All COPAs shall be governed by terms of certification. The
terms of certification shall include:
(a) Parties to a Cooperative Agreement who
have applied to the Department for a COPA shall pay all charges incurred in the
examination of the Application and, in the event the COPA is approved, all
charges incurred for the review and ongoing supervision of the Cooperative
Agreement, including all expenses of the Department, including, but not limited
to, experts and examiners employed in the review and ongoing supervision of the
Application and COPA.
compensation of the Department, experts and examiners designated by the
Commissioner for examining the Cooperative Agreement and all records shall be
fixed by the Commissioner at an amount commensurate with usual compensation for
(c) The Department
shall develop a formula to include charges incurred in the examination of the
Application and charges incurred for review and ongoing supervision and invoice
COPA Applicants and holders Department's costs at a regular interval.
Evaluation of the Application
by the Department that demonstrates Public Advantage in accordance with the
standards set forth in these rules.
Benefits to include:
1. Enhancement of the
quality of Hospital and hospital-related care provided to Tennessee
2. Preservation of
hospital facilities in geographical proximity to the communities traditionally
served by those facilities;
Gains in the cost containment and cost-efficiency of services provided by the
in the utilization of Hospital resources and equipment;
5. Avoidance of duplication of Hospital
6. Demonstration of
population health improvement of the region served according to criteria set
forth in the Cooperative Agreement and approved by the Department;
7. The extent to which medically underserved
populations have access to and are projected to utilize the proposed services;
8. Any other benefits that may
Disadvantages to include:
1. The extent of
any likely adverse impact on the ability of health maintenance organizations,
preferred provider organizations, managed health care organizations or other
healthcare payers to negotiate appropriate payment and service arrangements
with Hospitals, physicians, allied healthcare professionals or other healthcare
2. The extent of any
reduction in competition among physicians, allied health professionals, other
healthcare providers or other persons furnishing goods or services to, or in
competition with, hospitals that is likely to result directly or indirectly
from the Cooperative Agreement;
The extent of any likely adverse impact on (i) patients in the quality and
availability of healthcare services and (ii) patients and payers in the price
of healthcare services; and
availability of arrangements that are less restrictive to competition and
achieve the same benefits or a more favorable balance of benefits over
disadvantages attributable to any reduction in competition likely to result
from the Cooperative Agreement.
Ongoing Supervision through the use of an
Index tracking demonstration of Public Advantage.
(a) An Index will be created and used for the
Department to evaluate the proposed and continuing Public Advantage of the
The Index will include
measures of the cognizable benefits and disadvantages in the following
1. Population Health;
2. Access to Health Services;
3. Economic; and
4. Other Cognizable Benefits.
(c) Each category may be comprised
of Measures for subcategories of the Index which shall be recommended
separately by the Advisory Group and the parties to the Cooperative Agreement
for the COPA. The Department retains exclusive authority to add to, modify, or
to accept or reject recommendations when creating the Index.
The Department shall establish a baseline
score at the outset of the Index composition to allow for the future
demonstration of a Public Advantage. Subsequently, established ranges for the
score should demonstrate whether:
is clear and convincing; the COPA continues in effect,
2. Advantage is not clear and convincing; a
modification to the Cooperative Agreement under the terms of certification will
3. Advantage is not
evident; COPA is terminated.
1. Recommendations. The Advisory Group shall
recommend to the Commissioner Measures to be considered for inclusion in an
Index to objectively track the Public Advantage of a Cooperative
Advisory Group shall hold at least four (4) meetings with stakeholders to
obtain community input and comment, with guidance from the Department.
(i) All meetings shall be open in accordance
with T.C.A. §§
(ii) One (1) meeting shall provide for
comment from internal stakeholders, such as persons employed by or agents of
the parties to the Cooperative Agreement, its affiliates, contractors or
vendors, staff clinicians or other persons deriving income from their
activities with any of the parties to the Cooperative Agreement.
(iii) One (1) meeting shall provide for
comment from external stakeholders, such as competing health care providers,
non-staff clinicians, payers including self-insured employers, governmental
agencies, nongovernmental agencies, and other parties who derive income from
health or health care services or are who are not employed or affiliated with
and do not derive income from the parties to the Cooperative
(iv) One (1) meeting
shall provide for comment from other members of the community not represented
in the internal or external stakeholder groups, including, current or potential
patients, customers or other entities who are not affiliated, competing with or
otherwise contracting with the parties to the Cooperative Agreement.
(v) The final meeting shall be open to all
persons expressing an interest in the Cooperative Agreement and shall be held
following the completion of the Advisory Group's recommendation of Measures to
be considered for inclusion in the Index.
(vi) The Advisory Group, in consultation and
with the approval of the Department, may elect to alter the number and
composition of the meetings previously described.
(vii) The Department may provide guidance to
the Advisory Group.
Completion of Duties.
(i) The Advisory
Group's service shall conclude when the Department receives the Advisory
Group's recommendation of Measures proposed for inclusion in the
(ii) The Commissioner shall
have the authority to convene, change the composition of, dismiss and reconvene
the Advisory Group if necessary.
(4) A commitment to pass on or reinvest a
portion of cost savings and efficiencies gained through the Cooperative
Agreement to the citizens in the affected geographic service area.
(5) Additional conditions of reporting and
operations determined by the Department to demonstrate Public
Tenn. Comp. R. &
rule filed July 14, 2015; effective through January 10, 2016. New rule filed
October 6, 2015; effective January 4, 2016. Amendments filed December 10, 2018;
Authority: T.C.A. §§