negligently failing to submit a required notice about changes in ownership or control of a large group practice that is not subject to CON approval or a hospital’s pause of a service for more than 90 days. As under current law, the maximum penalty is $1,000 per day.

Below is an excerpt of an article published in the Massachusetts Bar Association’s Section Review.

Recent months have seen a significant shift in how pharmacy benefit managers (PBMs) are regulated at both the state and federal levels. PBMs are hired by health plans to manage administrative and other duties, while also serving as intermediaries by negotiating rates with drug companies. However, unlike most players in the health care system whose financial arrangements are heavily regulated and often subject to public scrutiny, PBMs have historically been permitted to operate with few disclosure or transparency requirements. 

PBMs wield substantial leverage to bargain with drug companies and influence drug prices. One service that PBMs provide is to negotiate rebates that the drug companies pay to health plans. In exchange for a larger rebate, PBMs may offer drug manufacturers a benefit, such as a more favorable position (typically meaning a lower patient copay) on a drug formulary: the list of drugs that the health plan covers, along with the pricing structure for those drugs. PBMs may, in some cases, retain portions of those rebates before passing them on to the health plan. While lower co-pays may, in the short term, be a benefit to patients, high rebates typically result in drug companies raising the list price of the drug over time, which means higher consumer costs.

Read the full article, here.

On April 23, 2026, the HHS Office of Inspector General (OIG) quietly—but pointedly—added two new FAQs to its “General Questions Regarding Certain Fraud and Abuse Authorities.” Although the principles articulated are not new, the timing and clarity of these FAQs reflect OIG’s continued effort to correct common—and risky—misunderstandings in the health care industry regarding the federal Anti‑Kickback Statute (AKS), the physician self‑referral law (“Stark”), and the role of fair market value (FMV) analyses. Together, these FAQs serve as a reminder that technical compliance with Stark or reliance on a fair market benchmark do not, standing alone, insulate an arrangement from AKS scrutiny.

The first new FAQ is FAQ #4: “Could a financial arrangement that satisfies an exception to the physician self-referral law (42 U.S.C. § 1395nn) violate the federal anti-kickback statute?” In its answer, OIG squarely addresses a persistent misconception that satisfying a Stark exception somehow rebuts AKS risk. OIG emphasizes several foundational points:

  • Stark and AKS serve different purposes, prohibit different conduct, and impose different consequences;
  • Stark is a strict liability statute; intent is irrelevant;
  • AKS is an intent‑based statute; knowing and willful intent to induce referrals is the core inquiry; and
  • Compliance with a Stark exception is not evidence that the parties lack AKS intent.

Even where a financial arrangement “fits” squarely within a Stark exception, the arrangement may still violate AKS if one purpose of the remuneration is to induce or reward referrals. To illustrate this point, the OIG provides the “sporting event” example. It pointed out that hospitals, laboratories, or other providers may offer sporting event tickets or entertainment to referring physicians. OIG acknowledges that such arrangements might, depending on facts, technically satisfy the Stark exception for nonmonetary compensation under 42 C.F.R. § 411.357(k). However, OIG warns that these forms of remuneration are “unlikely to receive protection under any safe harbor to the federal anti-kickback statute” and therefore remain subject to totality‑of‑the‑circumstances review, including intent. Importantly, OIG reiterates its long‑standing position that providing remuneration to referral sources can violate AKS regardless of Stark compliance, a theme echoed in enforcement actions and advisory opinions over many years.

The second new FAQ is FAQ #17: “Can fair market value arrangements violate the federal anti-kickback statute?” This FAQ tackles another common compliance belief that fair market value may be the sole compliance cornerstone for AKS purposes. OIG again says no. While confirming that fair market value analyses are important and often one of the elements of a safe harbor, OIG stresses that fair market value is just one element and that compliance with a safe harbor requires meeting each element. As discussed in a prior podcast with the American Health Law Association, there are other factors that are important including commercial reasonableness.

OIG expressly rejects the industry argument that FMV eliminates unlawful remuneration, calling that position inconsistent with (i) the statutory text, (ii) the regulatory safe harbors, and (iii) decades of OIG guidance that OIG characterizes as “consistent and unwavering.”

Why These FAQs Matter Now

Although neither FAQ announces new law, their explicit pairing and contemporaneous release is notable. OIG appears focused on dispelling two closely related myths that continue to surface in enforcement matters:

  1. “We meet Stark, so AKS isn’t a problem.”
  2. “We paid fair market value, so there’s no kickback.”

