> ## 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 by state > What entities each state uses. This page condenses the 51 [state pages](/reference/legal/states/alabama) into one table so you can see the map before reading the detail. Each row links to the state's full reference page, which carries the citations, the profession-by-profession caveats, and the verification checklist. The tier labels are this wiki's editorial classification, not legal categories; commentators disagree on roughly eight jurisdictions and the [CPOM concept page](/concepts/model/cpom#the-spectrum) explains why. Every row must be verified against the state page and with counsel licensed there before you rely on it. ## How to read the tiers | Tier | Meaning | | --------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Strict** | Explicit prohibition on lay ownership or control, active enforcement, narrow exceptions, often recent codification. Budget for state-specific counsel. | | **Moderate** | Doctrine recognized; workable MSO-PC structures are well established; enforcement varies. | | **Nuanced** | Genuinely contested: different surveys classify it differently, or it is strict for one profession and permissive for another. | | **Permissive / none** | No meaningful CPOM doctrine, **but the professional corporation act usually still limits who may own a professional entity**, and other doctrines (fee-splitting, patient brokering, clinic licensure) may apply. | **"Is my state a CPOM state?" is the wrong question.** The question that actually decides your structure has four parts, and a state can answer them differently: 1. **Who may own the professional entity?** Almost every state limits this to licensees through its professional corporation act, whether or not it "has CPOM." 2. **Who may employ the clinicians?** In strict states, only the professional entity (plus hospitals and other statutory exceptions). 3. **Which decisions must remain with the clinician?** The control prong, now enumerated by statute in Oregon, California, and Vermont. 4. **What may the MSO be paid, and how?** Fee-splitting and anti-kickback rules, which exist in states with no CPOM doctrine at all. The "Ownership" and "Fee-splitting" columns below answer parts 1 and 4 in shorthand. Parts 2 and 3 are on each state page. ## Strict | State | Entity forms | Ownership of the professional entity | Fee-splitting | | -------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | [California](/reference/legal/states/california) | PC only (Moscone-Knox); no PLLC for medicine | Licensees only; other listed licensees up to 49% (Corp. Code § 13401.5); officers and directors must be licensed | Percentage fees permitted for real services at FMV under B\&P § 650(b); referral-linked pay criminal under § 650(a); 2026 AG settlements bar revenue-based fees for the defendants | | [Illinois](/reference/legal/states/illinois) | PC or PLLC | Prohibited for non-licensees | Permitted; verify scope | | [Massachusetts](/reference/legal/states/massachusetts) | PC or LLC, or operation under a clinic license | Prohibited for non-licensees | Permitted; verify scope | | [Nevada](/reference/legal/states/nevada) | PC | Licensed professionals only | Not specified by statute | | [New Jersey](/reference/legal/states/new-jersey) | PC (N.J.S.A. 14A:17) or wholly licensee-owned LLC; no PLLC statute; GBC only in licensed-facility settings | Licensees only (N.J.S.A. 14A:17-5, -10); plenary licensee may not be employed by a limited licensee | No categorical bar; kickback rule construed broadly and other monetary arrangements need Board approval (N.J.A.C. 13:35-6.17(c), (h)(4)) | | [New York](/reference/legal/states/new-york) | PC or PLLC (Education Department review required) | Prohibited for non-licensees | Restricted. New York is the canonical strict fee-splitting jurisdiction. Percentage-of-revenue management fees are materially risky here; practitioners overwhelmingly use flat or cost-plus. | | [Oregon](/reference/legal/states/oregon): *Strict, the strictest MSO statute in the country* | PC / professional medical entity | Physician majority required. MSO or MSO-agent majority ownership or control is barred. Overlapping ownership by shareholders of professional medical entities is restricted. | Permitted, but read alongside the control prohibitions | | [Texas](/reference/legal/states/texas) | PA is the traditional form for physicians; PLLC also available. Certified nonprofit health organizations under Occ. Code § 162.001 are a distinct route. | Prohibited for non-licensees, with narrow statutory exceptions | Permitted, but read alongside the Board's rules on fee arrangements | ## Moderate | State | Entity forms | Ownership of the professional entity | Fee-splitting | | --------------------------------------------------------------------------- | -------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------- | | [Arizona](/reference/legal/states/arizona) | PC | Minority non-licensed ownership has been permitted