Certificate of Public Advantage

Information and resources about the Certificate of Public Advantage with sections and information on COPA announcements, history, official correspondence, submitting public Input and complaints, reports, and spending plans.

The COPA

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.​

*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.​

COPA Archives

Official Correspondence

03/11/25 – A letter from the Tennessee Department of Health regarding Ballad Health’s request for a waiver of the notice period for a proposed Long Term Care and Assisted Living Facilities transaction.

11/04/24 - A letter from Commissioner Alvarado approving Ballad Health's request to delay reporting after a Materially Adverse Event.

10/07/24 - The TN Department of Health's response to Ballad Health’s 10/02/24 notice of a Force Majeure Event and resulting Materially Adverse Event.

10/02/24 - Ballad Health‘s letter notifying the states of a Force Majeure Event and resulting Materially Adverse Event due to the impact of Hurricane Helene.

09/05/24 – A letter from the Tennessee Department of Health regarding Ballad Health’s Fiscal Year 2023 Monetary Commitment.

07/21/24 – A letter from the Tennessee Department of Health approving Ballad Health’s FY25 budget for FY23-FY25 spending plans.

07/22/24 – A letter from the Tennessee Department of Health regarding Ballad Health’s waiver request related to General Surgery and Bariatric & Colorectal Surgery in Sullivan County.

05/13/24 – A letter from Commissioner Alvarado regarding Ballad Health’s proposal to modify the HIE Plan to include funding for EPIC system Community Connect for ETSU clinics.

05/02/24 – A letter from Commissioner Alvarado regarding Ballad Health’s proposal to modify the HR/GME Plan to include funding for the Southwest Virginia Higher Education Center Simulation Laboratory.

02/08/24 – A letter from Commissioner Alvarado regarding Ballad Health’s proposal to modify the HR/GME Plan to include support for ETSU GME.

02/01/24 – A letter from the Tennessee Department of Health regarding Ballad Health’s Fiscal Year 2022 Monetary Commitment.

01/11/24 – A letter from the Tennessee Department of Health regarding Ballad Health’s waiver request related to employment of 8 general surgeons in Sullivan County, TN. (RE Ballad Health’s 11/07/23 general surgery employed physicians waiver letter.)

01/05/24 – A letter from the Tennessee Department of Health consenting to Ballad Health’s request to close surgical services at Hawkins County Memorial Hospital.   (RE Ballad Health’s 11/02/23 request to close surgical services at Hawkins County Memorial Hospital. )

11/07/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its Rural Health Plan to include certain funding for an additional ambulance in Carter County, Tennessee.

09/12/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its HR/GME Plan  to include funding for the Milligan University Simulation Laboratory.

09/12/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its HR/GME Plan  to include certain funding for the Appalachian Highlands Healthcare Academy.

07/05/23 – The Tennessee Department of Health accepted Ballad Health's proposed FY24 Population Health Process Measures that will be used in calculating the FY24 score.

06/28/23 – A letter from the Tennessee Department of Health approving Ballad Health’s FY24 budget for FY23-FY25 spending plans. (RE Ballad Health’s FY24 Plan Budget. )

06/15/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s waiver request related to Urologists in Washington and Sullivan County. (RE Ballad Health’s 05/12/23 urology employed physician waiver letter.)

05/05/23 – A letter from the Tennessee Department of Health consenting to Ballad Health’s proposed consolidation of Intensive Care Unit (ICU) and Progressive Care Unit (PCU) Services/Units at Sycamore Shoals Hospital with Johnson City Medical Center.  (RE Ballad Health’s 12/08/22 Sycamore Shoals ICU/PCU notice Letter.)

05/04/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its Rural Health Plan to incorporate expenses related to the reopening of Lee County Hospital.

04/10/23 – A letter from the Tennessee Department of Health approving Ballad Health’s request for a ninety-day extension on the replacement capital plan submission requirement.  (RE Ballad Health’s 03/22/23 Capital Plan Extension Letter. )

01/27/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s Fiscal Year 2021 Monetary Commitment.

