Robinson Cole LLP
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Conor O. Duffy co-chairs our firm's Health Law group. He advises hospitals, clinically integrated networks, physician groups, post-acute care facilities, community providers, and other health care entities on health care regulatory, transactional, and corporate matters. He also counsels clients on what measures are needed to safeguard data and patient information. 

Regulatory

Conor provides legal counsel to health care clients on various regulatory matters at the federal and state levels, such as Medicare and Medicaid program compliance, federal fraud and abuse laws, Certificates of Need and transaction approvals, and the Emergency Medical Treatment & Labor Act (EMTALA). Conor frequently assists clients in obtaining Certificates or Determinations of Need, and in assessing the applicability of such processes to potential transactions, as well as in obtaining approvals for changes of ownership or governance at the federal and state level (including before CMS and the Medicare and Medicaid programs, as well as the Department of Public Health, Department of Social Services, and the Department of Consumer Protection). He also assists with the full spectrum of healthcare matters, including those related to licensure, scope of practice, and staffing. Conor represents clients in state and federal administrative appeals and provides counsel related to internal investigations. He is a frequent speaker and writer on recent developments in healthcare regulation and enforcement, including fraud and abuse and False Claims Act jurisprudence.

Transactional

Conor provides strategic counsel to advise health care organizations on structuring transactions to meet their business objectives in accordance with federal and state law. He assists with transactions involving contracting, affiliations, joint ventures, leasing agreements, clinical service agreements, and the establishment of accountable care and physician-hospital organizations.

Information Privacy + Security

As a member of our firm’s Data Privacy + Cybersecurity team, Conor assists health care providers with compliance with the Health Insurance Portability and Accountability Act (HIPAA). He helps clients protect against impermissible disclosures of data and provides guidance on data breach response efforts. He also advises clients on security programs, policies, education, and the implementation of administrative, technical, and physical safeguards. Conor is a regular contributor to our firm’s Data Privacy + Security Insider publication. He is also a vice-chair of the American Bar Association Health Law Section’s Web & Tech Committee, a role in which he supports the online activities of the Health Law Section’s interest groups and manages technological matters on behalf of the Health Law Section.

Pro Bono + Community Involvement

Conor regularly undertakes pro bono matters. He has represented an Ethiopian political activist in his application for asylum. He also has provided pro bono counsel on reputation management related to unfavorable online search engine results, counseled a public high school on the establishment of a tax-exempt booster club, assisted in the establishment of a school-based health center at a charter school, and reviewed contracts for a prominent veterans’ support organization. While in law school, Conor interned at the University of Connecticut School of Law's Asylum & Human Rights Clinic, where he participated in the representation of a Middle Eastern journalist during her successful application for asylum in the United States.

He contributes to the firm's blog, Health Law Diagnosis.

  • University of Connecticut School of Law (Juris Doctor, with honors)
    • CALI Excellence Awards in Federal Courts, Mental Health Law, and the CULI Environmental Practice Clinic
  • Boston College (Bachelors)
    • B.A., History

  • State of Connecticut
  • Commonwealth of Massachusetts

Selected by his peers for inclusion in The Best Lawyers in America© in the area of Health Care Law for 2026

Selected by his peers for inclusion in Best Lawyers: Ones to Watch in America in the area of Health Care Law since 2021

Selected as a Rising Star to the Connecticut Super Lawyers list from 2017 to 2023

Hartford Business Journal, 2023 "Forty Under 40" Honoree 

 Recognized as a New Leader in the Law by the Connecticut Law Tribune, 2021

2018-2021 JD Supra Readers' Choice Top Author in the area of healthcare

American Bar Foundation
Fellow (2019)

New Haven County Bar Association
Treasurer (2025-2026), Secretary (2024-2025)
Executive Committee (2019)

New Haven Legal Assistance Association
Member, Board of Directors (2020)

First Choice Health Centers, Inc.
Board of Directors (2022)

Horizons at Foote
Board of Directors (2024)

New Haven Lawn Club
Board of Governors (2024)

Experience


Corporation Formed in Private Practice Model

Assisted hospital client with formation of professional corporation for employment of physicians in private practice model.

