Massachusetts Governor Maura Healey Signs into Law a Sweeping Health Care Market Oversight Bill
On January 8, 2025, Massachusetts Governor Maura Healey signed into law House Bill No. 5159, “An Act enhancing the health care market review process” (“H. 5159”), which was passed by the Massachusetts legislature in the last few days of 2024.
The bill will implement greater scrutiny of certain health care entities and affiliated companies—including private equity sponsors, significant equity investors, health care real estate investment trusts (“REITs”), and management services organizations (“MSOs”)—as well as pharmaceutical companies and pharmacy benefit management companies (“PBMs”) in the Commonwealth.
The passage of H. 5159 follows debate between the House and Senate earlier in 2024 over similar bills, which failed to pass during the summer legislative session. Notably, similar bills included debt limitations on certain private investor-backed entities and bans of certain private equity investments, as well as significant restrictions on the MSO business model. However, these restrictions (among various others) were stripped from H. 5159.
Although H. 5159 has widespread implications for health care entities in the Commonwealth, a significant portion of the bill is clearly aimed at increasing regulatory oversight of for-profit-backed health care organizations through increased regulatory oversight of certain health care transactions and expanded reporting obligations. The bill also seeks to contain health care costs, including by increasing oversight of pharmaceutical company and PBM arrangements.
Below in this alert we highlight some of the more significant provisions of H. 5159.
Health Policy Commission – Notices of Material Change
H. 5159 extends the authority of the Health Policy Commission (“HPC”) in the context of notices of material change under M.G.L. c. 6D § 13 (“Notices of Material Change”) to indirect owners and affiliates of health care providers, such as private equity companies, significant equity investors, MSOs, and health care REITs.
The bill also broadens the transactions that are subject to the HPC’s Notice of Material Change requirements to include (i) significant expansions in capacity of a provider or provider organization; (ii) transactions involving a significant equity investor resulting in a change of ownership or control of a provider or provider organization; (iii) real estate sale lease-back arrangements and other significant acquisitions, sales, or transfers of assets; and (iv) conversions of a provider or provider organization from a non-profit to a for-profit.
In the context of the HPC’s review of a Notice of Material Change, the HPC will be authorized to require the submission of documents and information from significant equity investors, such as information regarding the significant equity investor’s capital structure, financial condition, ownership and management structure, and audited financials.
H. 5159 also implements other related changes, such as reducing the market share threshold for mergers or acquisitions to be subject to the Notice of Material Change process (from “near majority” to “dominant” market share), enhancing the HPC’s authority to monitor post-transaction impacts, and expanding the review criteria for a cost and market impact review.
Health Policy Commission – Registration of Provider Organizations
Under H. 5159, the data and information collected under the HPC’s Massachusetts Registration of Provider Organizations Program (“MA-RPO Program”) will now also cover ownership, governance, and operational structure information of significant equity investors, health care REITs, and MSOs. H. 5159 also amends the MA-RPO Program reporting threshold to include revenue generated from payers other than commercial payers, such as governmental payers.
Health Policy Commission – Annual Cost Trends Hearing
As a complement to the increased authority discussed above, the list of stakeholders required to testify at the HPC’s Annual Cost Trends Hearing is expanded to include, among others, significant equity investors, health care REITs, and MSOs as well as PBMs and pharmaceutical companies.
Testimony from significant equity investors, health care REITs, and MSOs must cover topics such as health outcomes, prices, staffing levels, clinical workflow, financial stability and ownership structure of associated providers or provider organizations, dividends paid out to investors, and compensation (e.g., base salaries, incentives, bonuses, stock options, deferred compensation, benefits, and contingent payments to officers, managers, and directors of provider organizations owned or managed by the significant equity investors, health care REITs, or MSOs.
Testimony from PBMs and pharmaceutical companies must cover topics such as factors underlying drug costs and price increases as well as the impact of aggregate manufacturer rebates, discounts, and other price concessions on net pricing (provided that the testimony will not undermine the financial, competitive, or proprietary nature of the data).
H. 5159 further expands the topics covered by HPC’s Annual Cost Trends Hearings to expressly include costs, prices, and cost trends of providers, provider organizations, private and public payers, pharmaceutical companies, and PBMs as well as any impact of significant equity investors, health care REITS, or MSO on those costs, prices, and cost trends.
Health Policy Commission and CHIA – Operations Assessments
H. 5159 expands the categories of entities required to pay assessments to help fund the HPC and Center for Health Information and Analysis (“CHIA”) to include “non-hospital provider organizations,” pharmaceutical companies, and PBMs. A “non-hospital provider organization” is defined as any provider organization registered under the MA-RPO Program that is a non-hospital-based physician practice with annual gross patient service revenue of at least $500 million, a clinical laboratory, an imaging facility, or a network of affiliated urgent care centers. The methodology for calculating the amount assessed against each entity is based on entity type and the total amount appropriated by the Massachusetts legislature for the operation of HPC and CHIA.
CHIA – Reporting Requirements
Under H. 5159, CHIA will collect additional information from acute and non-acute care hospitals regarding their parent organizations and significant equity investors, health care REITs, and MSOs. Such information includes the audited financial statements of parent organizations’ out-of-state operations, significant equity investors, health care REITs, and MSOs, as well as financial data on margins, investments, and any relationships with significant equity investors, health care REITs, and MSOs.
H. 5159 also expands the scope of CHIA’s data collection under the MA-RPO Program. Notably, information subject to annual reporting will include, in relevant part, (i) comprehensive financial statements that include data on parent entities (including their out-of-state operations), corporate affiliates (including significant equity investors, health care REITs, and MSOs, as applicable), annual costs, annual receipts, realized capital gains and losses, accumulated surplus, and accumulated reserves; and (ii) information regarding other assets and liabilities that may affect the financial condition of the provider organization or the provider organization’s facilities (e.g., real estate sale-leaseback arrangements with health care REITs).
