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Behavioral Health Transactions and Operations

Headshot of Jim Bailey, Williams Mullen
Matthew M. Cobb Williams Mullen Headshot

The Behavioral Health Transactions and Operations Team at Williams Mullen helps providers with all aspects of service development and operation. We advise on how to efficiently navigate reimbursement frameworks, operate in compliance with state and federal regulations, contend with operational issues, and expand services through strategic transactions and use of regulatory processes.

Broad Industry Perspective

Attorneys at the firm have experience with a variety of settings in the behavioral health space. Those include acute care hospitals with specialized behavioral health units, freestanding psychiatric hospitals, substance use disorder treatment providers, residential treatment facilities, group homes, developmental disability support services, crisis services, licensing agencies, community-based behavioral health services, and behavioral-health focused physicians and other licensed professionals.

Practical Regulatory Experience

In the context of new facilities as well as acquisitions, we represent providers before state licensure agencies to help them secure timely licensure of behavioral health facilities and services as well as seamless change of ownership, where applicable.

Our team includes attorneys who previously worked at the Virginia Health and Human Resources Secretariat, the Virginia Department of Behavioral Health and Developmental Services, and the Virginia Office of the Attorney General. These experiences provide our team with an in-depth understanding of regulatory and reimbursement processes and the various regulatory agencies.

We also provide advice to clients seeking to achieve and maintain compliance with federal and state statutory and regulatory requirements, including:

  • The Virginia Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services
  • The Virginia Regulations for Children’s Residential Facilities
  • The Virginia Regulations to Assure the Rights of Individuals Receiving Services from Providers Licensed, Funded, or Operated by the Department of Behavioral Health and Developmental Services
  • Medicaid Provider Manuals
  • Managed care contracting
  • Fraud and abuse concerns
  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  • 42 CFR Part 2
  • Virginia Department of Health Professions licensure matters
  • North Carolina Boards of Social Work, Licensed Clinical Mental Health Counselors and Certified Substance Abuse Counselors, and the North Carolina Department of Health and Human Services

Extensive COPN and CON Track Record

Williams Mullen attorneys have represented numerous clients with Virginia Certificate of Public Need (COPN) and North Carolina Certificate of Need (CON) matters, assisting in all stages of the process, including opposition efforts, from strategy development through administrative hearings and judicial appeals. We have large and longstanding COPN and CON practices, providing us with strong insight into regulatory decision-making, precedent, strategy, and data sources.

Comprehensive Transaction Services

With both behavioral health-specific and broad-based health industry deal experience, our lawyers are well-qualified to provide counsel to entities that are purchasing and financing behavioral health facilities and licensed services. We can assist with all stages of a transaction, from letter of intent planning through closing, and including licensure and other regulatory requirements associated with transactions.

We can also structure joint venture agreements and leasing arrangements and can provide guidance with complicated ownership structures, including joint ventures and private equity-backed transactions. Our attorneys have experience working with dozens of lenders and can serve as borrower’s counsel for term, mezzanine, and working capital financing.

Insight Into Operational Issues

Our team can assist with a variety of matters that are integral to successful daily operations, including:

  • Policies and Procedures, including drafting new or amending existing policies and procedures such as medication administration, informed consent, quality improvement, risk management, serious incident reporting, and HIPAA.
  • Licensing, including initial and renewal licensure.
  • Regulatory Compliance and Complaint Response, including defense of professional license complaints and facility inspection deficiency citations.
  • Reimbursement, including Medicaid enrollment, Managed Care Organization (MCO) credentialing, overpayment investigations, audits and appeals, and other reimbursement initiatives.
  • Patient Rights, including policies, complaints, and appeals.
  • Telehealth, including compliance obligations throughout the 50 states.
  • Critical Documentation, including consent forms, medical records, and HIPAA.
  • Administration, Onsite Storage, and Dispensing of Medication, including navigating the interplay of pharmacy law, facility licensure rules, and Drug Enforcement Administration (DEA) requirements to maintain stat boxes and other mechanisms to maintain an immediately-available stock of medication when pharmacy dispensing is impossible or impractical.
  • Guardianships, including petitions and court-ordered treatment.
  • Services Contracts, including contracted clinical staff arrangements, employment agreements, management services, pharmacy and supplier vendor agreements, and professional training program student affiliation agreements.
  • Intellectual Property, including trademark and copyright registration, trademark and copyright enforcement, social media take-downs, and related services.
  • Corporate Practice Laws, including navigating options for establishing service in the context of limitations imposed by “corporate practice of medicine” and “fee splitting” restrictions.