Health Care Provider Representation

Provides regular representation of health care providers such as hospitals and nursing homes on matters of corporate governance, contracts, regulatory compliance, corporate compliance, risk management, policies, fundraising and tax exemption, employment, labor and litigation.

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Physician Recruitment + Retention Matters

Advises hospitals on physician recruitment and retention matters, including providing advice regarding Stark exceptions, anti-kickback safe harbors and tax exemption restrictions and drafting of income guarantees, loan forgiveness arrangements and employment agreements. 

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Publications


Connecticut Heightens Scrutiny of Private Equity in Healthcare with Law Banning Hospital Sale-Leaseback Agreements and Requiring Private Equity Attestations teaser
June 17, 2026

Connecticut Heightens Scrutiny of Private Equity in Healthcare with Law Banning Hospital Sale-Leaseback Agreements and Requiring Private Equity Attestations

Health Law Diagnosis
Connecticut Governor Signs Public Health Bill: What Health Care Organizations Need to Know teaser
June 4, 2026

Connecticut Governor Signs Public Health Bill: What Health Care Organizations Need to Know

Health Law Diagnosis
Connecticut Establishes New Process for Hospitals Seeking to Pause or Terminate Service Lines teaser
May 28, 2026

Connecticut Establishes New Process for Hospitals Seeking to Pause or Terminate Service Lines

Health Law Diagnosis
Connecticut Heightens Scrutiny of Private Equity in Healthcare with Law Banning Hospital Sale-Leaseback Agreements and Requiring Private Equity Attestations teaser
June 17, 2026

Connecticut Heightens Scrutiny of Private Equity in Healthcare with Law Banning Hospital Sale-Leaseback Agreements and Requiring Private Equity Attestations

Health Law Diagnosis
Connecticut Governor Signs Public Health Bill: What Health Care Organizations Need to Know teaser
June 4, 2026

Connecticut Governor Signs Public Health Bill: What Health Care Organizations Need to Know

Health Law Diagnosis
Connecticut Establishes New Process for Hospitals Seeking to Pause or Terminate Service Lines teaser
May 28, 2026

Connecticut Establishes New Process for Hospitals Seeking to Pause or Terminate Service Lines

Health Law Diagnosis
Everything Old is New Again: Connecticut Revamps Certificate of Need (CON) Program under Department of Public Health teaser
May 19, 2026

Everything Old is New Again: Connecticut Revamps Certificate of Need (CON) Program under Department of Public Health

Health Law Diagnosis
Massachusetts HPC Proposes to Update Material Change Reporting Requirements to Align with Newly Expanded Oversight Authority teaser
March 5, 2026

Massachusetts HPC Proposes to Update Material Change Reporting Requirements to Align with Newly Expanded Oversight Authority

Health Law Diagnosis
Hospitals Face New Attestation and NPI Requirements for Off-Campus Outpatient Locations by January 1, 2028 teaser
February 25, 2026

Hospitals Face New Attestation and NPI Requirements for Off-Campus Outpatient Locations by January 1, 2028

Health Law Diagnosis
Continuing Appropriations Act, 2026: Another Lifeline for Medicare Telehealth Flexibilities teaser
February 4, 2026

Continuing Appropriations Act, 2026: Another Lifeline for Medicare Telehealth Flexibilities

Health Law Diagnosis
Two Weeks Notice for Covered Entities: February 16 Deadline Approaches to Update HIPAA Notice of Privacy Practices teaser
February 3, 2026

Two Weeks Notice for Covered Entities: February 16 Deadline Approaches to Update HIPAA Notice of Privacy Practices

Health Law Diagnosis
Song Remains the Same – Medicare Telehealth Services At Risk of Expiring Again on January 30, 2026 teaser
January 29, 2026

Song Remains the Same – Medicare Telehealth Services At Risk of Expiring Again on January 30, 2026

Health Law Diagnosis


Everything Old is New Again: Connecticut Revamps Certificate of Need (CON) Program under Department of Public Health teaser
May 19, 2026

Everything Old is New Again: Connecticut Revamps Certificate of Need (CON) Program under Department of Public Health

Health Law Diagnosis
Massachusetts HPC Proposes to Update Material Change Reporting Requirements to Align with Newly Expanded Oversight Authority teaser
March 5, 2026

