Behavioral health providers have unique regulatory, clinical and business issues that require both federal and state legal experience and real-world knowledge of the behavioral health industry and health care law generally. A significant component of Polsinelli’s health care practice - one of the largest in the country - is devoted to representing investors and operators in the behavioral health space including:

  • Private equity and venture capital funds 
  • Acute care psychiatric hospitals and units 
  • Substance abuse and eating disorder treatment providers
  • Residential, outpatient and adolescent treatment facilities 
  • Community mental health centers 
  • Digital and telehealth treatment providers 

Polsinelli’s experienced behavioral health law group includes lawyers with deep experience representing leading behavioral health providers in all facets of their legal affairs. Our extensive industry experience spans corporate and M&A, regulatory, privacy, payer relations, real estate and other legal disciplines that allow us to fully partner with investors and providers to help them effectively achieve their business goals.

Mergers, Acquisitions and Transactional

  • Acting as lead counsel for Elements Behavioral Health in its proposed sale to a private equity-backed buyer out of Chapter 11 bankruptcy proceedings involving more than $200 million in obligations, handling all M&A, regulatory, bankruptcy, finance and real estate work involving 13 facilities across the U.S. and its related laboratory operation.
  • Structuring, negotiating, and completing dozens of mergers and acquisitions, and other complex transactions, including joint ventures and affiliation agreements on behalf of for-profit and non-profit behavioral health providers, investors, ownership and management groups.
  • Providing full-spectrum due diligence and deal support involving dozens of behavioral health mergers and acquisitions, including evaluation and mitigation of business and legal risks including regulatory compliance, government investigations and transition of licensing and payer contracts.
  • Supporting the development and launch of de novo behavioral health programs, including real estate acquisition and leasing, land use, licensing and credentialing matters.
  • Advising on other contracting issues for behavioral health providers including payer contract negotiations, IT and information systems, EMR platforms, vendor contracting and outsourcing arrangements.
  • Structured, negotiated and completed over 50 M&A and other complex transactions in the behavioral health space, including sale transactions in $5 million to $1.2 billion rage.
  • Joint venture transactions including for-profit substance abuse, eating disorder and weight management services, and affiliation of non-profit substance abuse treatment providers.
  • Represented private equity sponsored company in acquisition of substance abuse treatment centers.
  • Represented private equity client in acquisition of an adolescent, residential substance abuse and eating disorder treatment center.
  • Represented a national substance abuse treatment company in its acquisition of a chemical drug dependency hospital, including obtaining Attorney General approval for the transaction.
  • Acted as health care M&A counsel in the sale-leaseback of six behavioral health facilities across three states by privately owned, national owner/operator to major health care real estate investment trust for purchase price of more than $400 million.
  • Acted as counsel for-owned closely-held behavioral health facilities in $50 million sale to newly-formed roll-up platform in the behavioral health space.
  • Represented a national eating disorder treatment provider in its acquisition of multiple eating disorder treatment facilities and programs.
  • Represented a privately held for-profit provider of behavioral health, developmental disability and group home services in its sale to a national provider.
  • Represented a privately held non-profit behavioral health care provider in its spin-off of a Level I psychiatric facility.
  • Represented seller and management team in private equity recapitalization transaction involving multi-site behavioral health provider.
  • Served as borrower’s counsel in connection with over $250 million of financing and refinancing of prop-co and op-co (and joint ventures) loans for the acquisition, construction, development and operation of behavioral health and chemical dependency facilities across four states.
  • Lead counsel to treatment centers for addiction and mental health disorders in the United States and its affiliates in their chapter bankruptcy cases.
  • Represented behavioral health care providers in connection with the organization and divestiture of assets and operations in neighboring states.
  • Represented a privately held non-profit behavioral health care provider in its acquisition of multiple outpatient clinics.
  • Acted as counsel for a venture capital and private equity firm in the acquisition of 51% controlling interest in physician-owned pain management clinic. 
Corporate Practice, Compliance and Privacy
  • Providing guidance related to compliance with corporate practice of medicine restrictions. 
  • Assisting with laboratory compliance issues for behavioral health providers including specialized laboratory coding and coverage issues for urine drug testing.
  • Advising on pharmacy licensure, compliance and billing issues.
  • Advising on and drafting admission and discharge policies and procedures, including specialized admission criteria dictated by applicable state laws.
  • Drafting policies and procedures related to federal and state privacy and security laws including state preemption issues related to behavioral health patients in multiple jurisdictions across the U.S.
  • Developing, implementing and testing corporate compliance programs for behavioral health providers.
  • Representing behavioral health providers in Government investigations at the state and federal level including Federal Civil False Claims Act matters.
  • Directing both internal and external payer audits impacting the behavioral health, laboratory, and pharmacy space.
  • Advising on fraud and abuse compliance issues and guiding providers through the federal and state anti-kickback, self-referral and civil monetary penalties laws impacting behavioral health related to, for example, marketing arrangements and patient brokering issues.