Our attorneys can also provide representation for your labor and employment, immigration, tax, real estate, land use, and litigation matters.

Reimbursement Solutions

We provide counsel on the enrollment process with federal and state payors, including Medicare, Medicaid, and Medicaid Managed Care Organizations. Our attorneys help providers appeal audit findings, investigate potential overpayments, and defend against federal or state actions to recoup alleged overpayments. We also work to maximize reimbursement in accordance with the regulatory requirements and resolve disputes over reimbursement with payors.

Crisis Gameplan

We can assist practitioners in all stages of licensure complaints and investigations, including:

  • Complaint response
  • Preparation for informal and formal hearings
  • Compliance with corrective action plans
  • Appeals
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  • Represented a private equity investment firm in its acquisition of a mental health and substance use disorder treatment provider serving patients across multiple states.
  • Advised a substance use disorder treatment provider on navigating state restrictions and local zoning ordinances governing the establishment and operation of substance use disorder services.
  • Defended a substance use disorder treatment provider against neighborhood opposition to treatment facilities/sober houses in both administrative hearings and litigation.
  • Represented a substance use disorder treatment provider in disputes over subpoenas and records requests related to 42 CFR Part 2 (substance abuse confidentiality regulations).
  • Advised a substance use disorder treatment provider on responding to licensure inquiries and surveys by a state’s division of licensing.
  • Reviewed clinical documentation to determine compliance with DMAS billing requirements, analyzed risks for a Medicaid audit, and advised a behavioral health provider on next steps related to an audit.
  • Advised a behavioral health provider on various regulatory matters, including requirements under the Ryan Haight Act, CMS’s incident to billing rules, and state supervision laws.
  • Advised a residential treatment facility for substance abuse disorders on maintaining stat boxes for storing detox medication to be administered on an emergency basis.
  • Represented a provider of behavioral health services in an appeal of coverage determination. Facilitated 100% payout of moneys owed.
  • Provided counsel to a substance use disorder treatment provider regarding overpayments from state and federal payors.
  • Advised a provider of mental health and substance use disorder treatment services on Anti-Kickback Statute and Eliminating Kickbacks in Recovery Act (EKRA) matters.
  • Represented a client that obtained a ruling that the COPN law in Virginia does not apply to certain residential substance use disorder treatment facilities and certain detox programs.
  • Represented a private equity-backed behavioral health treatment provider in a joint venture transaction involving the acquisition of Chapter 11 liquidation assets across multiple states.
  • Provide government relations services advocating for increased reimbursement and changes to Virginia law to increase access to treatment on behalf of a substance use disorder treatment provider.
  • Advised a substance use disorder treatment provider on establishing new service lines and submitting service modifications.
  • Assisted a large non-profit hospital in extensive COPN strategy development and COPN review in various behavioral health initiatives.
  • Obtained COPNs for child and adolescent psychiatric beds.
  • Provided counsel regarding regulatory and reimbursement issues for the development of a behavioral health unit within a skilled nursing facility. 
  • Evaluated competing trademarks and prepared/issued a cease and desist letter to a behavioral health services provider using a confusingly similar name to a client’s registered trademark.
  • Represented a provider in the licensing of a multi-part pediatric behavioral health service line.
  • Advised a hospital on a matter related to the development of a freestanding psychiatric hospital.
  • Advised a residential treatment facility for substance use disorders on maintaining stat boxes for storing detox medication to be administered on an emergency basis.
  • Assisted a substance use disorder treatment provider at a formal hearing during which the provider obtained a decision that it did not cause the death or neglect of a patient.
  • Assisted with resolving a trademark dispute on behalf of a subsidiary facility providing acute psychiatric care to teens struggling with emotional or behavioral issues.
  • Assisted with a trademark re-branding evaluation for a behavioral health care provider.