Massachusetts HPC Proposes to Update Material Change Reporting Requirements to Align with Newly Expanded Oversight Authority

Health Law Diagnosis
Hospitals Face New Attestation and NPI Requirements for Off-Campus Outpatient Locations by January 1, 2028 teaser
February 25, 2026

Hospitals Face New Attestation and NPI Requirements for Off-Campus Outpatient Locations by January 1, 2028

Health Law Diagnosis
Continuing Appropriations Act, 2026: Another Lifeline for Medicare Telehealth Flexibilities teaser
February 4, 2026

Continuing Appropriations Act, 2026: Another Lifeline for Medicare Telehealth Flexibilities

Health Law Diagnosis
Two Weeks Notice for Covered Entities: February 16 Deadline Approaches to Update HIPAA Notice of Privacy Practices teaser
February 3, 2026

Two Weeks Notice for Covered Entities: February 16 Deadline Approaches to Update HIPAA Notice of Privacy Practices

Health Law Diagnosis
Song Remains the Same – Medicare Telehealth Services At Risk of Expiring Again on January 30, 2026 teaser
January 29, 2026

Song Remains the Same – Medicare Telehealth Services At Risk of Expiring Again on January 30, 2026

Health Law Diagnosis

News


October 20, 2025

Conor Duffy and Danielle Tangorre Author Article on Expiration of COVID-Era Telehealth Policies amid Government Shutdown

Health Law group lawyers Conor Duffy and Danielle Tangorre authored an article titled “Shutdown Imperils Telehealth Access for Medicare Patients” published in Law360 Expert Analysis on October 14, 2025. In the article, Conor and Danielle discuss how the expiration of COVID-era telehealth flexibilities that had preserved expansive access to telehealth services for Medicare beneficiaries has created significant legal and financial uncertainty on health care providers and patients. Without a legislative solution, providers and patients are left in limbo on how to proceed. “Healthcare providers must decide whether to honor existing telehealth appointments for Medicare beneficiaries and must weigh the benefits of preserving access for a vulnerable patient population against the various financial and legal risks associated with the continued provision of telehealth services,” they write. “The longer the shutdown persists, the greater the potential risk.” To read the article, click here.

Law360 Expert Analysis
August 26, 2025

78 Robinson+Cole Lawyers Listed in The Best Lawyers in America© 2026

Firm receives top listing in Connecticut lawyer count in national peer review survey
78 Robinson+Cole Lawyers Listed in The Best Lawyers in America© 2026 teaser
October 22, 2024

Conor Duffy Elected Secretary of the New Haven County Bar Association

New Haven County Bar Association
October 20, 2025

Conor Duffy and Danielle Tangorre Author Article on Expiration of COVID-Era Telehealth Policies amid Government Shutdown

Health Law group lawyers Conor Duffy and Danielle Tangorre authored an article titled “Shutdown Imperils Telehealth Access for Medicare Patients” published in Law360 Expert Analysis on October 14, 2025. In the article, Conor and Danielle discuss how the expiration of COVID-era telehealth flexibilities that had preserved expansive access to telehealth services for Medicare beneficiaries has created significant legal and financial uncertainty on health care providers and patients. Without a legislative solution, providers and patients are left in limbo on how to proceed. “Healthcare providers must decide whether to honor existing telehealth appointments for Medicare beneficiaries and must weigh the benefits of preserving access for a vulnerable patient population against the various financial and legal risks associated with the continued provision of telehealth services,” they write. “The longer the shutdown persists, the greater the potential risk.” To read the article, click here.