Payment, Contracting and Enrollment 

  • Successfully litigate and resolve payer audit, recoupment and reimbursement claims, including via enforcement of the Mental Health Parity and Addiction Equity Act.
  • Guiding providers through Medicare and Medicaid enrollment, coverage, and payment issues.
  • Advising on Medicare Advantage and Medicaid managed care contracting and risk-bearing networks for behavioral health providers.
  • Evaluating behavioral health and substance abuse coverage under other government payers, such as Federal Employee Benefits Plans, Veterans Administration and Indian Health Services.
  • Developing and advising on participation and non-participation strategies with commercial and other third-party payers related to behavioral health coverage.

Finance

  • Advising behavioral health investors and providers seeking financing and other capital arrangements regarding expansion, operations and acquisition strategies.

Licensing, Certification and Enforcement

  • Advising on state licensure, certification and accreditation including compliance with applicable regulatory requirements, enforcement matters, and hearings before administrative agencies.
  • Counseling on personnel licensure and enforcement actions involving various state agencies with administrative authority over behavioral health providers and clinical personnel.
  • Providing guidance relating to the applicability and securing of certificates of need for the development or expansion of behavioral health facilities.
  • Providing guidance on regulatory requirements for physical plant attributes, clinical personnel scope of practice issues, staffing ratios, and supervision requirements.

Public Policy Advocacy 

  • Assisted behavioral health precision medicine provider in advocating before Congress and the Centers for Medicare & Medicaid Services (CMS) regarding coverage, coding, and reimbursement issues.
  • Representing large national behavioral health professional association in federal legislative and regulatory advocacy.  

Medical Staff

  • Advising on medical staff requirements including bylaws, grievances, hearings and associated compliance issues. 
eAlerts Alerts
October 2018
text icon Publications & Presentations
Author, Bloomberg Law
October 1, 2018
webinar Webinars
August 21, 2018
text icon Publications & Presentations
Speaker, National Conference on Alcohol and Addiction Disorders
August 2018
text icon Publications & Presentations
Presenter, National Conference on Alcohol & Addiction Disorders
Anaheim, CA
August 20, 2018
text icon Publications & Presentations
Obtaining and Structuring Debt & Equity in the Behavioral Health Market
Speaker, Balance Healthcare Services
Behavioral Health & Addiction Treatment
Capital Markets Conference
August 14, 2018
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Quoted, Behavioral Healthcare Executive
July 2018
text icon Publications & Presentations
Healthcare Dealmakers: The Future of AI, Risks & Opportunities in Substance Abuse
Mentioned, Dallas Innovates
May 2018
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Legal Pitfalls Affecting a Treatment Center's Growth
Speaker, Treatment Center Investment Retreat
December 2017
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What You Don't Know Can Hurt You: Best Practices and Key Legal Issues in Health Care Due Diligence
Co-Author, Journal of Health Care Compliance
July-August 2017