Behavioral Health Law Attorneys | Epstein Becker Green

The complex legal and regulatory landscape that plays such an outsized role in the health care industry takes on another order of complexity when it comes to behavioral health.

Our behavioral health attorneys help providers and health plans of all kinds navigate the constantly evolving landscape, which is filled with unique challenges and fraught with compliance pitfalls.

As the demand for behavioral health services remains high—and as access to those services lags woefully behind—our clients depend on us to help them launch their businesses, get reimbursed for their services, and maintain compliance with the intimidating array of behavioral health laws, rules, and regulations. Clients value our deep roots in behavioral health provider operations and regulatory policy, and our commitment to serving as thought leaders in the industry.

We Know the Industry

Our behavioral health team has a broad and deep bench of experience in the behavioral health space. For decades, we have helped clients of all sizes with their regulatory compliance, operational, transactional, investigation, and litigation needs.

Advancing New Service Models

The behavioral health services system is in the midst of a major transformation. New models of care are being legalized, authorized, regulated, and reimbursed on a rolling basis across the country. Behavioral health providers and other clients need help navigating this complex and quickly evolving landscape. For decades, we have participated in developing regulatory and program policy, pushing the boundaries of behavioral health service models. We provide clients with advice and insight drawn from our experience supporting innovative practices in obtaining changes in federal, state, and local laws and regulations; developing clinical models, coverage guidelines, and accreditation programs; and creating operational and compliance policies to advance new models of care.

Providing Comprehensive Solutions

The full gamut of legal services offered by our team of behavioral health attorneys also includes the following:

Read more

Compliance

• Counseling clients on complying with federal and state operational regulations, funding program requirements, and accreditation standards
• Advising substance use disorder (SUD) providers and marketing organizations on Opioid Addiction Recovery Fraud Prevention Act compliance
• Helping MH/SUD providers ensure state licensure compliance
• Representing behavioral health providers, plans, and other entities in the development of network agreements that satisfy business needs and comply with the rapidly evolving regulatory environment
• Advising on complying with state and federal MH privacy laws (including 42 CFR Part 2 and HIPAA), and assisting with privacy-related compliance program development, government relations, and policy advocacy
• Providing advice on payor-provider contracting; MH/SUD coding, coverage, and payment; reimbursement and parity; grant funding; and medical necessity issues
• Supporting new entrants and service area expansions in the psychiatric specialty pharmacy market, and helping clients navigate state pharmacy licensing and Medicaid enrollment/coverage issues relating to psychiatric specialty pharmacies

Operations

• Providing advice and counsel regarding compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) as it applies to patients with psychiatric conditions and substance use disorders in the emergency environment
• Supplying clients with step-by-step guidance and support in the often challenging process of launching a platform for the online delivery of behavioral (also known as “telebehavioral” or “telemental”) health services
• Providing advice to hospitals and MH/SUD provider facilities on how to more effectively manage the safe transfer and discharge of long-term, complex psychiatric patients
• Counseling MH/SUD service organizations on occupational safety and health matters
• Advising on crisis and risk management, including the development of crisis management protocols
• Navigating owners and developers through every phase of the process of constructing or expanding an MH/SUD provider facility while minimizing risks and maintaining regulatory compliance from conception to completion and beyond

Transactions

• Providing guidance to for-profit and nonprofit MH/SUD companies through corporate and health care transactions, including mergers and acquisitions, and conducting due diligence for, as well as offering value insight to, private equity and venture funds looking to invest in MH/SUD service organizations
• Offering detailed industry and market insights, which are based on our in-depth regulatory and other experience gained from advising a range of MH/SUD service providers, when managing a transaction
• Designing, establishing, counseling, and repairing the legal structures necessary to permit non-licensed investors to establish and develop partnerships with licensed mental health (MH) and SUD providers, and addressing ancillary unlicensed services and technologies

Investigations

• Counseling behavioral health providers on responding to government inquiries into allegations of fraud and abuse, performing internal investigations, and defending against fraud and abuse investigations and criminal prosecutions
• Defending companies in Federal Trade Commission investigations and enforcement efforts related to allegations of improper marketing of SUD treatments
• Assisting clients with privacy-related investigations and enforcement defense

Litigation

• Representing hospitals, health systems, and providers in civil commitment litigation
• Representing MH/SUD service organizations’ management in workplace safety and health litigation arising out of federal and state enforcement actions
• Providing representation to clients in payor-provider contract, reimbursement and parity, and medical necessity and payment disputes

Our Telemental Health Laws App

As the online delivery of telebehavioral or telemental health services grows exponentially, we continue to update our invaluable app, Telemental Health Laws, a comprehensive collection of state regulatory requirements for all 50 states plus the District of Columbia and Puerto Rico. This free app, available to anyone, provides users with state-specific content relating to the regulatory requirements for professional practitioners and stakeholders in multiple MH fields.

Read less