Law360 Expert Analysis
August 26, 2025

78 Robinson+Cole Lawyers Listed in The Best Lawyers in America© 2026

Firm receives top listing in Connecticut lawyer count in national peer review survey
78 Robinson+Cole Lawyers Listed in The Best Lawyers in America© 2026 teaser
October 22, 2024

Conor Duffy Elected Secretary of the New Haven County Bar Association

New Haven County Bar Association
October 15, 2024

Conor Duffy Joins Horizons at The Foote School’s Board of Directors

Horizons at The Foote School
October 10, 2024

Jennifer Driscoll and Conor Duffy Co-Author Chief Healthcare Executive Article on Antitrust Scrutiny of Consolidation in For-Profit Healthcare Industry

August 15, 2024

78 Robinson+Cole Lawyers Listed in The Best Lawyers in America© 2025

78 Robinson+Cole Lawyers Listed in <i>The Best Lawyers in America</i>© 2025 teaser
January 23, 2024

Jen Driscoll, Conor Duffy, and Ed Heath Author Health Law Weekly Article on Health Care Transactions and Civil Investigative Demands

Health Law Weekly
October 26, 2023

Robinson+Cole Lawyers Recognized in 2023 Super Lawyers®

Super Lawyers
September 29, 2023

Conor Duffy and Abby Warren Named to Hartford Business Journal’s 2023 “40 Under Forty” Class

Hartford Business Journal

October 15, 2024

Conor Duffy Joins Horizons at The Foote School’s Board of Directors

Horizons at The Foote School
October 10, 2024

Jennifer Driscoll and Conor Duffy Co-Author Chief Healthcare Executive Article on Antitrust Scrutiny of Consolidation in For-Profit Healthcare Industry

August 15, 2024

78 Robinson+Cole Lawyers Listed in The Best Lawyers in America© 2025

78 Robinson+Cole Lawyers Listed in <i>The Best Lawyers in America</i>© 2025 teaser
January 23, 2024

Jen Driscoll, Conor Duffy, and Ed Heath Author Health Law Weekly Article on Health Care Transactions and Civil Investigative Demands

Health Law Weekly
October 26, 2023

Robinson+Cole Lawyers Recognized in 2023 Super Lawyers®

Super Lawyers
September 29, 2023

Conor Duffy and Abby Warren Named to Hartford Business Journal’s 2023 “40 Under Forty” Class

Hartford Business Journal

Events


Past

KnowledgeBridge: Proactive Approaches to Compliance: A Preventative Checkup

Jan 29 2026
Consero Healthcare Chief Ethics & Compliance Officer Forum
Past

60-Day Rule – What Providers Need to Know About Reporting and Returning Overpayments in 2025

Dec 4 2025
HFMA / NEHIA Joint 2025 Compliance & Internal Audit Conference
Past

KnowledgeBridge: Proactive Approaches to Compliance: A Preventative Checkup

Jan 29 2026
Consero Healthcare Chief Ethics & Compliance Officer Forum
Past

60-Day Rule – What Providers Need to Know About Reporting and Returning Overpayments in 2025

Dec 4 2025
HFMA / NEHIA Joint 2025 Compliance & Internal Audit Conference
Past

Telehealth Compliance in Transition: What You Need to Know

Jul 23 2025
MHA Hot Topics Webinar Series
Past

New CMS 60-Day Rule Revisions: Key Changes Impacting Reporting and Return of Medicare/Medicaid Overpayments

May 22 2025
Strafford Webinar
Past

Are You Ready? Navigating ICE Raids and Immigration Enforcement in Healthcare

Feb 11 2025
R+C Hosted Webinar
Past

Post-Pandemic Compliance – Best Practices and Areas of Regulatory Scrutiny

Nov 30 2023
NEHIA Compliance and Internal Audit Conference
Past

Telehealth Compliance in Transition: What You Need to Know

Jul 23 2025
MHA Hot Topics Webinar Series
Past

New CMS 60-Day Rule Revisions: Key Changes Impacting Reporting and Return of Medicare/Medicaid Overpayments

May 22 2025
Strafford Webinar
Past

Are You Ready? Navigating ICE Raids and Immigration Enforcement in Healthcare

Feb 11 2025
R+C Hosted Webinar
Past

Post-Pandemic Compliance – Best Practices and Areas of Regulatory Scrutiny

Nov 30 2023
NEHIA Compliance and Internal Audit Conference

Health Law Diagnosis


Below is an excerpt of the Health Law Diagnosis blog posts authored by Conor.

New Connecticut Law Expedites Claim Disputes Between Health Care Providers and Insurers

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.

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Connecticut Heightens Scrutiny of Private Equity in Healthcare with Law Banning Hospital Sale-Leaseback Agreements and Requiring Private Equity Attestations

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.

