> ## Documentation Index
> Fetch the complete documentation index at: https://mso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.
# CPOM & MSO legislation tracker
> Enacted and pending legislation reshaping MSO rules, with bill numbers, effective dates, who is covered, and practical impact.
Legislation reshaping the corporate practice of medicine and MSO arrangements. **2025 and 2026 were the most active period in the doctrine's modern history**, and several states now impose obligations that did not exist when most operating MSAs were drafted.
**Checked August 2026.** Legislation moves quickly and this page ages. Verify current status against the primary source before relying on any entry, and confirm applicability with counsel licensed in the state.
## Enacted, CPOM and MSO restrictions
### Oregon, SB 951 and HB 3410 (2025)
| | |
| --------------- | ------------------------------------------------------------------------------------------------------------------------ |
| **Bills** | S.B. 951; H.B. 3410, 2025 Regular Session |
| **Codified at** | Amends ORS 58.375 and 58.376; adds ORS 676.555 |
| **Enacted** | June 9, 2025 |
| **Effective** | **January 1, 2026** for arrangements formed on or after June 9, 2025 · **January 1, 2029** for pre-existing arrangements |
| **Covers** | Professional medical entities and the MSOs that serve them |
| **Carve-outs** | Includes dental, physical therapy / occupational therapy, veterinary, and certain behavioral health arrangements |
**What it does:** Bars an MSO, or an MSO's agents, from holding majority ownership or exercising control over a professional medical entity. Restricts overlapping ownership by shareholders of professional medical entities and limits share-transfer arrangements. Reaches MSO control over scheduling, clinician compensation, coding, billing, and payer contract terms. Voids most physician noncompetes.
**Practical impact:** The strictest MSO statute in the country. Groups with Oregon PCs formed before June 9, 2025 have until **January 1, 2029** to restructure, which sounds distant and is not, given that restructuring may involve share transfers, MSA renegotiation, and payer notification.
**Sources:** [Enrolled bill](https://olis.oregonlegislature.gov/liz/2025r1/Downloads/MeasureDocument/SB951) · [Holland & Knight implementation update (May 2026)](https://www.hklaw.com/en/insights/publications/2026/05/an-update-on-the-implementation-and-implications-of-oregons) · [Nixon Peabody analysis](https://www.nixonpeabody.com/insights/alerts/2025/07/11/oregon-sb-951-corporate-practice-of-medicine-law-explained)
***
### California, SB 351 and AB 1415 (2025)
| | |
| --------------- | -------------------------------------------------------------------------------------- |
| **Bills** | S.B. 351; A.B. 1415 (2025) |
| **Signed** | October 6, 2025 |
| **Effective** | **January 1, 2026** |
| **Covers** | Private equity groups and hedge funds involved with physician and **dental** practices |
| **Enforcement** | State Attorney General, via injunctive and other equitable relief |
**What it does:** Codifies and expands California's CPOM and corporate practice of dentistry rules. Prohibits a private equity group or hedge fund from interfering with the professional judgment of physicians or dentists, expressly including determining what diagnostic tests are appropriate, determining the need for referrals, being responsible for the overall care of a patient, and determining how many patients a clinician may see or how many hours they may work. Separately bars management entities from participating in billing, coding, equipment selection, and clinical staff oversight. Makes noncompete and non-disparagement clauses in provider agreements unenforceable, with narrow exceptions for sale-of-business covenants and confidentiality.
AB 1415 expands healthcare transaction reporting.
**Practical impact:** The enumerated prohibitions should be reflected verbatim in your clinical carve-out. Note the explicit targeting of **PE and hedge fund** ownership — who owns the MSO is now legally relevant.
**Sources:** [Benesch analysis](https://www.beneschlaw.com/insight/california-enacts-sb-351-new-restrictions-on-private-equity-and-hedge-fund-involvement-in-physician-and-dental-practices/) · [Epstein Becker Green](https://www.healthlawadvisor.com/california-governor-signs-sb-351-strengthening-the-states-corporate-practice-of-medicine-doctrine) · [Stinson, on both laws now effective](https://www.stinson.com/newsroom-publications-new-california-health-care-transaction-rules-are-here-sb-351-and-ab-1415-are-now-effective)
***
### Vermont, Act 133 (2026)
| | |
| ------------- | ---------------------------------------------------------------------- |
| **Bill** | H.583, enacted as Act 133 |
| **Signed** | June 15, 2026 |
| **Effective** | Prohibition operative on enactment; **reporting from March 1, 2027** |
| **Covers** | Private equity groups and hedge funds; health care facilities and MSOs |
**What it does:** Three operative sections. § 9772 codifies Vermont's common-law prohibition on corporate involvement in clinical decision-making as it relates to PE and hedge fund investments. § 9773 requires disclosure of PE and hedge fund ownership and control interests in certain health care entities. § 9774 provides for public transparency and information sharing.
**Reporting trigger:** Beginning **March 1, 2027**, health care facilities and MSOs in which a PE group or hedge fund held an ownership or investment interest as of June 1, 2026 must report specified ownership and control information to the Green Mountain Care Board.
**Practical impact:** Vermont had no meaningful CPOM doctrine before this. Groups operating there should assess both the substantive prohibition and the reporting obligation.