H. 5159 further provides that CHIA may require in writing, at any time, such additional information as CHIA deems reasonable and necessary to determine a registered provider organization’s organizational structure, business practices, clinical services, market share, or financial condition, including information related to its total adjusted debt and total adjusted earnings.
CHIA will also have the authority to require registered provider organizations with private equity investment to report required information on a quarterly basis and require disclosure of relevant information from any significant equity investor associated with a registered provider organization. CHIA may also assess increased penalties for non-compliance with these reporting requirements.
Acute and non-acute care hospitals and registered provider organizations should note that, pursuant to M.G.L. c. 12C § 17, the Massachusetts Attorney General (“AG”) may review and analyze any information submitted to CHIA under M.G.L. c. 12C §§ 8, 9, and 10. Thus, the AG may review and analyze all information regarding significant equity investors, health care REITs, and MSOs submitted to CHIA under H. 5159’s expanded reporting requirements.
Department of Public Health (“DPH”) – Determinations of Need
With exceptions, existing Massachusetts law forbids entities from making substantial capital expenditures for the construction of a health care facility or substantially changing the service of the facility unless DPH has approved a determination of need application (“DON”). H. 5159 expands and clarifies DPH considerations in reviewing a DON. These include (i) the state health resource plan; (ii) the Commonwealth’s cost containment goals; (iii) the impacts on the applicant’s patients, including considerations of health equity, the workforce of surrounding health care providers and on other residents of the commonwealth; and (iv) any comments and relevant data from CHIA and the HPC, and any other state agency. H. 5159 codifies a current DPH regulation allowing the period of time DPH has to review a DON to toll if an independent cost-analysis is required and clarifies the effective date of a determination of need issued to holders subject to cost and market impact reviews and/or performance improvement plans. Finally, the legislation adds that a party of record may review a DON for which it is appropriately registered and provide written comment or specific recommendations for consideration by DPH.
Department of Public Health – Licensure of Acute-Care Hospitals
H. 5159 adds provisions to the licensure process of acute-care hospitals, mandating that no original license shall be granted or renewed to establish or maintain such facilities if the main campus of the acute-care hospital is leased from a health care REIT (with an exemption for those acute-care hospitals leasing a main campus from a health care REIT as of April 1, 2024). An exempt acute-care hospital shall remain exempt “after a transfer to any transferee and subsequent transferees,” and those transferees shall be issued a license upon meeting all other requirements. “Main campus” is defined in H. 5159 as “the licensed premises within which the majority of inpatient beds are located.” Additional new licensure requirements for acute-care hospitals mandate the disclosure of documents to DPH relating to leases, licenses, or other agreements for the use, occupancy, or utilization of the premises occupied by the acute-care hospital. Acute-care hospitals also must remain in compliance with applicable reporting requirements.
Department of Public Health – Licensure of Office-Based Surgical Centers
H. 5159 mandates that DPH, in consultation with the Massachusetts Board of Registration in Medicine, establish rules, regulations, and practice standards for the licensing of office-based surgical centers by October 1, 2025. Such licensure will be effective for an initial period of two years and subject to renewal. Pursuant to H. 5159, DPH may impose a fine of up to $10,000 on (1) a person or entity advertising, announcing, establishing, or maintaining an office-based surgical center without a license and (2) a licensed office-based surgical center that violates DPH’s forthcoming rules and regulations. Each day during which a violation continues will constitute a separate offense, and DPH may conduct surveys and investigations to enforce compliance. Notwithstanding the foregoing, H. 5159 permits DPH to grant a one-time provisional license to applicant office-based surgical centers if such applicants hold a (1) current accreditation from the Accreditation Association for Ambulatory Health Care, American Association for Accreditation of Ambulatory Surgery Facilities, or the Joint Commission; or (2) current certification for participation in Medicare or Medicaid, and DPH determines that such applicants meet all other licensure requirements.
Attorney General’s Office – False Claims Statute
H. 5159 amends the Massachusetts False Claims Statute to extend potential liability to those with an “ownership or investment interest” in an entity that violates the statute, if such owner or investor knows of the violation and fails to disclose it to the Commonwealth within 60 days of identifying the violation. As a result, the AG has broadened authority to pursue actions against private equity companies and other owners or investors for not addressing a violation of the False Claims Act of which they are aware, regardless of whether the private equity company or other owner or investor caused the violation. Notably, the definition of “ownership or investment interest” captures significant equity investors, as defined elsewhere in the bill, as well as private equity companies with any investment or ownership interest in an entity that violates the statute.
Primary Care Payment and Delivery Task Force
H. 5159 also establishes a 23-member primary care payment and delivery task force (“Task Force”) charged with (i) studying primary care access, delivery, and payment; (ii) developing and issuing recommendations to stabilize and strengthen the primary care system and increase recruitment and retention of primary care workers; and (iii) increasing investment in, and patient access to, primary care in the Commonwealth.
Among other recommendations, the Task Force must create a primary care spending target for private and public payers that takes into account the cost to deliver evidence-based, equitable, and culturally competent primary care services and propose payment models to increase private and public reimbursement for primary care services.
The bill requires the Task Force to issue its first recommendations by September 15, 2025, and requires recommendations to be issued in a sequential manner thereafter, through May 15, 2026.
Takeaways
The true impact of H. 5159 will depend in large part on the regulatory bodies tasked with enforcement and implementation of its provisions. Importantly, we expect that HPC, which has been petitioning the legislature for greater oversight authority over the past several years to review private equity health care investments in Massachusetts, will play a central role in determining the level of scrutiny for-profit investors in hospital systems and provider organizations will face moving forward.