COPA Reports

Ballad Health Annual Reports

Ballad Health Annual Reports FY2025 |  FY2024 | FY2023 | FY2022| FY2021 | FY2020 | FY2019 | FY2018

FY2024 Ballad Annual Report Cover Letter

FY2020 Full Year Data


COPA Monitor Reports

COPA Monitor Annual Report on fiscal year  2024 | 2023 | 2022 | 2021 | 2020 | 2019 | 2018


COPA Compliance Annual Reports

COPA Compliance Office Annual Reports FY2020 | FY2019  | FY2018

As of FY2021 each COPA Compliance Office Annual Report is included with the Ballad Health Annual Report for the same fiscal year


Department Reports

Department Annual Report by Fiscal Year 2024 | 2023| 2022 | 2021 | 2020 | 2019 | 2018


Sub-Index Reports

As of FY2021 each Sub-Index Report is included with the Department Annual Report for the same fiscal year.

How to Provide Feedback to the Tennessee Department of Health

The Tennessee Department of Health (TDH) is responsible for on-going active state supervision of mergers granted under a Certificate of Public Advantage (COPA), according to 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 public is encouraged to provide feedback on the progress and impact of the Ballad Health merger on the region.

Leave a Comment   

How to File a COPA Complaint

The public is encouraged to alert TDH of potential violations to the Terms of Certification that should be investigated.

For complaints specific to the impact of the COPA, please download and complete this complaint intake form.  Please submit the completed complaint intake form to TDH:

By email:    TN.Health@tn.gov (as an attachment).

By mail:      TN Department of Health – COPA

710 James Robertson Parkway, 5th Floor

Nashville, TN 37243.
 

How to File Other Complaints Against Ballad Health

Some issues are not a result of the merger of the two hospital systems and thus, not resolvable under the COPA Terms of Certification (TOC). There are processes in place for receiving and investigating certain health care complaints. Examples of issues that are not COPA-related include:

Cleanliness, staffing concerns, and certain health care issues. These issues may or may not have happened as a result of the merger of the hospital systems and are not violations of the COPA Terms of Certification. Safety concerns should be directed to TDH’s Office of Health Care Facilities. The Office of Health Care Facilities remains responsible for the licensing and regulation of hospitals in the State. The process for filing a complaint against a Tennessee health care facility or provider is available here.

To be clear, while it is not the role of the TDH under the TOC to assist or track individual patients who have a negative experience at a Ballad Facility, TDH is tracking Ballad’s performance on dozens of safety and quality measures including timely and effective care, infection rates, and patient satisfaction scores at 1) a system level, 2) a statewide level, and 3) each Ballad facility. Quarterly and Annual data for Ballad Health’s total patient population will be used to track demonstration of an overall improvement or decline in care quality subsequent to the issuance of the COPA.

Labor concerns. Staff labor concerns are regulated by the Tennessee Department of Labor and Workforce Development. Information on its statutes governing employee meals and breaks, wage regulation, and fringe benefits can be accessed from that Department’s website here and its Labor Standards Unit with information how to file a complaint can be contacted by calling 844-224-5818.

Certain employee benefits and protections are covered by the COPA and are described under Section 3.08 Terms of Certification.

Billing issues. High deductibles, high premiums, and co-pays are a part of the complex United States health care system and not related to the COPA. Double billing or coding issues may be errors caused by a human data entry error. Those issues should be directed to Ballad Health’s billing department, which can be reached by calling at (423) 431-1700 or (423) 408-7400.

Compliance questions. The COPA Compliance Office is part of the Active Supervision Framework outlined in the Terms of Certification. The Ballad Health COPA Compliance Office reviews, logs, investigates, and seeks to resolve compliance issues. The COPA Compliance Office can be contacted through an Anonymous Alertline, at 1-800-535-9057, or via general email, at copa.compliance@balladhealth.org.


