Massachusetts regulators are preparing to bring long-awaited nursing home oversight rules before the state Public Health Council next month, a move that would force the Department of Public Health to weigh an operator's litigation history, financial capacity, and private equity ties before approving a license. The regulations stem from a 2024 law that Governor Maura Healey signed in September of that year, and they arrive after a Boston Globe Spotlight investigation exposed how one New Jersey-based chain expanded across Massachusetts while resident care quality collapsed at several of its homes.
The Department of Public Health has finalized regulations implementing the 2024 law and plans to bring them to the Public Health Council on October 14, according to NBC Boston. The rules are not yet in effect. Under the law, DPH must now consider an operator's in-state and out-of-state quality history, criminal history, civil litigation, financial capacity, ownership and management-company history, and private equity involvement before signing off on an acquisition — and management companies themselves are now subject to the same suitability scrutiny as the nursing homes they run.
The law also requires continuing disclosure of significant changes in an operator's financial status, including receivership, bankruptcy, defaults, and liens, so the state isn't caught off guard after a deal has already closed. Separate guidance issued by Mass.gov in January established that operators must disclose anyone holding a 5% or greater controlling interest, along with related-party vendor transactions exceeding $25,000 — a disclosure form patterned after the federal Medicare CMS Form 855A.
The RegalCare Case That Forced the Issue
Per NBC Boston, the Boston Globe Spotlight investigation found that DPH has not denied a nursing home acquisition or revoked a license in at least seven years, a stretch during which the department approved purchases by RegalCare, a New Jersey nursing home chain. RegalCare's owner acknowledged a personal role in a Medicare and Medicaid fraud scheme and agreed to a settlement with state and federal prosecutors this month, according to the same report. On his applications to operate in Massachusetts, the owner reported that he had never had a license revoked — even though New Jersey revoked his license in 2018, per the Globe's reporting.
A separate CommonWealth Beacon summary of the Globe's Spotlight work detailed how operator Eliyahu Mirlis expanded RegalCare into one of Massachusetts' largest nursing home chains while cutting nursing hours by nearly half in Taunton, and shifting millions into affiliated real estate entities through inflated rent charges, according to CommonWealth Beacon. RegalCare homes declined in quality after the company took over, per the Globe's reporting, and facilities in Quincy and Taunton fell from five federal government stars all the way down to one star.
The human cost of that decline showed up in specific, documented incidents. CommonWealth Beacon's summary of the Globe investigation noted a blind resident suffered a brain hemorrhage during a 2023 ramp fall at a Quincy home, and two Medford facilities racked up more than $400,000 in federal fines in 2024. Those episodes, laid alongside the ownership disclosures the Globe uncovered, became central evidence in the case for the regulatory overhaul now headed to the Public Health Council.
Healey Points to Holyoke as the Contrast
Governor Healey made her case for the new rules while speaking in New Bedford, saying she wants nursing-home residents' loved ones to know they will be well cared for. She said she put forward the strongest nursing home regulations and that they will bring accountability to the nursing home community across Massachusetts, adding that the new rules give the state power to scrutinize transactions and hold bad actors accountable, according to NBC Boston's report.
Healey's administration is also opening a new facility at the Holyoke Soldiers' Home, where more than 75 veterans died of COVID-19 during the deadly 2020 outbreak. That replacement facility, a $480 million, 234-bed project that was still under construction in 2024, received a perfect rating from the U.S. Department of Veterans Affairs and shifts away from institutional-style wards toward single-occupancy residential rooms, according to New England Public Media. The Holyoke tragedy remains one of the state's most prominent elder-care failures. Separately, the broader oversight law is moving through the Public Health Council process.
Statewide Stakes Beyond One Chain
The stakes extend beyond the RegalCare case. MassHealth funds long-term care for seven out of every ten nursing facility residents statewide, with total MassHealth spending reaching $22.1 billion in fiscal year 2026, Hoodline previously reported. That means taxpayers carry substantial exposure whenever a chain's finances or care quality deteriorates.
Staffing shortages complicate the picture further. Reporting by Newsday found that between 53% and 74% of Massachusetts nursing homes failed to meet state minimum staffing standards from 2021 through 2024, and resident advocates have argued that understaffing fines were previously treated as a routine cost of doing business. Industry data cited by the American Health Care Association shows up to 70% of Massachusetts nursing homes have had to deny or restrict new admissions because they can't find enough nurses and aides.
Whether the department has the administrative capacity to implement the new ownership-vetting rules remains an open question as the October 14 Public Health Council meeting approaches.