Ann W. Parks contributed to this article
The North Carolina Board of CPA Examiners: A Licensed Professional User’s Guide
The North Carolina Board of CPA Examiners (“Board”) plays a pivotal role in ensuring the integrity and professionalism of the accounting field within the state.
As the governing body for Certified Public Accountants (“CPAs”), the Board upholds rigorous standards of practice, oversees the licensing process, and enforces compliance with ethical rules and regulations. For both aspiring CPAs and experienced professionals, understanding the Board’s responsibilities, processes, and expectations is essential for navigating the path to licensure and maintaining professional standing. It can be a daunting task navigating the expectations. This article highlights some of the requirements and functions for licensees.
Licensing Process
The licensing process for Certified Public Accountants (CPAs) in North Carolina is a structured pathway that involves meeting educational, examination, and experience requirements. The North Carolina Board of CPA Examiners oversees the critical examination component of this process, managing the application, administration, and scoring of the Uniform CPA Exam. This exam is a crucial step in obtaining CPA licensure in all U.S. jurisdictions, and while the education and experience requirements may differ across states, the Uniform CPA Exam remains the same nationwide.
To sit for the Uniform CPA Exam in North Carolina, candidates must meet several eligibility criteria:
Be a U.S. citizen or resident alien, or a citizen of a foreign jurisdiction with similar examination privileges.
Be at least 18 years old.
Be of good moral character.
Meet the specific education requirements outlined by the Board.
Applicants may not be eligible to take the exam if the Board determines the applicant has violated the laws and rules of Professional Ethics and Conduct. An applicant can challenge this determination. Additionally, exam applicants are required to undergo a background check as part of the application process. If an applicant is concerned about a criminal conviction in their past and whether they will be eligible for licensure, they may ask the Board for a predetermination of eligibility as early as prior to entry into an educational program. Experienced counsel should be considered to assist in navigating these processes.
In addition to successfully passing the Uniform CPA Exam, an applicant must provide evidence of appropriate work experience and proof of successful completion of the North Carolina Association of CPAs course, NC Accountancy Law: Ethics, Principles, & Professional Responsibilities, an accountancy law course. The work experience and course must be completed prior to applying for licensure with the Board.
Maintaining the License
Once licensed, it’s important to carefully maintain all aspects of the Board’s requirements to retain the license. All CPAs licensed in North Carolina must:
renew their license annually before July 1 and pay a $60 renewal fee
complete Continuing Professional Education (CPE) in accordance with 21 NCAC 08G .0401, including at least 50 minutes of regulatory or behavioral professional ethics and conduct by December 31 each year and report those at the time of renewal
retain CPE completion certificates and provide them to the Board upon notification of an audit
notify the Board in writing of any change in mailing address, physical address, practice/business address, phone number, employment, email address, or website address within 30 days of a change
Failure to comply with any of the above could result in the licensee being disciplined.
Navigating Practice Complaints
A complaint against a CPA to the Board is taken seriously. An investigation can be quite daunting and overwhelming to the professional faced with one, and experienced counsel should be considered by the CPA if an investigation is opened.
The Board’s Professional Standards Committee (“Committee”) is a three Board member committee tasked with enforcing the Board’s law and rules of Professional Ethics and Conduct. Violations of the law or rules may result in discipline to the CPA in the form of revocation (partial or in full) of the license, censure, and/or imposition of a civil penalty.
The Board has jurisdiction to investigate and take action pursuant to their authority in N.C. Gen. Stat. §93-12(9) which states:
The Board shall have the power to adopt rules of professional ethics and conduct to be observed by certified public accountants in this State and persons exercising the practice privilege authorized by this Chapter. The Board shall have the power to revoke, either permanently or for a specified period, any certificate issued under the provisions of this Chapter to a certified public accountant or any practice privilege authorized by the provisions of this Chapter or to censure the holder of any such certificate or person exercising the practice privilege authorized by this Chapter. The Board also shall have the power to assess a civil penalty not to exceed one thousand dollars ($1,000) for any one or combination of the following causes:
Conviction of a felony under the laws of the United States or of any state of the United States.
Conviction of any crime, an essential element of which is dishonesty, deceit or fraud.
Fraud or deceit in obtaining a certificate as a certified public accountant.
Dishonesty, fraud or gross negligence in the public practice of accountancy.
Violation of any rule of professional ethics and professional conduct adopted by the Board.
Any disciplinary action taken shall be in accordance with the provisions of Chapter 150B of the General Statutes. The clear proceeds of any civil penalty assessed under this section shall be remitted to the Civil Penalty and Forfeiture Fund in accordance with G.S. 115C-457.2.
When the Board receives a complaint, staff and legal counsel review the allegations and evidence submitted. Once a determination has been made that an investigation should be commenced, an inquiry letter is sent to the CPA, allowing for a response to the allegations.
If you receive an inquiry letter, always respond. All CPAs are required to participate in inquiries from the Board. In a written response, be mindful of your tone and resist being argumentative or using unprofessional language. Provide the documentation requested, if any, in order to inform the Board and assist in their full and informed decision making. Experienced counsel at the inquiry stage can be quite helpful in determining the appropriate path of response. The Board is not obligated to provide counsel; however, every CPA has the right to be represented.
After their review of your response, the staff and legal counsel may send your reply to the Complainant for further information and response. The inquiry may end at this point if the determination is made that no violation has occurred.
If staff and legal counsel believe a violation has occurred, the Committee will be asked to review the complaint, any supporting documentation, and response(s). Their duty is to recommend to the full Board a resolution to the complaint after weighing whether there is competent evidence to proceed. They may recommend closing the matter, requesting additional information, or recommending that the matter continue forward down the disciplinary path. You or your counsel will be informed of their decision.
