Timeline for COPA, CON repeals to go into effect

NASHVILLE — Tennessee legislators eliminated Certificate of Needs laws and the Ballad Health Certificate of Public Advantage during the general assembly this year, bringing big changes to the healthcare landscape of Northeast Tennessee and the rest of the state. Certificates of Need, or CON laws, require prospective hospitals to demonstrate an area has a need for their services before the state grants it a license. The Certificate of Public Advantage, or COPA, allowed Ballad Health to operate outside antitrust laws, with state oversight instead. Both bills passed through the general assembly with bipartisan support. Both were signed into law earlier this month. Arguments over the implementation timeline were central to the discussions among lawmakers. Dates had to be reworked after the Federal Trade Commission sent a letter advising Tennessee lawmakers to repeal CON laws before the Ballad Health COPA. The letter stated that, if the COPA were allowed to expire first, Ballad Health could leverage the state's CON laws to oppose incoming hospitals and hinder potential competition. "Ballad Health, for its part, would have 'every incentive' to oppose competitors applying for CONs, which would decrease the likelihood of entry," reads the letter. "Repealing the CON laws as soon as possible—and in no event later than the expiration of any COPA—would offer the promise of additional competition in Northeast Tennessee." Lawmakers addressed the issue by amending the COPA bill to carve out an exception for acute care hospitals seeking to establish in Northeast Tennessee. Those hospitals will be the first in the state to be freed from CON law requirements, beginning in 2028. CON laws will be dropped in 2030 for acute care hospitals across the rest of the state. Acute care hospitals typically treat patients with an average stay of 25 days or less. They are the most common kind of hospital in the state, with 114 facilities across Tennessee. The following is a timeline showing when the legislation will go into effect. Timeline: June 30, 2028: COPA expires June 30, 2028: Acute care hospitals seeking to establish in Northeast Tennessee are no longer subject to CON requirements July 1, 2028: CON requirements dropped for satellite emergency departments and cardiac catheterization clinics July 1, 2030: CON requirements dropped for acute care hospitals in the rest of the state June 30, 2033: COPA pricing restrictions expire by this date or when a competing acute-care hospital moves into the region — whichever comes first