**Sources:** [Act text](https://legislature.vermont.gov/Documents/2026/Docs/ACTS/ACT133/ACT133%20As%20Enacted.pdf) · [Bill status](https://legislature.vermont.gov/bill/status/2026/H.583) · [Ropes & Gray analysis](https://www.ropesgray.com/en/insights/alerts/2026/06/vermont-enacts-new-restrictions-on-private-equity-and-hedge-fund-involvement-in-health-care-key)
## Enacted, transaction review, notice, and transparency
These do not restrict the structure directly but impose notice, review, or disclosure obligations that can gate transactions.
| State | Instrument | Effect |
| ----------------- | ------------------------------------------------------- | ------------------------------------------------------------------------------------ |
| **Indiana** | H.B. 1666 (signed May 6, 2025) | Grants the Attorney General market oversight authority; requires ownership reporting |
| **New Mexico** | H.B. 586 (signed April 7, 2025; effective July 1, 2025) | Establishes a permanent hospital transaction approval requirement |
| **Massachusetts** | H.5159 (January 2025) | Requires notice for PE, REIT, and MSO involvement; limits sale-leasebacks |
| **Connecticut** | S.B. 196 (May 27, 2026) | Limits PE and REIT hospital ownership; bans certain sale-leasebacks |
| **Colorado** | S.B. 25-083; S.B. 25-126 | Voids provider noncompetes; requires pre-merger notice |
| **Maine** | L.D. 985 (2025) | One-year moratorium on PE/REIT hospital acquisitions |
| **Washington** | H.B. 2548 (signed March 25, 2026) | Amends the healthcare transaction reporting statute |
| **Illinois** | H.B. 5000 (passed both chambers May 28, 2026) | Transaction notice, **confirm final status and effective date** |
| **California** | A.B. 1415 (2025), effective January 1, 2026 | Expands healthcare transaction reporting |
## Pending and failed
Tracking these matters because a bill that fails one session frequently returns.
| State | Bill | Status |
| ------------------------------- | ------------------------------------------------------------------------ | ------------------------------------- |
| **Washington** | 2SSB 5387 (introduced January 12, 2026), sweeping CPOM codification | **Failed to advance from the Senate** |
| **North Carolina** | S.B. 570, CPOM/MSO codification | **Failed, June 2026** |
| **Pennsylvania** | H.B. 1460 (passed House June 10, 2025); H.B. 2115 (2026) | Pending |
| **Rhode Island** | H.B. 7721 / S.B. 2459 (2026), CPOM, MSO, and ownership reporting | Pending |
| **New York** | S8442 / A9012, MSO ownership limits; budget transaction-review expansion | Pending |
| **Virginia** | H.B. 1458 (2026), study bill | Pending |
| Maine, Minnesota, New Hampshire | Various prior sessions | Failed |
## The federal picture
| Item | Status |
| ---------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **A federal CPOM law** | None. CPOM remains entirely state law. |
| **FTC Non-Compete Rule** | **Vacated.** The rule was vacated in August 2024; the FTC dismissed its appeals on September 5, 2025; 16 C.F.R. pt. 910 was removed from the CFR effective **February 12, 2026**. Noncompete regulation is now primarily a state matter, with the FTC pursuing case-by-case enforcement.1 |
| **FTC/DOJ healthcare consolidation attention** | Ongoing; not CPOM-specific |
## Physician noncompete status, selected states
Relevant because several CPOM bills carry noncompete provisions.
| State | Status |
| -------------- | -------------------------------------------------------------------------------------------------------------------------- |
| **California** | General prohibition; SB 351 makes provider noncompetes and non-disparagement clauses unenforceable, with narrow exceptions |
| **Oregon** | SB 951 voids most physician noncompetes |
| **Colorado** | S.B. 25-083 voids provider noncompetes |
| **Utah** | Healthcare-worker noncompete ban effective **May 6, 2026** |
| **Tennessee** | Wage-floor threshold effective **July 1, 2026** |
| **Virginia** | Severance-or-void rule effective **July 1, 2026** |
| **Washington** | Near-total ban signed; effective **June 30, 2027** |
**Verify before drafting.** This table will age, and several of these were enacted within the last year.
## What to do about all of this
For every state you operate in. Law firm alerts and state legislature bill trackers are the practical sources.
An MSA drafted before 2025 is very likely out of date in Oregon and California. See [Get agreements reviewed](/guides/agreements/get-agreements-reviewed).
Oregon's is **January 1, 2029**. That is a restructuring project, not a document review.
Vermont from March 2027; several states already. Reporting obligations attach to the MSO, not only the PC.
Cover the enumerated functions from every state you operate in, plus state-specific riders. See [MSA clause anatomy](/reference/legal/msa-clause-anatomy).
## Sources
1. FTC, [Federal Trade Commission Files to Accede to Vacatur of Non-Compete Clause Rule](https://www.ftc.gov/news-events/news/press-releases/2025/09/federal-trade-commission-files-accede-vacatur-non-compete-clause-rule) (Sept. 5, 2025); removal of 16 C.F.R. pt. 910, [Federal Register (Feb. 12, 2026)](https://www.federalregister.gov/documents/2026/02/12/2026-02866/revision-of-the-negative-option-rule-withdrawal-of-the-cars-rule-removal-of-the-non-compete-rule-to).
Additional tracking sources: Holland & Knight, [Q1 2026 recap on proposed legislation affecting healthcare consolidation](https://www.hklaw.com/en/insights/publications/2026/03/q1-recap-on-proposed-legislation-affecting-healthcare-consolidation); The Source on Healthcare Price & Competition, [Corporate Practice of Medicine Bills](https://sourceonhealthcare.org/corporate-practice-of-medicine-bills-full/).
## Related topics
- [The corporate practice of medicine doctrine](/concepts/model/cpom.md)
- [Enforcement, and what happens when structures fail](/concepts/model/enforcement-and-risk.md)
- [Hire healthcare counsel (and use them well)](/guides/agreements/get-agreements-reviewed.md)
- [Run a CPOM self-audit](/guides/compliance/run-a-cpom-self-audit.md)
- [CPOM case law](/reference/legal/cpom-case-law.md)
- [Oregon — CPOM & MSO reference](/reference/legal/states/oregon.md)