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Certificate of Public Advantage (COPA)

 Announcement: Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, announced January 31, 2018 that the state is officially allowing a merger of Wellmont Health System and Mountain States Health Alliance by issuing a Certificate of Public Advantage or COPA to their parent company, Ballad Health.​

  Announcement on the COPA decision: Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, announced Sept. 19, 2017 that the request for a Certificate of Public Advantage from Wellmont Health System and Mountain States Health Alliance has been granted.​
  Press Release
  Terms of Certification
  Executed Letter of Approval
  Approval Certificate Signed by MSHA
  Approval Certificate Signed by WHS

*The resolution unanimously adopted by the Board of Wellmont Health System approved the September 16, 2017 draft of the Terms of Certification and any subsequent “more favorable terms” as may be agreed to by the State of Tennessee.  The September 18, 2017 draft of the Terms of Certification contains a “more favorable term” that was agreed to by the State and, therefore, the September 18, 2017 draft of the Terms of Certification were approved by the Wellmont Board.​

A Certificate of Public Advantage (COPA) is the written approval by the Department which governs a Cooperative Agreement among two or more hospitals.  The goal of the COPA application process is to protect the interests of the public in the region affected and the State. The application process will allow the applicants to submit information and data about their Cooperative Agreement in sufficient detail to enable the State to determine the benefits/advantages and disadvantages of the Cooperative Agreement. Permanent Rules 1200-38-01-.01 et seq. , effective January 4, 2016, -implement TCA Sections 68-11-1301 – 68-11-1309, which govern the COPA process.

The Permanent Rules found here, detail the Department’s intent to make the COPA application, review, decision, and supervision process participatory and transparent.


  • 3/8/19 The COPA Local Advisory Council’s Annual Report can be read here.
  • 3/6/19 The Department’s COPA Index Reports, which include the Population Health Report, Access to Health Services Report, and Other (Quality) Report, can be read here
  • 3/5/19   A signed Conditional Waiver, regarding cross-credentialing of Employed Physicians at all Ballad hospitals, can be read here

Public Meetings Calendar


General Questions

Statement of the Tennessee Department of Health regarding Ballad Health’s announced Trauma System Changes and other Systematic Changes

Ballad Health recently announced several proposals regarding changes to its regional trauma and emergency system along with other systematic changes including pediatric services.

Since the announcement, the department has received a variety of questions, concerns and feedback from Northeast Tennessee residents on these issues.

As the state regulator of the Certificate of Public Advantage (COPA) granted to Ballad Health, the department’s role in these proposals is clear.

The changes to the regional trauma system, specifically designating Johnson City Medical Center as the region’s Level I trauma center, is a decision that Ballad has the authority to make based on the COPA Terms of Certification without specific state approval.

The department is required, however, under the Terms of Certification to decide whether to approve or disapprove Ballad’s proposed changes to pediatric services in the region.  Ballad submitted an initial request to the department, and the department has requested additional information. 

Once the department has received all necessary information on which to make a decision, the department will have 90 days to make a decision.

Media Inquiries

For media and press inquiries, please contact and/or 615-741-3111.