Tennessee, Ballad Health agree to changes in COPA terms
JOHNSON CITY, Tenn. (WJHL) — Rules governing Ballad Health's state-authorized hospital monopoly have just undergone their biggest revision after more than a year of negotiations between Tennessee officials and Ballad.
Homelessness increased in Northeast TN, according to 2025 PIT Count
The Tennessee Department of Health released the fifth version of the 'terms of certification' today. Those cover everything from quality of care measures and access to care to capital spending, charity care, public input and how much Ballad can charge insurance companies.
In a news release, the Tennessee Department of Health (TDH) said the revisions cover five key areas: prioritizing quality of care, overall system scoring, rural hospitals, charity care, and listening sessions with the public.
News Channel 11 spoke to Ballad CEO Alan Levine during those negotiations. At that time, earlier this year, he said the final sticking points had more to do with language than significant differences.
'Fundamentally, we're all in agreement,' Levine said. 'We want to see access and quality of care be the guideposts for what we're doing here.'
The Tennessee rural hospitals in Greeneville, Elizabethton, Rogersville, Erwin, Mountain City and Sneedville will now stay open at least two years longer than the previous commitment and four years longer if the federal government okays a statewide proposal to increase TennCare reimbursements.
'If you go to any rural community that's lost their hospital, first of all, mortality rates go up in that community,' Levine told News Channel 11 during a late January interview about the negotiations with TDH.
'The economy in that community suffers. Those are good paying jobs for that community. Access to physicians deteriorates dramatically because the hospital does support those physicians. So I think people in the rural communities are very concerned about the loss of their hospitals.'
The terms of certification exist because Ballad operates under a 'Certificate of Public Advantage' (COPA) granted by the state of Tennessee, which enabled the 2018 merger of formerly competing hospital systems Wellmont and Mountain States. Because that created an inpatient hospital monopoly that the Federal Trade Commission (FTC) opposed, the parties had to seek what's called 'state action immunity' from both Tennessee and Virginia to avoid facing an FTC lawsuit.
'For more than a year we have worked with the Tennessee Attorney General's Office and Ballad Health to ensure the COPA continues to provide a public benefit in meeting Northeast Tennessee's health needs,' TDH Commissioner Dr. Ralph Alvarado said in a news release.
'Our effort and progress serve as a model for health care in Tennessee, the Appalachia Region, and the entire nation. It is vitally important we get it right.'
TDH will prepare a narrative review for the assessment of Ballad's performance through the end of the company's 2025 fiscal year June 30, the release said. This is to allow Ballad time to implement the new, numerical COPA performance scoring process for the 2026 Fiscal Year, beginning on July 1.
In a statement released immediately after the TDH release, Ballad called the changes 'thoughtful and reasonable.'
'Our goals are the same,' Ballad's release reads. 'At a time when 150 rural hospitals have closed throughout the nation, and 700 more have been identified as being in danger of closure, keeping rural hospitals open for our communities is at the core of why the COPA was created. Access to high quality care is a goal everyone shares.'
This is a developing story.
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