How to Submit General Comments Regarding Ballad Health

General comments regarding the progress of the Ballad Health merger and its impact on the region can be submitted to the Tennessee Department of Health.

Spending Plans

Current 

FY26-FY28 Plans

 

FY23 - FY25 Spending Plans

FY23-FY25 Plans

05/13/24 – A letter from Commissioner Alvarado regarding Ballad Health’s proposal to modify the HIE Plan to include funding for EPIC system Community Connect for ETSU clinics.

05/02/24 – A letter from Commissioner Alvarado regarding Ballad Health’s proposal to modify the HR/GME Plan to include funding for the Southwest Virginia Higher Education Center Simulation Laboratory.

02/08/24 – A letter from Commissioner Alvarado regarding Ballad Health’s proposal to modify the HR/GME Plan to include support for ETSU GME.

11/07/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its Rural Health Plan to include certain funding for an additional ambulance in Carter County, Tennessee.

09/12/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its HR/GME Plan  to include funding for the Milligan University Simulation Laboratory.

09/12/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its HR/GME Plan  to include certain funding for the Appalachian Highlands Healthcare Academy.

05/04/23 – A letter from the Tennessee Department of Health regarding Ballad Health’s request modify its Rural Health Plan to incorporate expenses related to the reopening of Lee County Hospital.

 

Former Spending Plans

Ballad’s Three-Year Plans

Revised Children’s Health Plan (submitted April 2021)

Ballad Health’s HIE Plan.  

Ballad Health’s HR/GME Plan.    

Ballad Health ‘s Rural Health Plan.

Ballad Health’s Behavioral Health Plan.   

Ballad Health’s Children’s Health Plan.   

Ballad Health’s Population Health Plan.  

 

Ballad Health’s Plan Updates (“Implementation Roadmaps”) 

FY20 Implementation Roadmaps containing updated schedules of quarterly milestones and data metrics for Ballad Health’s six 3-year plans: Behavioral Health, Children’s Health, Health Information Exchange, Health Research and GME, Population Health and Rural Health.

 

One-Year Plan Extension

Ballad’s request for a one-year extension of the three-year plans.

TDH letter approving the one-year extension of Ballad Health’s three-year plans.

 

Plan Modification Requests

TDH Approval of Ballad’s HR/GME Plan Modification Request to add a program at the Appalachian School of Law dated 9/29/20.

Ballad’s HR/GME Plan Modification Request to add a program at the Appalachian School of Law dated 9/18/20.

TDH’s approval of Ballad’s Children’s Health Plan Modification Request to add Miracle Field dated 6/7/21.

TDH’s approval of Ballad’s Rural Health Plan Modification Request to add the purchase of new cardiac monitors for regional EMS providers dated 7/27/21.

TDH’s approval of Ballad Health’s request to modify the Population Health Plan to include Lee County Community Fund spend dated 11/08/21.

TDH’s approval of Ballad Health’s request to modify the HR/GME Plan to include support for the Emory and Henry College Bachelor of Science in Nursing program dated 03/01/22.

TDH’s approval of Ballad Health’s request to modify the HR/GME Plan to include support for a Regional Center for Nursing Professional Advancement for the Appalachian Highlands dated 03/01/22.

TDH’s approval of Ballad Health’s request to modify the HR/GME Plan to include funding of the Gatton College of Pharmacy Center of Pharmacy Education, Advocacy and Outreach dated 03/22/22.

TDH’s approval of Ballad Health’s request to modify the HR/GME Plan to include funding to the STREAMWORKS program dated 03/22/22.

 

TDH Approval of Plans

TDH’s conditional approval of Ballad Health’s Rural Health Plan.

TDH’s conditional approval of Ballad Health’s Health Information Exchange (HIE) and Health Research and Graduate Medical Education (HR/GME) Plan.

TDH’s conditional approval of Ballad Health’s Behavioral Health, Children’s Health, and Population Health Plan.

This Page Last Updated: March 27, 2026 at 9:10 AM