The Committee also has the ability to offer the CPA a resolution to settle the matter. The CPA (or their counsel) will receive the offer in the form of a consent order. This is an informal process, and a CPA should evaluate all the facts and violations alleged, as well as the sanction offered. Again, experienced counsel can assist with determining whether the offer of resolution proposed is reasonable or whether further due process is warranted. A public hearing, while expensive and time consuming for the CPA, may nonetheless be necessary.
MiCAR in der Praxis: BaFin veröffentlicht Merkblatt für Krypto-Dienstleistungen
Die Bundesanstalt für Finanzdienstleistungsaufsicht („BaFin„) hat zum Jahresbeginn ein Merkblatt zu den Kryptowerte-Dienstleistungen gemäß der neuen EU-Verordnung über Märkte für Kryptowerte („MiCAR„) veröffentlicht. Diese Verordnung gilt seit dem 30. Dezember 2024 unmittelbar für Krypto-Dienstleister in der EU.
Das Merkblatt bietet Klarstellungen zu den erlaubnispflichtigen Krypto-Dienstleistungen und den Anforderungen an Anbieter. Die wesentlichen Punkte im Überblick:
Definitionen von Krypto-Dienstleistungen: Die BaFin präzisiert die erlaubnispflichtigen Kryptowerte-Dienstleistungen und verknüpft diese mit den bereits bekannten Wertpapierdienstleistungen der MiFID II.
Zulassung von Krypto-Dienstleistern: Das Merkblatt enthält detaillierte Informationen, ab wann eine Zulassungspflicht besteht und welche Unternehmen zulassungsfähig sind.
Notifizierung: Unternehmen mit bestehenden Lizenzen (z. B. Kredit- oder Wertpapierinstitute) können bestimmte Kryptowerte-Dienstleistungen ohne gesonderte Erlaubnis erbringen, müssen dies jedoch der BaFin gemäß den Vorgaben der MiCAR anzeigen (sog. „Notifizierung„). Die genauen Anforderungen an die Notifizierung werden im Merkblatt erläutert.
Das Merkblatt bietet Krypto-Unternehmen eine praktische Orientierungshilfe, um die neuen regulatorischen Anforderungen der MiCAR sicher und effizient zu erfüllen.
TMA Chicago Midwest Podcast Hosted by Paul Musser | Chapter President David Levy Talks How to ‘Make It Rain,’ Distressed Deal Financing and the State of Commercial Real Estate [Podcast]
For the first 2025 episode of the TMA Chicago Midwest Podcast, Insolvency and Restructuring Partner and host Paul Musser sat down with David Levy, the newly appointed President of the Turnaround Management Association’s (TMA) Chicago/Midwest Chapter. David, who also leads Chicago/Midwest operations for Summit Investment Management and Keen-Summit Capital Partners, shared insights from his journey in restructuring, his aspirations for the TMA chapter in 2025, and his background in distressed debt and real estate markets.
While describing the path that led him to become TMA’s president, David said that he has been driven by his recognition of the incredible network and opportunities that the organization provides, highlighting the importance of a community that supports its members’ professional growth. Following a simple encouragement from his boss at the time to get involved, David developed meaningful connections and assumed roles within the organization, including his participation in TMA’s membership committee. He went on to emphasize the collegial atmosphere and dynamic nature of TMA, where individuals from a multitude of professional backgrounds come together to solve complex problems and support each other’s growth.
As its 2025 president, David shared that he aims to celebrate the strengths of TMA’s Chicago/Midwest Chapter while introducing new initiatives. His primary goals are to enhance membership engagement and create a pipeline for future members through university relations. He also plans to leverage professional development programs, such as the popular “13-Week Cash Flow” webinar, to spread the word about TMA’s work with a focus on exploring opportunities in the large-cap sector. David’s theme for the year, “Make It Rain,” reflects his goal of inspiring members to leverage TMA for business growth and to help the broader restructuring industry recognize the impact of their work.
David also delved into the current state of the real estate market and, as the podcast’s first guest in the distressed debt area, the role of distressed note buyers such as Summit Investment Management in the restructuring field. He noted that while market conditions have improved, there is still a significant amount of distressed commercial real estate that needs to be addressed. Distressed note buyers play a crucial role in managing and resolving these troubled assets, offering solutions that range from purchasing distressed debt and providing bridge loans to facilitating structured workouts.
Throughout the episode, David underscored the importance of networking and business development, marketing oneself and participating in professional organizations such as TMA. He concluded by advising those who are just starting out in the industry to invest time in building relationships and be proactive in their marketing efforts. By consistently engaging with their network and being helpful to others, they can then position themselves as valuable resources and create opportunities for career growth. David’s insights and experiences serve as a testament to the power of community and the impact of strategic networking, particularly in the insolvency and restructuring industry.
What Private Equity Investors and Real Estate Investment Trusts Need to Know About the Newly Enacted Massachusetts Health Oversight Law
On December 30, 2024, the Massachusetts state legislature passed House Bill 4653 (the Act), which significantly enhances regulatory oversight in the Massachusetts health care market. As signed into law by Governor Maura Healy on January 8, the Act will have profound effects for private equity (PE) investors and real estate investment trusts (REITs) engaging with the Massachusetts health care market. Passage of the Act comes on the heels of prominent PE-backed hospital failures in Massachusetts.
The Act Expands Existing Law and Government Infrastructure to Address Issues in Health Care Quality and Affordability
The Act overhauls the functions of, and increases coordination among, certain state agencies, including the Health Policy Commission (HPC), Department of Public Health (DPH), and the Center for Health Information and Analysis (CHIA). In addition, the Act expands the investigatory and enforcement powers of the Massachusetts Attorney General (MA AG) as it relates to health care activities, with particular attention to private equity investors, REITs, and management services organizations (MSOs). The Act does the following:
Increases HPC Oversight for PE Investors, REITs, and MSOs
The HPC is a Massachusetts government agency charged with monitoring health care cost trends and reviewing certain “material changes” to health care providers (e.g., proposed changes in ownership, sponsorship, or operations by health care providers). The Act broadens the scope of the HPC cost trend hearings to encompass a review of pharmaceutical manufacturers, pharmacy benefit managers (PBMs), PE investors, REITs, and MSOs. Additionally, Registered Provider Organizations (RPO) now must disclose ownership information about PE investors, REITs, and MSOs to HPC.