For entities in the healthcare space, these FAQs signal that you must look at the totality of the arrangement and ask the hard questions surrounding the relationship.

On February 5, 2026, the Massachusetts Health Policy Commission (HPC) published proposed amendments to its Material Change regulations at 958 CMR 7.00 (the Proposed Amendments). Among other things, the Proposed Amendments broaden the HPC’s market review authority by subjecting more transactions to the HPC’s Material Change Notice (MCN) process and provide the HPC greater latitude to conduct Cost and Market Impact Reviews (CMIRs) of proposed transactions. Below, we summarize the background and timing for public hearing and adoption, and major provisions of the Proposed Amendments.

Background & Timing

In January 2025, Massachusetts enacted Chapter 343 of the Acts of 2024, “An Act Enhancing the Market Review Process” (the Act), which expanded the HPC’s health care market oversight role, including by authorizing the agency to review a wider range of transactions. The Act (which we discussed here) aimed to strengthen regulatory oversight of health care market transactions, conferring more authority not just on the HPC, but also on the Center for Health Information and Analysis (CHIA) and the Attorney General’s Office. The Act focuses on transactions involving private equity, pharmacy benefit managers, real estate investment trusts, and management service organizations, in order to expand the types of transactions subject to the MCN requirement.

The Proposed Amendments seek to codify a number of changes included in the HPC’s Bulletin HPC-2025-01 guidance that went into effect on April 8, 2025. The HPC’s Bulletin provided guidance to providers and provider organizations concerning implementation of the Act. The Bulletin included several new categories of transactions subject to the MCN requirement, new definitions affecting MCNs, as well as changes to the review process for MCNs. The Proposed Amendments are consistent with the Bulletin, with some additional clarifications, as described below. When adopted, the Proposed Amendments will supersede Bulletin HPC-2025-01.

The HPC will conduct a virtual public hearing on the Proposed Amendments at 1:00 PM on March 12, 2026. Interested parties are encouraged to submit either oral or written testimony and comments, and parties may request to provide live testimony during the hearing. The HPC will accept testimony and comments until 5:00 PM on March 20, 2026, and is expected to vote on the final adoption of the Proposed Amendments at its board meeting on April 16, 2026.

Proposed Amendments

The major provisions of the Proposed Amendments are as follows:

  1. New definitions: The Proposed Amendments add new definitions, including the following definitions allowing for regular adjustment of monetary filing thresholds by the HPC and establishing the type of investors now subject to the Act and any exceptions thereto:
    • MCN Filing Threshold and Revenue Increase Threshold: Current regulations apply MCN reporting requirements to providers/provider organizations with more than $25 million in Net Patient Service Revenue (NPSR) as well as to certain transactions that would result in an increase of more than $10 million in NPSR. The Proposed Amendments formally define these monetary thresholds, setting $25 million in NPSR as the “MCN Filing Threshold” (applicable to MCN reporting associated with clinical affiliations) and $10 million in NPSR the “Revenue Increase Threshold” (applicable to MCN reporting associated with mergers, acquisitions, certain other affiliations, and significant capacity increases). These monetary thresholds are subject to annual adjustment by the HPC.
    • Private Equity Company and Significant Equity Investor:
      • The Proposed Amendments newly define the term “Private Equity Company” in broad terms to refer to any entity that collects capital investments, however organized, and which purchases directly or through another owned or controlled entity, a direct or indirect ownership share of a provider, provider organization, or management services organization (MSO).
      • The Proposed Amendments separately define “Significant Equity Investor” as a Private Equity Company that holds—or would hold, following a proposed transaction—any financial interest in a provider, provider organization, or MSO; or any investor that holds—or would hold, following a proposed transaction—equity amounting to more than 10 percent of a provider, provider organization, or MSO.
      • Both defined terms include narrow exceptions for venture capital firms exclusively engaged in funding start-ups and early stage businesses; and Significant Equity Investors exclude individual licensed health care providers who practice medicine, dentistry or another health care profession as a full or partial owner of the provider or provider organization.
  2. Expanded scope of MCN-triggering transactions: The Proposed Amendments would clarify the scope of review for transactions currently subject to the MCN process. These transactions include:
    • Mergers or affiliations involving both a provider or provider organization and an insurance carrier, and acquisitions by an insurance carrier of a provider or provider organization (and vice versa).
    • Mergers with or acquisitions of hospitals or hospital systems, or of a provider or provider organization by a hospital or hospital system.
    • Mergers, acquisitions, or affiliations (including corporate affiliations, contracting affiliations, and employment of health care professionals) where: (a) the arrangement is between providers, or involves one of the following: a provider organization, an MSO that establishes contracts with insurance carriers or third-party administrators, or an entity that represents health care providers (including out-of-state providers) in contracting with payers for health care services; and (b) such arrangement would result in an increase in one party’s NPSR equal to or greater than the Revenue Increase Threshold (defined above), or in one party gaining a dominant market share (as such term is defined in these regulations) in a given service area or region.
    • Clinical affiliations between two or more providers or provider organizations that each have a NPSR greater than the MCN Filing Threshold. The Proposed Amendments specify arrangements that explicitly constitute clinical affiliations covered under this requirement, as follows: co-branding, co-located services, complete or substantial staffing of an acute hospital service line, funding EHR interconnectivity, regular and ongoing provision of telemedicine services, preferred provider relationships, and discount arrangements. The Proposed Amendments maintain the pre-existing exclusion for affiliations solely related to clinical trials or graduate medical education programs.
    • Any form of partnership, joint venture, accountable care organization, parent corporation, MSO, or other organizational structure created to administer contracts with insurance carriers, third party administrators, or other contractors.