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Connecticut Governor Signs Public Health Bill: What Health Care Organizations Need to Know

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.

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Connecticut Establishes New Process for Hospitals Seeking to Pause or Terminate Service Lines

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.

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Everything Old is New Again: Connecticut Revamps Certificate of Need (CON) Program under Department of Public Health

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: Timeline Event 10 days after adjournment of hearing The 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 complete The 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 decision The 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 decision The 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 decision The 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 decision The 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 negotiations The 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.

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Massachusetts HPC Proposes to Update Material Change Reporting Requirements to Align with Newly Expanded Oversight Authority

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: 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. 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. 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. 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. 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.

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Hospitals Face New Attestation and NPI Requirements for Off-Campus Outpatient Locations by January 1, 2028

The Consolidated Appropriations Act of 2026, HR 7148 (the Act), just signed into law on February 3, 2026, ended a brief government shutdown and includes multiple provisions with a critical impact on health care organizations. We have previously covered the Act’s renewal and extension through 2027 of COVID-era Medicare telehealth flexibilities and its revisions to pending rate cuts and reporting deadlines for certain clinical laboratories. Health care organizations should be aware of another section of the Act that newly imposes mandatory attestation and National Provider Identifier (NPI) requirements on off-campus outpatient departments of Medicare-enrolled hospitals (i.e., HOPD(s)) by January 1, 2028. This new requirement is likely to pose a significant compliance burden and may foreshadow additional scrutiny on off-campus hospital sites of outpatient services. HOPDs: Attestation and NPI Requirements Subject to specific regulatory conditions, departments of a Medicare-enrolled hospital provider that are “off campus,” i.e., generally more than 250 yards from the provider’s main campus or a remote location, are allowed to bill as provider-based departments of the hospital. For many years, whether a particular off-campus location met all regulatory requirements for provider-based status was the subject of an honor system for Medicare enrollment purposes, with organizations having the option to submit an attestation of provider-based status to the Centers for Medicare and Medicaid Services (CMS) (through the assigned CMS Medicare Administrative Contractor). These submissions were voluntary and offered the advantage of potentially reducing liability for overpayments if a location was determined not to meet the applicable requirements, but not all hospitals elected to submit them for their HOPDs. Now, § 6225 of the Act removes the previous optionality by imposing two additional requirements for off-campus outpatient departments of a hospital to continue receiving payment from Medicare for services furnished as provider-based on or after January 1, 2028: Attestation. Under the Act, each off-campus HOPD location must now submit an attestation of compliance with the provider-based regulatory requirements. The provider (i.e., main hospital) of an off-campus department must submit an initial attestation for existing departments before January 1, 2028. Providers must also submit subsequent attestations according to a timeframe and process to be determined by the Secretary of the Department of Health and Human Services (DHHS) through future regulations. Initial attestations will also be subject to the DHHS’ future process, but the statute permits providers to use the current attestation process for the initial attestation until the new process has been established. The uncertain regulatory process and timing for new attestation requirements in advance of the January 1, 2028, deadline creates additional uncertainty for hospitals nationwide. NPI. Starting January 1, 2028, each off-campus provider-based department must obtain and bill under its own NPI number rather than continue to bill under its provider’s NPI number. Assessing and Strengthening Departmental and Provider Regulatory Compliance Providers should assess whether their current off-campus department locations independently meet all applicable CMS regulatory requirements. Of note, certain Medicare Administrative Contractors offer checklists that can be used to compare against current provider-based status requirements, but organizations would also be well-advised to anticipate additional guidance from CMS. Preparing for Enhanced Government Scrutiny The Act directs DHHS to engage in rulemaking to determine the methods to review and determine compliance with the NPI and attestation requirements. Although site visits and remote audits are cited as potential methods for verifying compliance, the Act gives DHHS discretion to use other means “as determined appropriate.” This directive, in combination with the upcoming NPI requirement, may indicate a broader trend toward increased scrutiny of providers and more dynamic enforcement in the future. Providers should proactively prepare for potential investigations and ensure their attestations continue to be comprehensive and defensible, minimizing the risk of enforcement actions as the standards continue to evolve.