The bill amends the HPC Material Change Notification (MCN) process and now stipulates that the following activities are material changes for providers and provider organizations, in addition to certain mergers, affiliations, and acquisitions:
Significant expansions in capacity.
Transactions involving a significant equity investor which result in a change of ownership or control.
Significant transfers of assets, including, but not limited to, real estate sale leaseback arrangements.
Conversion from a non-profit to a for-profit organization.
In addition to expanding the scope of the MCN process, the Act allows the HPC to make and refer to the MA AG a report on certain proposed material change transactions, which creates a rebuttable presumption that the provider or provider organization has engaged in unfair or deceptive trade practices. Upon receipt of such a report, the MA AG is permitted to seek legal redress, including injunctive relief, and the proposed material change cannot be completed while that legal action remains pending.
Expands CHIA Oversight of PE Investors, REITs, and MSOs
CHIA is an existing Massachusetts government agency that is generally charged with improving transparency and equity in the health care delivery system. Significant among CHIA’s responsibilities is the collection, evaluation, and reporting of financial information from certain health care organizations. The Act expands CHIA’s oversight in the following ways:
As with the HPC, expands RPO reporting requirements to include PE investors, REITs, MSOs, and certain other entities.
Increases financial penalties for failure to make timely reports to CHIA.
Expands hospital financial information reporting and monitoring requirements as to relationships with significant equity investors, REITs, and MSOs.
Requires CHIA to notify HPC and DPH of failures to comply with reporting requirement which, in turn, will be considered by HPC and DPH in their review and oversight activities.
Increases DPH Oversight and Authority to Include Hospitals with PE Investor or REIT Relationships
The Act expands DPH health facility licensure and Determination of Need (DON) oversight and authority in a variety of ways:
Charges DPH with establishing licensure and practice standards for office-based surgical centers and urgent care centers.
Directs that the Board of Registration in Medicine be under the oversight of DPH in certain ways.
Amends the DON review process for projects, which will be guided by considerations that include the state health plan, the state’s cost-containment goals, impacts on patients and the community, and comments and relevant data from CHIA, HPC, and other state agencies. DPH may impose reasonable conditions on the DON as necessary to achieve specified objectives, including measures to address health care disparities to better align with community needs. The DPH may also consider special circumstances related to workforce, research, capacity, and cost. These special needs and circumstances may pertain to a lack of supply for a region, population, or service line as identified in the state health plan or focused assessments.
Prohibits DPH from granting or renewing a license for an acute care hospital if its main campus is leased from a REIT. However, any acute care hospital leasing its main campus from a REIT as of April 1, 2024, is exempt from this prohibition.
Prohibits DPH from granting or renewing a hospital license unless all documents related to any lease, master lease, sublease, license, or any other agreement for the use, occupancy, or utilization of the premises are disclosed to DPH.
Prohibits DPH from granting or renewing any hospital license unless the applicant is in compliance with all CHIA reporting requirements.
Permits DPH to seek an HPC analysis on the impact of a proposed hospital closure or discontinuation of services.
Expanded MA AG Authority Over PE Investors, REITs, and MSOs
In addition to the MA AG authority noted above in seeking to enjoin transactions that create concern for the HPC, the Act expands the MA AG’s investigatory powers pertaining to false claims to encompass document production, answering interrogatories, and providing testimony under oath by provider organizations, significant equity investors, health care REITs, and MSOs. Similarly, and significantly, the MA AG’s authority to seek civil monetary penalties for health care false claims act violations is expanded to include those parties that have an ownership or investment interest in a violating party.
Key Takeaways
The Massachusetts legislature aims to improve the quality and affordability of health care in the Commonwealth by increasing transparency of private investment in the health care market. The Act overhauls and increases coordination among state agencies like the HPC, DPH, and CHIA, and expands the investigatory and enforcement powers of the MA AG. For-profit investors and REITs must be aware of the following provisions of the Act to avoid civil penalties and state-sanctioned injunctions, and in planning for transactions and investments in Massachusetts:
Increased HPC Oversight: The HPC’s annual cost trend includes reviews of pharmaceutical manufacturers, PBMs, PE investors, REITs, and MSOs. New MCNs (significant expansions, equity investor transactions, asset transfers, and organizational conversions) must be reported to HPC in a timely manner.
Increased CHIA Oversight: CHIA’s scope of oversight for RPOs includes PE firms, REITs, and MSOs. The Act increases financial penalties for providers’ noncompliance and enhances hospital financial reporting. CHIA must inform HPC and DPH of providers’ reporting failures, which will influence HPC and DPH oversight activities.
Increased DPH Authority: DPH’s oversight now includes development and implementation of licensure standards for surgical and urgent care centers. DPH may not issue or renew licenses for acute care hospitals leasing their main campus from an REIT, subject to the April 1 exemption, or to a party not in compliance with CHIA reporting requirements. DPH also has increased authority to require information regarding leasing and other operational contracts prior to issuing a hospital license.
Increased MA AG Authority: The MA AG’s powers are expanded to include investigatory and enforcement actions against false claims involving PE investors, REITs, and MSOs.
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HUD’s Proposed ORCA Program – A New Option for Earlier Mortgagee Reimbursement
On December 19, 2024, the Fair Housing Administration (FHA) and the U.S. Department of Housing and Urban Development (HUD) published a draft Mortgagee Letter proposing a new Optional Reimbursement Claim Alternative (ORCA) program. ORCA is intended to allow mortgagees to seek reimbursement for property tax and insurance payments the mortgagee advances on behalf of forward mortgage borrowers before the final claim payment.
