The Texas Health and Human Services Commission (HHSC) will issue a Certificate of Public Advantage (COPA) if:

1. (1) it determines under the totality of the circumstances that:

   1. (A) the proposed merger would likely benefit the public by maintaining or improving the quality, efficiency, and accessibility of health care services offered to the public; and
   2. (B) the likely benefits resulting from the proposed merger agreement outweigh any disadvantages attributable to a reduction in competition that may result from the proposed merger; and

2. (2) the application:

   1. (A) provides specific evidence showing that the proposed merger would likely benefit the public;
   2. (B) explains in detail how the likely benefits resulting from the proposed merger agreement outweigh any disadvantages attributable to a reduction in competition; and

   3. (C) sufficiently addresses the following factors:

      1. (i) the quality and price of hospital and health care services provided to citizens of this state;
      2. (ii) the preservation of sufficient hospitals within a geographic area to ensure public access to acute care;
      3. (iii) the cost efficiency of services, resources, and equipment provided or used by the hospitals that are a party to the merger agreement;
      4. (iv) the ability of health care payors to negotiate payment and service arrangements with hospitals proposed to be merged under the agreement;
      5. (v) the extent of any reduction in competition among physicians, allied health professionals, other health care providers, or other persons providing goods or services to, or in competition with, hospitals; and
      6. (vi) any other factor the applicant deems relevant to HHSC's determination under Texas Health and Safety Code §314A.056.

Source Note:The provisions of this §280.26 adopted to be effective October 25, 2020, 45 TexReg 7588; amended to be effective January 1, 2023, 47 TexReg 8724; transferred effective May 1, 2025, as published in the April 11, 2025, issue of the Texas Register, 50 TexReg 2439.