Massachusetts Health Policy Commission Proposes Significant Expansion of Private Equity Reporting Requirements for Provider Organizations—Comments Due September 24

On September 9, 2026, the Massachusetts Health Policy Commission (HPC) and the Center for Health Information and Analysis (CHIA) released for public comment proposed updates (the “Proposed Updates”) to the reporting requirements of the Massachusetts Registration of Provider Organizations Program (the “MA-RPO Program”).

If implemented, these changes to the MA-RPO 2026 data collection cycle would dramatically expand the financial, governance, and operational data that a registered provider organization (the “Provider Organization”) with private equity (PE) investment must report to the Commonwealth each year.

What You Need to Know

• MSO Reporting: The proposal includes updates to the information on Management Services Organizations (MSOs) that Provider Organizations are required to report.
• SEI Reporting: The proposal also includes updates to and clarifications of the existing requirement to report Significant Equity Investors (SEIs), adding new reporting requirements for Provider Organizations that have a reportable Category I SEI (i.e., a PE investor).
• Comment Deadline: Stakeholders are invited to submit comments to the Proposed Updates by Thursday, September 24, 2026, at 5:00 p.m., to HPC-RPO@mass.gov.

This Insight summarizes the key proposed changes, identifies important considerations for affected stakeholders (including PE firms and Provider Organizations with PE investment), and highlights areas where public comments may be warranted.

Summary of Proposed Changes

Expansion of SEI Reporting

The MA-RPO Program 2025 Data Submission Manual identifies two types of SEIs: Category I SEIs and Category II SEIs. A Category I SEI is defined as “[a]ny private equity company with a financial interest in a provider, provider organization or MSO.” A Category II SEI is defined as “an investor, group of investors or other entity with a direct or indirect possession of equity in the capital, stock or profits totaling more than 10 percent of a provider, provider organization or MSO; provided, however, that [the SEI] shall not include venture capital firms exclusively funding startups or other early-stage businesses.”

The Proposed Updates would significantly expand the scope of information that Provider Organizations with PE investment will have to report related to Category I SEIs, including the following.  

• Fund-Level Information. Each fund associated with any PE firm with a financial interest in the Provider Organization or in one of its corporate affiliates, as well as the name of each management company and general partner associated with a reported fund.
• Total Private Equity Liabilities. The amount of a Provider Organization’s total liabilities in the most recent complete fiscal year owed to a PE firm, regardless of whether the PE firm is a reportable SEI.
• Dividend Recapitalizations. Whether a Provider Organization’s loan agreements permit dividend recapitalization.
• Total MSO, SEI, or PE Payments Made in the Most Recent Fiscal Year. The total amount of payments or fees in the most recent fiscal year made to a corporately affiliated MSO, Category I SEI (including any subsidiaries, parent entities, or related parties), or PE firms (regardless of whether any PE firm is a reportable SEI), including:
  • loan and debt payments;
  • distributions (defined as payouts by the Provider Organization to investors, owners, or affiliates of the SEI);
  • management, monitoring, transaction, and consulting fees; and
  • rent and realty payments.
• MSO Services. Whether the Provider Organization’s corporately affiliated MSOs provide any of the following services under the terms of the management services agreement(s): revenue cycle management, human resources, purchasing, patient scheduling, payer contracting, network development, or other services (to be described by the party submitting the information).
• Agreements and Authorities. Whether the Provider Organization’s corporate affiliates that are direct providers of patient care services are subject to agreements or authority with another entity, such as a corporately affiliated MSO or a Category I SEI:
  • continuity agreements;
  • non-compete agreements for staff of the provider;
  • authority of another entity to appoint board members;
  • authority of another entity to direct or approve the budget, strategic plan, new debt or loans, new expenditures or investments, or the sale of property, plant, and equipment of the provider(s);
  • authority of another entity to direct or approve a sale, merger, or change-of-control transaction involving the provider(s) or any of its corporate affiliates;
  • authority of another entity to direct the hiring or firing of clinical and non-clinical staff of the provider(s); and
  • authority of another entity to direct or approve the reduction, elimination, or addition of clinical service lines of the provider(s).
• Recent Activities. Whether any of the following events occurred at reportable corporate affiliates during the most recent fiscal year:
  • the full-time equivalent clinical or non-clinical staff decreased by more than 10 percent;
  • a reportable corporate affiliate sold real property;
  • a reportable corporate affiliate declared bankruptcy;
  • a reportable corporate affiliate received a notice of default or covenant violation; or
  • a reportable corporate affiliate reduced or eliminated clinical services.

Key Considerations for Affected Stakeholders

Several aspects of the Proposed Updates merit careful attention from PE firms, Provider Organizations, MSOs, and their advisors:

• Stakeholders may reasonably question whether changes of this magnitude should be promulgated through formal notice-and-comment rulemaking under Chapter 30A of the General Laws rather than through an administrative bulletin subject to a 15-day comment window.
• All data submitted to the MA-RPO Program is publicly available. As a result, detailed information about a Provider Organization’s liabilities related to PE, payment structures, fee arrangements, dividend recapitalization provisions, governance authorities, and staffing changes would become part of the public record. Affected entities should carefully evaluate the competitive sensitivity and potential market impact.
• The filing obligation rests with the Provider Organization, not the PE firm. Much of the information sought, such as loan agreement terms, general partner and management company structures, and payment breakdowns across multiple categories, may be held by the PE investor or its affiliates rather than the Provider Organization. This may create practical compliance challenges, particularly where information-sharing arrangements between Provider Organizations and their investors are limited.
• The expanded requirements will primarily affect non-hospital Provider Organizations backed by PE, including physician practices, behavioral health organizations, ambulatory surgical centers, and similar entities. These organizations may have more limited compliance infrastructure than large hospital systems.

What Should Affected Organizations Do Now?

• Stakeholders should consider submitting comments by September 24, 2026, at 5:00 p.m. Given the brief 15-day comment period, stakeholders may wish to request an extension of the comment deadline. Comments should be sent to HPC-RPO@mass.gov. Questions about the proposed requirements may be directed to Liz Reidy, Associate Director, at Elizabeth.Reidy@mass.gov.
• Provider Organizations should determine whether the information sought, particularly financial data on payments related to PE, loan terms, and organizational governance authorities, is currently accessible. Provider Organizations should identify any gaps and determine what information-sharing arrangements with PE firms or affiliates may be needed.
• PE firms, MSOs, portfolio company management, and outside counsel should coordinate to develop a unified understanding of the proposed requirements and, where appropriate, a coordinated commenting strategy.

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For additional information about the issues discussed in this Insight or the proposed MA-RPO Program changes, or for assistance in preparing comments, please contact the attorney(s) listed on this page or the Epstein Becker Green Health Care and Life Sciences attorney who regularly handles your legal matters.

Staff Attorney Ann W. Parks contributed to the preparation of this Insight.