Overview of ORCA
As outlined in the draft Mortgagee Letter, ORCA enables mortgagees to file early claims for reimbursement of advances made toward property taxes, hazard insurance, and flood insurance on defaulted forward mortgages. Currently, these costs are reimbursed only after the final resolution of a claim to HUD, meaning mortgagees are required to incur significant upfront costs for an uncertain period of time. The draft Mortgagee Letter recognizes that in the current higher interest rate environment these upfront costs are potentially exacerbating mortgagee liquidity issues.
If enacted, ORCA will allow mortgagees to make multiple claims during a single default episode. The term “single default episode” is not defined, but given FHA’s definition of “default,” a “single default episode” would likely encompass the period in which a borrower is at least 30 days delinquent under the mortgage until the borrower cures the delinquency. For a single default episode, mortgagees can claim up to 48 months of payments for eligible expenses, provided they meet the following eligibility requirements:
All property taxes and insurance obligations are paid before the due date;
The escrow funds intended for these expenses “were exhausted and were inadequate to meet these obligations;”
The delinquency/default code accurately reflects that the relevant mortgage has been in default for at least six months; and
The maximum allowable ORCA claims have not already been filed for a particular default.
In addition to the eligibility requirements above, mortgagees should be aware that initial ORCA claims can be submitted six months from the initial date of default, with subsequent claims allowed “no less than six months from the date the previous ORCA was filed.” Additionally, mortgagees will be required to maintain copies of all ORCA claims, as well as detailed servicing and transaction histories supporting the amounts claimed. Mortgagees should be sure to review the draft Mortgagee Letter to get a better understanding of the detailed proposed changes to the FHA Single Family Housing Policy Handbook related to the implementation of the ORCA program.
Takeaways
ORCA appears to offer mortgagees a positive new avenue for FHA claims that will likely ease liquidity pressures during the mortgage servicing process. By facilitating earlier reimbursement, HUD seems to recognize the need to mitigate the financial burdens mortgagees face and better position them to effectively service FHA mortgages. In light of the potential impact ORCA could have, we encourage mortgagees and other industry participants to review the draft Mortgagee Letter announcement and to provide feedback by the response deadline of March 3, 2025.
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AFIDA Penalties Are Coming: Costs for Renewable Development May Be More Than You Think
When evaluating the all-in costs of a renewable development project, it is critical that costs associated with Agricultural Foreign Investment Disclosure Act (AFIDA) enforcement and compliance are considered. Since its enactment in 1978, AFIDA has provided for substantial penalties for the failure to file, or the late filing, of mandated reports on agricultural acreage held by an entity with an ultimate non-U.S. parent.
AFIDA reporting requirements are applicable to any non-U.S. based direct or indirect owner of agricultural land, which includes every company organized in the United States but in which a significant interest or substantial control (i.e., ten percent or more) is held by a non-U.S. parent.
A substantial percentage of renewable development in the United States is driven by companies that fall within the bounds of AFIDA’s reporting obligations, yet a small number of renewable developers appear to be current with their AFIDA reporting obligations.
Both the acquisition and disposition of agricultural land are required to be reported to the United States Department of Agriculture within 90 days of the acquisition or disposition. Stated another way, each executed lease or fee interest purchase of agricultural land, or the disposition of either, starts the clock ticking.
If AFIDA compliance reporting and potential penalties are not yet on your company’s diligence checklist, this may be about to change.
Penalties for failure to file or late-filing can be a substantial cost to renewable development. Federal regulations enable penalties of up to 25% of the fair market value of the land, as determined by the USDA.
Although penalties have been an option since AFIDA’s enactment, a review of the USDA’s annual report to Congress reveals that relatively few, and relatively small, penalties were assessed up until 2010. The USDA assessed only eight penalties for AFIDA violations between 2012-2022, although the number of filings dramatically increased during the same time period. AFIDA filings were made for 911 parcels of land in 2012, which jumped to 6,363 parcels in 2021. No penalties were assessed for AFIDA violations during the period 2015-2018 due to low levels of staffing in the office tasked with enforcing the law.
The number of AFIDA compliance and enforcement specialists at the USDA has doubled within the last year and a half, in part due to questioning of the gap in AFIDA enforcement by concerned members of the House. In response to this concern, the USDA responded by noting its increased staffing and its renewed commitment to assessing ex post penalties starting with late filings in the calendar year 2021 and going forward.
If your company acquires leasehold or fee interests in agricultural property and has a non-U.S. parent, it is very likely that Federal AFIDA reporting obligations apply. More than half of all states have similar reporting requirements as well.
If AFIDA is applicable to your business, it is critical that you engage counsel experienced in AFIDA matters to rectify any historical failures to report and establish a process for ongoing AFIDA compliance. Waiting until the final due diligence call to mention AFIDA compliance to counterparties is not your best strategy.
AFIDA in Brief:
Who Must Report?
Foreign investors who have significant interest or substantial control and acquire, dispose of, or hold an interest in U.S. agricultural land must report their holdings and transactions to the U.S. Department of Agriculture. Interests include land owned as well as land leased for ten years or more. This includes:
Foreign individuals.
Foreign organizations.
Foreign governments.
U.S. organizations – if a significant interest or substantial control is directly or indirectly held by foreign individuals, organizations, or governments.
How is Agricultural Land Defined by AFIDA?
Land exceeding 10 acres in the aggregate that has been used within the last 5 years for farming, ranching, forestry, or timber production.
Land exceeding 10 acres in which 10 percent is stocked by trees of any size, including land that formerly had such tree cover and will be naturally or artificially regenerated.
