Press Release: 2/13/2026
Raising the Bar on Suitability: Massachusetts Proposes Regulations Affecting Skilled Nursing Facility Owners, Management Companies, and Capital Partners
FEBRUARY 12, 2026
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Massachusetts proposed amendments to the regulations that govern skilled nursing facilities (SNFs). Here is what operators, real property owners, and investors need to know as they acquire facilities, change managers, and navigate licensure renewals in Massachusetts.
In September 2024, An Act to improve quality and oversight of long-term care was passed with changes to improve oversight and standards at long-term care facilities through additional Department of Public Health oversight. On January 16, the Department filed proposed amendments to the regulations at 105 CMR 153.000. There will be a public hearing on February 13 to discuss the proposed amendments.
The Department drafted the proposed amendments to conform to the Act’s requirements, including conducting suitability reviews of management companies that work with long-term care facilities such as SNFs. These changes will significantly affect how operators, real property owners, and investors operate SNFs in Massachusetts. The Division of Health Care Facility Licensure and Certification will extend suitability requirements to real property owners and management companies. Additionally, the Division will be charged with scrutinizing the financial capacity and compliance history of licensees, proposed transferees, and management companies.
Suitability Findings for Managers
The proposed regulations create rigorous vetting requirements for management companies. As a condition precedent to contracting with a management company, an applicant, potential transferee, or licensee will need to obtain a determination from the Division that the proposed manager is suitable to manage a long-term care facility. This will require the applicant, potential transferee, or licensee to provide the Division with a copy of the proposed management agreement within two days of engaging the manager. If there are amendments to the management agreement on file with the Division, the applicant, potential transferee, or licensee will need to provide the Division with an updated management agreement within 30 days of execution of the amendment. If the Division determines that the manager is not suitable, that determination takes effect on the date the notice is provided to the applicant, potential transferee, or licensee. In practical terms, the parties cannot proceed with, or must cease, engagement as of the notice date.
Suitability Findings for Real Property Owners
The proposed amendments to the regulations explicitly define who an “owner” is, unlike the current regulations which do not define owners. Under the proposed amendments to the regulations, an owner will include any person with at least a 5% ownership interest or a controlling interest in the applicant, licensee, or potential transferee, or in the real property on which the facility sits.
This means that applicants, potential transferees, or licensees must disclose their landlords as facility owners on licensing and renewal applications. Furthermore, the new licensure framework under the proposed amendments to the regulations will require the Division to evaluate landlords for suitability alongside operating entities and management companies.
Other Suitability Considerations
The Division’s suitability analysis of applicants, potential transferees, or licensees, including their owners and management companies, shall include consideration of the following factors:
Liens.
Unpaid taxes or fees.
Lending or lease defaults.
Receivership.
Bankruptcy.
Litigation profiles.
Enforcement outcomes.
The standards also look to ownership and control ties. The Department may consider whether 50%+ owners, officers, or directors have facilities with adverse licensure or Medicaid certification actions. The Department also weighs sustained substandard care, failure to report abuse, relevant felony convictions, and material litigation tied to long-term care operations. The Division will also consider private equity involvement when evaluating quality-of-care results. These factors may create grounds for enforcement actions and suitability concerns regarding owners and managers.
Accelerated Reporting for Financial Status Changes
The proposed regulations impose accelerated financial reporting requirements. Applicants, potential transferees, and licensees must report changes in financial status within two days of the change. This accelerated timeline also applies to the owners of such entities. Changes in financial status include, but are not limited to, bankruptcy filings, defaults under lending agreements or leases, appointment of a receiver, and any recording of a lien.
Grounds for Limitation, Restriction, Suspension, or Revocation of Licenses
The proposed amendments to the regulations expand the Department’s responsibilities and remedies to address noncompliance and protect residents. The Department may take a range of licensing actions “for cause.” The proposed amendments to the regulations clarify that “for cause” grounds for licensing actions include:
Substantial or sustained failures in resident care or regulatory compliance.
Repeated violations of the same or similar requirement within 12 months.
Lack of financial capacity signaled by liens, unpaid taxes or fees, lease or loan defaults, receivership, or bankruptcy.
Lack of suitability under the suitability section.
Findings of immediate and serious threat.
Denial of a required certificate of inspection.
Noncompliance with resident transfer or facility closure requirements.
Specified criminal convictions or pleas related to resident abuse, violent felonies, or misuse of Medicaid and Medicare or resident funds.
Under the proposed amendments to the regulations, the Department has robust remedies. If it finds deficiencies at a facility, the Department may issue written notices and require Plans of Correction with deadlines. If violations persist, the Department may impose civil fines. It may also suspend, revoke, or refuse to renew a facility’s license; require the licensee, at its expense, to retain a Department‑approved temporary manager for at least three months; suspend a license when an immediate and serious threat to resident safety exists; limit or halt admissions when a facility lacks substantial compliance; and conduct unannounced inspections, comprehensive site visits, and complaint investigations.
Key Takeaways
In anticipation of the implementation of the proposed regulations, operators, real property owners, and investors should prepare for enhanced disclosures, suitability reviews, and mandatory reporting requirements. Interested parties must:
Plan for earlier and more comprehensive suitability engagement, including for potential transferees, real property owners, and management companies.
Update renewal packages to include expanded sworn ownership and control disclosures, including qualifying secured obligation holders.
Track and calendar the two-day deadline for financial status changes and the 30-day deadline for other updates.
Obtain Division approval for management companies before contract execution and make timely post-execution filings.
For additional information about how these proposed regulations may affect your organization, contact a member of the ArentFox Schiff Health Care group.