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Continuing Appropriations Act, 2026: Another Lifeline for Medicare Telehealth Flexibilities

This post was co-authored by Paul Palma, legal intern at Robinson+Cole. Paul is not admitted to practice law. On February 3, 2026, President Trump signed HR 7148, the Consolidated Appropriations Act, 2026 (“the Act”) ending the 4-day partial government shutdown. The Act, part of a broader fiscal year (FY) 2026 spending package, includes a further extension of Medicare telehealth flexibilities that recently expired on January 31, 2026. Originally introduced as temporary pandemic-era measures, these telehealth policies have been repeatedly sustained through short term legislative extensions. Here’s what the latest development means for the future of telehealth care. Medicare Telehealth Flexibilities Extended by the Act Geographic and Originating Site flexibilities: Medicare beneficiaries may continue to receive telehealth services in any location through December 31, 2027. Expanded Practitioner Eligibility: Occupational therapists, physical therapists, speech-language pathologists, and audiologists may continue providing Medicare-covered services via telehealth through December 31, 2027. Telehealth for FQHCs and RHCs: Federally qualified health centers (FQHCs) and rural health clinics (RHCs) may continue providing telehealth services through December 31, 2027, including the provision of mental health visits via telehealth to Medicare beneficiaries without needing to meet annual in-person service requirements. Audio-Only Telehealth: Telehealth services can continue to be provided via audio-only communications systems through December 31,2027. In-Person Requirement for Mental Health Visits: Medicare patients receiving services for the diagnosis, evaluation, or treatment of a mental health disorder via telehealth may continue to do so without having received a Medicare-covered in person item or service through January 1, 2028. Telehealth for the Recertification of Hospice Care: Hospice physicians and nurse practitioners may continue having face-to-face encounters to recertify a patient’s eligibility to remain on hospice via telehealth through December 31,2027. While this bill once again provides temporary relief for telehealth services, Congress is currently considering legislation that would make the current telehealth flexibilities permanent. Notably, H.R. 4206 and S. 1261, the house and senate versions of the CONNECT for Health Act of 2025, were introduced in early 2025. Although progress on those bills has been limited since their introduction, they continue to enjoy strong bipartisan back with H.R. 4206 obtaining 212 cosponsors and S. 1261 obtaining 71 co-sponsors. We will continue to monitor the progress of these and other telehealth related bills and provide updates as they arise.

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Two Weeks Notice for Covered Entities: February 16 Deadline Approaches to Update HIPAA Notice of Privacy Practices

February 16, 2026, is the deadline for each HIPAA covered entity to update its Notice of Privacy Practices (NPP) to incorporate new regulatory requirements enacted in 2024. Specifically, HIPAA-covered entities (including health care providers and health plans) are required to review and revise their NPPs as necessary to ensure compliance with a 2024 federal rulemaking related to records of treatment and referral for substance use disorder services under 42 C.F.R. Part 2 (Part 2 Records).  We previously discussed the 2024 Part 2 Records regulatory changes here, and the HIPAA regulatory rule addressing NPP updates and reproductive health care here (note that the reproductive health care regulations were subsequently vacated, as discussed here, but the NPP changes were upheld). Accordingly, by February 16, 2026, HIPAA-covered entities are obligated to update NPPs to address the protections afforded to Part 2 Records that may be created, received, or disclosed by HIPAA covered entities (including those who may have Part 2 programs as components of their organization). The required changes include, without limitation: For uses or disclosures that are prohibited or materially limited by Part 2, the NPP description of such use or disclosure must reflect the more stringent legal requirement; NPPs must include a statement to put individuals on notice of the potential that, once information is disclosed pursuant to the NPP, it may be subject to redisclosure by the recipient and no longer subject to HIPAA protection; NPPs must explain that Part 2 Records may now be used or disclosed pursuant to a single consent for treatment, payment, and health care operations purposes consistent with HIPAA (but subject to limited exceptions); NPPs must add a statement indicating that Part 2 Records (and testimony regarding such Records) cannot be used or disclosed in civil, criminal administrative or legislative proceedings without individual written consent, or pursuant to a court order after notice and an opportunity to be heard is given to the individual or the holder of the Records, and any such court order must be accompanied by a subpoena or other legal requirement compelling disclosure before the Records can be used or disclosed; and NPPs must explain that, for covered entities that create or maintain Part 2 Records and intended to use such Records for fundraising purposes, each individual patient must be given the opportunity to opt out of fundraising communications in advance. Now is the time for all HIPAA covered entities to review and confirm that their NPPs comply with federal law and, if not, to reach out to advisors to make the necessary changes. We are available to assist covered entities with all matters related to HIPAA, including NPP drafting and compliance.