under the professional corporation framework | Permitted | | [Arkansas](/reference/legal/states/arkansas) | PC (medical board certificate required before filing) | Limited to licensees | Permitted | | [Colorado](/reference/legal/states/colorado) | PC, LLC, or LLP (comparatively flexible) | Lay directors and officers have been permitted without share ownership; verify the current provisions | Permitted | | [Connecticut](/reference/legal/states/connecticut) | PC, PLLC, or LLP; nonprofit medical foundations are a distinct route | Limited: medical foundation structures have required substantial provider control | Permitted | | [Indiana](/reference/legal/states/indiana) | PC or PLLC | Prohibited for non-licensees | Permitted | | [Iowa](/reference/legal/states/iowa) | PC, LLP, LLC, or HMO structures | Limited | No specific statute; professional ethics standards have been the reference point | | [Kansas](/reference/legal/states/kansas) | PC | Prohibited for non-licensees; hospitals may employ | Permitted | | [Kentucky](/reference/legal/states/kentucky): *Moderate (lightly enforced)* | PC; charitable nonprofits exempt | Limited, though not strictly enforced where autonomy is preserved | Permitted | | [Maryland](/reference/legal/states/maryland): *Moderate (common law)* | PC; hospital and HMO exceptions | Prohibited for non-licensees outside exempt categories | Permitted | | [Michigan](/reference/legal/states/michigan) | PC or PLLC | Prohibited for non-licensees; nonprofit arrangements less strictly enforced | Not specified by statute | | [Minnesota](/reference/legal/states/minnesota) | PC, LLC, or LLP | Licensed professionals only | Permitted | | [North Carolina](/reference/legal/states/north-carolina) | PC or PLLC | Limited | Not specified by statute | | [North Dakota](/reference/legal/states/north-dakota) | PC | Prohibited for non-licensees | Not specified | | [Pennsylvania](/reference/legal/states/pennsylvania) | PC or PLLC | Prohibited for non-licensees | Not specified by statute | | [Rhode Island](/reference/legal/states/rhode-island) | Professional service corporation or PLLC | Prohibited for non-licensees | Not specified | | [South Carolina](/reference/legal/states/south-carolina) | PC | Limited | Not specified | | [South Dakota](/reference/legal/states/south-dakota) | PC | Limited | Not specified | | [Tennessee](/reference/legal/states/tennessee) | PC; nonprofit and hospital exceptions | Limited | Not specified | | [Washington](/reference/legal/states/washington) | PC or PLLC | Prohibited for non-licensees under the doctrine | Not specified by statute | | [West Virginia](/reference/legal/states/west-virginia) | PC | Limited | Permitted | | [Wisconsin](/reference/legal/states/wisconsin) | PC or PLLC | Prohibited for non-licensees | Not specified | ## Nuanced | State | Entity forms | Ownership of the professional entity | Fee-splitting | | ----------------------------------------------------------------------------------- | ------------------------------------------- | --------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------- | | [District of Columbia](/reference/legal/states/district-of-columbia) | PC | Nuanced; verify | Not specified | | [Georgia](/reference/legal/states/georgia) | PC | Largely permissive post-1982; verify | Permitted, including referral fee-splitting provisions; verify scope | | [Louisiana](/reference/legal/states/louisiana) | PC | Non-physician involvement has been treated as permissible where there is no interference with clinical judgment | Permitted | | [Mississippi](/reference/legal/states/mississippi): *Nuanced, strict for optometry* | Flexible for medicine; strict for optometry | Largely permissive for medicine | Not specified | | [Montana](/reference/legal/states/montana) | PC, with exceptions | Permissive with conditions | Not specified | | [Ohio](/reference/legal/states/ohio): *Nuanced (evolving)* | PC or LLC | Increasingly permissive; verify | Not specified | ## Permissive / none | State | Entity forms | Ownership of the professional entity | Fee-splitting | | -------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------- | | [Alabama](/reference/legal/states/alabama) | PC or PA; comparatively flexible | Non-physician ownership has been treated as permissible where clinical autonomy is preserved | Permitted | | [Alaska](/reference/legal/states/alaska) | PC | Restricted to licensed persons under the Professional Corporation Act | Not specified by statute | | [Delaware](/reference/legal/states/delaware) | PC (8 Del. C. ch. 6) or ordinary LLC; a general corporation may not render medicine | PC: licensed individuals only (8 Del. C. § 610); LLC: unrestricted by entity law, unresolved under the Medical Practice Act | Physician-to-physician referral fees barred by Board rule; nothing reaches management fees | | [Florida](/reference/legal/states/florida): *Permissive / none, but see the clinic license route* | PA or PC, or a licensed health care clinic | A non-physician-owned entity may bill for