Landholding totaling 10 acres or less in the aggregate if producing annual gross receipts in excess of $1,000 from the sale of farm, ranch, forestry, or timber production.
Complying With the New “Open Banking” Regime: Primer and Fact Sheet
The Consumer Financial Protection Bureau (CFPB) finalized its “open banking” rule in late 2024. As required by Section 1033 of the Consumer Financial Protection Act, the CFPB promulgated the rule to require certain financial services entities to provide for the limited sharing of consumer data and to standardize the way in which that data is shared. The CFPB has stated that the open banking rule will “boost competition” by facilitating consumers’ ability to switch between banks and other financial service providers.
In general, the open banking rule:
Provides consumers with control over their data in bank accounts, credit card accounts, and other financial products, including mobile wallets and payment apps;
Allows consumers to authorize third-party access to consumers’ data including transaction information, account balance information, and information needed to initiate payments; and
Requires financial providers to make this information in accurate, machine-readable format and with no charge to consumers.
For more background on the history and policy of open banking, please review our prior alert.
Compliance Deadlines
Numerous comments to the proposed rule urged the CFPB to lengthen the period of time for businesses to comply with the rule. The CFPB responded to those comments by extending the original six month compliance date for the largest affected institutions to provide a 1.5 year implementation period. The table below summarizes the compliance schedule by which different sized entities must operate in compliance with the rule:
Compliance Timeline
Depository Institutions
Nondepository Institutions
1 April 2026 (~1.5 years)
At least US$250b total assets
At least US$10b in total receipts as of either 2023 or 2024
1 April 2027 (~2.5 years)
At least US$10b total assets, but less than US$250b total assets
Less than US$10b in total receipts in both 2023 and 2024 (this is the final compliance date for nondepository institutions)
1 April 2028 (~3.5 years)
At least US$3b total assets, but less than US$10b total assets
–
1 April 2029 (~4.5 years)
At least US$1.5b total assets, but less than US$3b total assets
–
1 April 2030 (~5.5 years)
Less than US$1.5b total assets, but more than US$850m (depositories holding less than US$850m are exempted from compliance)
–
Making Consumer Financial Data Available
Under the final rule, a “data provider” must provide, at the request of a consumer or a third party authorized by the consumer, “covered data” concerning a consumer financial product or service that the consumer obtained from the data provider. The rule defines data provider to include depository institutions, electronic payment providers, credit card issuers, and other financial services providers. The rule defines covered data to include transaction information, account balances, and other information to enable payments.
A data provider’s obligations regarding covered data arise only when holding data concerning a consumer financial product or service that the consumer actually obtained from that data provider. Notwithstanding third-party obligations, merely possessing data from another data provider does not implicate the rule. The CFPB revised the definition of covered data in a manner that offers some clarity for the consumer reporting agencies (CRAs), which typically gather data for other entities for consumer credit reports.
Electronic Payments
Credit Cards
Other Products and Services
Data Provider
A financial institution, as defined in Regulation E.
A card issuer, as defined in Regulation Z.
Any other person that controls or possesses information concerning a covered consumer financial product or service that the consumer obtained from that person.
Covered Consumer Financial Product or Service
A Regulation E account.
A Regulation Z credit card.
Facilitation of payments from a Regulation E account or Regulation Z credit card.
Data Provider Interfaces
As part of the provision of data, data providers must create both consumer and developer interfaces to enable the efficient provision and exchange of consumer data. In addition to various technical requirements, data providers must also establish and maintain written policies and procedures to ensure the efficient, secure, and accurate sharing of consumer data. Data providers are prohibited from charging fees for providing this service.
Interface Requirements
Consumer Interface
Developer Interface
When to Provide Data
Data provider receives information sufficient to: (1) authenticate the consumer’s identity; and (2) identify the scope of the data requested.
Data provider receives information sufficient to: (1) authenticate the consumer’s identity; (2) authenticate the third party’s identity; (3) document the third party is properly authorized; and (4) identify the scope of the data requested.
Data Format
Machine-readable file
Standardized and machine-readable file
Interface Performance
Strict requirement to provide data
Minimum 95% success rate
Data Request Denials
Unlawful, insecure, or otherwise unreasonable requests may be denied
Unlawful, insecure, or otherwise unreasonable requests may be denied
Authorizing Third Parties
To lawfully access covered data, a third party must generally do three things, namely: (1) provide the consumer with an authorization disclosure; (2) certify that the third party complies with various restrictions on the use of the data; and (3) obtain the consumer’s express approval to access the covered data.
The rule prohibits three uses of data: (1) targeted advertising; (2) cross-selling of other products or services; and (3) selling covered data. While commenting on the proposed rule, several CRAs requested that the CFPB allow for use of covered data for internal purposes such as research and development of products. The CFPB found this reasonable and permitted “uses that are reasonably necessary to improve the product or service the consumer requested.”
Conclusion
The open banking rule establishes a robust framework for the exchange and transmission by certain entities regarding certain types of consumer data and the safeguarding of that data. Although the final rule extends the implementation deadlines beyond those originally proposed, implementation will require careful coordination among various functions of affected data providers’ businesses and by entities authorized to receive covered data.
Navigating the UTPR and ISDS: Implications in the EU
Overview
The global tax landscape is experiencing a profound transformation as the OECD/G20’s Pillar Two rules are adopted. Among these, the Undertaxed Profits Rule (UTPR) has emerged as a pivotal mechanism designed to ensure that multinational enterprises are subject to a minimum effective tax rate of 15% on their global profits. For those companies operating within the European Union, the implementation of the UTPR presents both a significant compliance challenge and a strategic risk.
In this client alert, we offer an analysis of the operational framework of the UTPR, examine its potential ramifications for businesses within the EU, and explain how Investor-State Dispute Settlement (ISDS) mechanisms can play a pivotal role in resolving disputes arising from this innovative tax measure for States and multinational enterprises.