The Proposed Amendments would also add new categories of transactions subject to MCN review:

  • Any significant increase to a provider or provider organization’s capacity, including:
    • Any increase to capacity that would trigger the Determination of Need (DoN) process due to a Substantial Capital Expenditure (as defined in the DoN regulations at 105 CMR 100.000) or any other basis meeting the monetary criteria for a Substantial Capital Expenditure, and any increase to capacity that would result in an increase to the provider’s NPSR equal to or greater than the Revenue Increase Threshold (set at $10 million currently) based on expected revenue from the planned capacity (e.g., any increases to operational capacity that do not meet the DoN monetary thresholds for Substantial Capital Expenditures but will result in NPSR increasing at least $10 million).
  • Any transaction involving a Significant Equity Investor, including a Private Equity Company (as each are defined above), that results in a partial or complete change of ownership or control of a provider, provider organization, or MSO.
  • A significant acquisition, sale, or transfer of provider/provider organization assets, including real estate lease-backs involving the sale of real property used to deliver healthcare services.
  • Any conversion of a provider or provider organization from a non-profit entity to a for-profit entity.
  1. Additional CMIR authority: The Proposed Amendments would additionally allow the HPC to conduct a CMIR if a proposed material change is “likely to have a significant impact” on the competitive market or on the Commonwealth’s ability to meet its financial goals pursuant to the Health Care Cost Growth Benchmark, a metric for cost containment established and updated annually by the HPC. The Proposed Amendments would also give the HPC discretion to conduct a CMIR on any provider organization that exceeded the Health Care Cost Growth Benchmark in the previous year, as reported by CHIA.
  2. Expanded review and enforcement authority relevant to the MCN and CMIR processes: Under the Proposed Amendments, the HPC would have expanded authority to request information from parties to a transaction and certain other market participants. While the authority to request documents and other materials is not new, the Proposed Amendments add Significant Equity Investors to those from whom information may be requested, including information about the entity’s capital structure, general financial condition, ownership and management, and audited financial statements. HPC may also request information from payers related to a particular MCN.
  3. Post-transaction review of material changes: The Proposed Amendments would allow the HPC to conduct post-transaction reviews of material changes for up to five years, at its discretion. Under its post-transaction review authority, the HPC would be able to require parties to a material change to submit any data and information it deems necessary to assess the post-transaction impacts, and to make referrals to the Attorney General or other state or federal agencies as appropriate.

Key Takeaways

For health care organizations, the Proposed Amendments reinforce the significantly expanded authority of the HPC to oversee healthcare market transactions and arrangements, and will require close vetting to ensure future transactions and arrangements are appropriately reported. The Proposed Amendments also shed light on how the HPC might exercise its authority to review transactions, particularly those transactions involving private equity investors and MSOs, and those meeting certain financial thresholds. Stakeholders are encouraged to provide public comments on the Proposed Amendments as soon as practicable, and before March 20, 2026, in order to be heard prior to the HPC’s vote on the Proposed Amendments. We will continue to monitor the HPC’s rulemaking and guidance, as well as its implementation of the Proposed Amendments (once approved) and any resulting changes to the MCN process.