care if it holds a health care clinic license, which requires a licensed medical or clinic director. Exemptions exist for certain wholly physician-owned entities. | Permitted, but Florida has an explicit patient brokering statute and fee-splitting provisions in its practice acts: percentage arrangements draw attention | | [Hawaii](/reference/legal/states/hawaii): *Permissive / none (weak)* | PC | Licensed persons only; DCCA review applies | Not specified | | [Idaho](/reference/legal/states/idaho): *Permissive / none (weak)* | PC | Limited enforcement of ownership restrictions in practice; verify the statutory text | Not specified | | [Maine](/reference/legal/states/maine) | PC or PA; comparatively flexible | Lay ownership has been treated as permissible | Not specified | | [Missouri](/reference/legal/states/missouri) | Flexible | Lay ownership generally permissible | Not specified | | [Nebraska](/reference/legal/states/nebraska) | Flexible | Lay ownership generally permissible | Not specified | | [New Hampshire](/reference/legal/states/new-hampshire) | PC or nonprofit | Lay ownership generally permissible | Not specified | | [New Mexico](/reference/legal/states/new-mexico): *Permissive / none, with new transaction review* | PC | Permissive on the CPOM analysis | Not specified | | [Oklahoma](/reference/legal/states/oklahoma) | Flexible | Lay ownership generally permissible | Not specified | | [Utah](/reference/legal/states/utah) | PC | Lay ownership generally permissible | Not specified | | [Vermont](/reference/legal/states/vermont): *Permissive historically, changed by Act 133 (2026)* | Flexible | Historically permissive; now subject to Act 133's prohibition on PE/hedge-fund interference with clinical decision-making | Not specified | | [Virginia](/reference/legal/states/virginia) | PC | Lay ownership generally permissible | Not specified | | [Wyoming](/reference/legal/states/wyoming) | PC | Lay ownership generally permissible | Not specified | ## Reading the fee-splitting column "Permitted" means the state has no rule that categorically bars a management fee calculated as a percentage of practice revenue; it does not mean any percentage is safe. Every state's anti-kickback, patient-brokering, or referral-fee statute still reaches a fee that varies with referrals rather than with services. "Not specified" means no statute or regulation squarely addresses percentage management fees and the analysis proceeds from general principles. **New York** is the canonical jurisdiction where percentage fees are materially risky; **Florida** and **California** have explicit statutes that shape the analysis. See [Fee-splitting rules](/concepts/model/fee-splitting) and the [California page](/reference/legal/states/california#4-fee-splitting-and-percentage-management-fees). ## What this table does not tell you * **Other professions.** The tiers are for medicine. Dentistry, optometry, physical therapy, chiropractic, veterinary medicine, and behavioral health each sit on a different map: Mississippi is permissive for physicians and strict for optometrists. Section 2 of each state page covers this. * **Officer and director requirements.** Several states restrict who may serve as a director or officer of the professional entity, not only who may own shares. See [Who can own a professional entity](/concepts/entities/who-can-own-what#officers-and-directors-not-just-owners). * **Transaction notice and MSO registration.** A growing set of states require notice of healthcare transactions or disclosure of MSO and private-equity ownership regardless of tier. See the [legislation tracker](/reference/legal/cpom-legislation-tracker). * **Noncompetes.** Governed by separate state law that moved substantially in 2025–2026. Section 5 of each state page. ## Sources Each state page carries its own citations to the professional corporation act, medical practice act, board rules, attorney general opinions, and case law. For the national picture, the secondary surveys this wiki cross-checks against are Epstein Becker Green's [Corporate Practice of Medicine 50-State Survey](https://www.ebglaw.com/insights/publications/corporate-practice-of-medicine-50-state-survey) and MedPath's [CPOM Across the 50 States and D.C.](https://medpathcompliance.com/resources/corporate-practice-of-medicine-cpom-50-state-guide); they do not agree on every state, which is itself the point of the "Nuanced" tier. Primary sources on the state page control where they conflict with a survey. ## Related topics - [The corporate practice of medicine doctrine](/concepts/model/cpom.md) - [Fee-splitting rules, explained](/concepts/model/fee-splitting.md) - [Who can own a professional entity](/concepts/entities/who-can-own-what.md) - [Run a CPOM self-audit](/guides/compliance/run-a-cpom-self-audit.md) - [Form a professional corporation (PC)](/guides/formation/form-a-pc.md) - [CPOM & MSO legislation tracker](/reference/legal/cpom-legislation-tracker.md) - [CPOM case law](/reference/legal/cpom-case-law.md)