In Depth
WHAT IS THE UTPR?
The Undertaxed Profits Rules, integral to the broader Pillar Two framework, complements the Income Inclusion Rule (IIR) by addressing low-taxed profits that are otherwise not subject to taxation under the IIR. Its primary objective is to bridge gaps in the taxation of multinational enterprises, ensuring that all group entities contribute a minimum level of tax.
Under the UTPR, jurisdictions may levy top-up taxes on low-taxed income that is not otherwise captured by the IIR. This mechanism functions by reallocating taxing rights among jurisdictions, effectively serving as a safeguard against base erosion and profit shifting.
In the EU, the UTPR has been codified through the Directive on Global Minimum Taxation, which was adopted in December 2022. Member States were required to implement the directive into domestic law by December 31, 2023, with UTPR application commencing in 2025.
THE ROLE OF INVESTOR-STATE DISPUTE SETTLEMENT (ISDS)
The implementation of the UTPR raises critical questions regarding its interplay with international investment law, particularly within the framework of bilateral investment treaties (BITs), multilateral investment treaties (such as the Comprehensive Economic and Trade Agreement), and other investment agreements.
1. Understanding ISDS Protections
Tax disputes have been a longstanding component of ISDS. According to the United Nations Conference on Trade and Development, from 1987 to 2021 more than 150 ISDS cases were initiated to challenge tax measures. During this period, the proportion of ISDS cases involving tax measures doubled. Additionally, some of the most substantial ISDS awards to date, notably those stemming from the Yukos saga, have originated from investors contesting taxation measures.
ISDS mechanisms are designed to safeguard foreign investors from adverse actions by host states. They offer recourse to arbitration for claims arising from alleged breaches of investment treaty obligations, such as:
Fair and Equitable Treatment (FET): Investors might be able to challenge allegedly arbitrary or inconsistent enforcement of the UTPR as a violation of the FET standard.
Expropriation: Purportedly excessive taxation under the UTPR might be argued to constitute indirect expropriation of an investor’s assets.
Non-Discrimination: Investors might be able to allege breaches of non-discrimination clauses if the UTPR disproportionately impacts foreign entities compared to domestic businesses.
Additionally, foreign investors may seek provisional measures designed to safeguard the parties’ rights pending a definitive resolution on the merits. For instance, Article 47 of the ICSID Convention provides that “the Tribunal may […] recommend any provisional measures which should be taken to preserve the respective rights of either party.” A comparable provision exists under the UNCITRAL Arbitration Rules as well.
2. Potential Hurdles
Investors bringing claims based on the UTPR may encounter several potential hurdles.
First, the availability of a suitable treaty protecting foreign investments is not guaranteed. Despite the existence of thousands of BITs and other multilateral agreements globally, foreign investors from a particular country of origin may not enjoy protection in every jurisdiction in which they choose to invest. And even where a treaty exists, they are not all the same (as explained in more detail below) and, therefore, even where a treaty is otherwise available, it may not provide coverage. This lack of universal coverage can expose investors to significant risks, as they may find themselves without recourse to the protections typically afforded by such treaties. As a result, investors must conduct thorough due diligence to determine the existence and applicability of investment treaties in their target jurisdiction(s) to mitigate potential vulnerabilities and ensure that their investments are protected. Similarly, host States may be able to take measures to proactively address and resolve these disputes at an early stage.
Second, certain BITs incorporate a tax carve-out, thereby excluding specific protections for tax matters under the relevant treaty. While older-generation investment treaties typically lack such provisions, contemporary BITs increasingly include them. Nevertheless, even with a tax carve-out, the precise wording of these provisions, alongside the factual circumstances triggering the dispute, remains crucial. Additionally, several tribunals have adjudicated that tax carve-outs may only pertain to “bona fide taxation actions,” which adds an additional layer of complexity.
Third, BITs may impose procedural prerequisites on investors. For instance, some treaties feature a “fork-in-the-road” clause, permitting an investor to pursue claims either in domestic courts or through investment arbitration, but not both. Consequently, under certain conditions and depending on the exact language of the BIT, an investor might be precluded from initiating an ISDS claim if a domestic claim against the same tax measure has already been pursued. Conversely, other BITs mandate the exhaustion of local remedies prior to commencing arbitration.
Fourth, investors might be able to lodge ISDS claims contingent upon the specific factual matrix involved. The success of such claims will hinge on how Pillar Two and the UTPR have been implemented by a particular State and the resultant impact on foreign investors. Similarly, the specific implementation of the UTPR by States in the coming years will also be a critical factor in determining the viability of an ISDS claim. Investors may also have a viable case if the implementation of Pillar Two contravenes their legitimate expectations regarding the applicable fiscal framework and its duration. However, States may present robust defenses. BITs not only may include a tax carve-out but also might intersect with other international agreements, such as double taxation treaties. A State confronted with an ISDS claim on these grounds will likely invoke its regulatory authority, which, although not absolute, may encompass the introduction of new, good-faith tax measures. All the above are also issues for States to consider in the implementation of their UTPR-related taxation measures.
CONCLUSION
The UTPR represents a paradigm shift in international taxation, with profound implications for multinational enterprises operating in the EU and States alike. As States advance with their implementation of the UTPR, businesses and States must navigate a complex and evolving landscape of compliance obligations, risks, and opportunities.
Simultaneously, the intersection of the UTPR with international investment law underscores the critical importance of leveraging ISDS mechanisms for foreign investors to protect against the unfair or discriminatory application of these rules, and for host States to defend against such claims. By adopting proactive measures and seeking advice from counsel multinational enterprises can mitigate risks, safeguard their investments, and position themselves for long-term success in a rapidly changing tax environment. Similarly, host States can anticipate potential treaty claims raised by foreign investors and proactively address these disputes at an early stage.