North Carolina Removes Prior Review Requirement for Dental Management Agreements

A recent change to how North Carolina regulates dental management arrangements will streamline the process by which dental support organizations enter into such arrangements with dental practices in the state. Under Session Law 2026-41, enacted July 7, 2026, the state no longer requires parties to submit management agreements to the North Carolina State Board of Dental Examiners for review.

For years, North Carolina distinguished itself by requiring advance board review of management arrangements between dental practices and dental support organizations. That process often delayed transactions, increased costs and introduced uncertainty. Under the new legislation, parties may enter management arrangements without first obtaining board review or a deemed compliance letter. Notably, this change contrasts with a broader trend in several states toward greater review and oversight of similar arrangements. (See our Holland & Knight Navigator that tracks these developments.)

Although the legislation eliminates the front-end review process, it leaves the underlying legal and compliance framework intact. The board retains authority to investigate management arrangements, review underlying agreements and enforce the Dental Practice Act. Accordingly, compliance remains critical, but the board will no longer evaluate management arrangements in advance.

Implications for Practices

• No Prior Review Required. Parties may now execute agreements without submitting them to the board.
• Other Existing Rules Remain. Long-standing requirements governing written agreements, fair compensation structures and restrictions on control of clinical matters continue to apply.
• Risk Shifts, But Still Persists. The board retains the authority to review and challenge arrangements, particularly in response to complaints or investigations.
• Transaction Timelines Should Improve. Parties no longer need to factor board reviews into transaction or management arrangement timelines.
• Administrative Burden Reduced. Parties no longer need to submit every agreement amendment, attest to the existence of all current and future agreements, or report dental support organization-level ownership changes to the board.

Considerations and Next Steps

Holland & Knight has extensive experience navigating North Carolina's former review process and advising on compliant management structures across diverse regulatory environments. That experience remains invaluable, particularly because parties may not identify compliance concerns until after execution.

We will continue to monitor the board's implementation of this legislation and any related rulemaking activity. In the meantime, parties entering into or updating management arrangements in North Carolina should carefully structure those arrangements to satisfy existing legal requirements.

For additional information or questions, please contact the authors.

Information contained in this alert is for the general education and knowledge of our readers. It is not designed to be, and should not be used as, the sole source of information when analyzing and resolving a legal problem, and it should not be substituted for legal advice, which relies on a specific factual analysis. Moreover, the laws of each jurisdiction are different and are constantly changing. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. If you have specific questions regarding a particular fact situation, we urge you to consult the authors of this publication, your Holland & Knight representative or other competent legal counsel.