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Song Remains the Same – Medicare Telehealth Services At Risk of Expiring Again on January 30, 2026

Healthcare providers are currently facing yet another termination of Medicare telehealth flexibilities at the end of the day on January 30, 2026, unless Congress acts on proposals to further extend the COVID-era flexibilities for telehealth. If no legislative action is taken before January 30, 2026, the providers and Medicare patients who have depended on expanded telehealth options will encounter substantial limitations in access beginning January 31, 2026.   As a reminder, in October-November 2025, in connection with the government shutdown, federal COVID-era telehealth flexibilities for Medicare beneficiaries expired, which led to significant billing challenges and restrictions in access for patients (which we previously discussed here). Those flexibilities were retroactively extended as part of the government funding bill passed in November 2025, through January 30, 2026. Health care providers, and their patients, are now in the same position of looking to Congress to act to further extend those flexibilities to protect continued access to telehealth services. It remains to be seen whether Congress will be able to pass another extension and, if so, how long the extension may be. There has been at least one proposal passed in the House of Representatives that would extend the telehealth flexibilities through December 31, 2027, but it remains to be seen if that will be taken up by the Senate. A summary of the existing telehealth waivers and their newly proposed expiration dates is included below. Key Telehealth Provisions Proposed to be Extended Geographic and Originating Site Flexibility: Without another extension, beginning January 31, 2026, Medicare beneficiaries may only receive telehealth services in approved health care facilities in rural locations (outside of metropolitan statistical areas); Note that the Social Security Act contains exceptions that would permit telehealth services at home (or other locations) for patients in specific circumstances approved by law or regulation, including patients being treated for: (1) symptoms of acute stroke; (2) substance use disorder; or (3) patients with mental health disorder; and (4) patients on home dialysis; Expanded Practitioner Eligibility: If the “cliff” is averted: Medicare patients would be allowed to receive care from approved Medicare-enrolled providers, which under the prior COVID-era waiver includes occupational therapists, physical therapists, speech-language pathologists, and audiologists; If the “cliff” is not averted:  Medicare beneficiaries will lose access to telehealth services provided by PTs, Ots, SLPs, and audiologists, all of whom play a key role in rehabilitation; Telehealth for FQHCs and RHCs: If the “cliff” is averted: Federally qualified health centers (FQHCs) and rural health clinics (RHCs) would be allowed to continue providing telehealth services to patients in other locations; Audio-Only Telehealth: If the “cliff” is averted: Telehealth services could continue to be provided via audio-only communications systems; If the “cliff” is not averted: Substantial limitation on coverage for audio-only services and providers must be technically capable of using audio-video technology; In-Person Requirement for Mental Health Visits: If the “cliff” is averted: Medicare patients may continue to receive mental health services from FQHCs and RHCs via telehealth; If the “cliff” is averted: Medicare patients receiving services for the diagnosis, evaluation, or treatment of a mental health disorder may continue to do so without receiving in-person care; If the “cliff” is not averted:  providers are required to furnish a Medicare-covered item to the beneficiary in-person at least six months prior to furnishing telehealth services. Additionally, the provider must furnish a Medicare-covered item in person at least once a year following each subsequent telehealth service. Note that the annual in-person follow-up requirement may be waived if the provider and beneficiary agree that the risks of receiving an in-person service outweigh the benefits; and Telehealth for the Recertification of Hospice Care: If the “cliff” is averted: Hospice physicians or nurse practitioners may continue having face-to-face encounters to recertify a patient’s eligibility to remain on hospice via telehealth. With the expiration date for the existing telehealth waivers looming, health care organizations should prepare to comply with additional telehealth restrictions beginning on January 31, 2026, similar to the situation faced in October 2025. We will continue to closely monitor this issue and will provide additional updates as soon as they become available.

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