On September 19, 2017, after more than two years of opposition from the FTC, the Tennessee Department of Health granted a certificate of public advantage (COPA), exempting the merger of Mountain States Health Alliance and Wellmont Health System from federal antitrust scrutiny. In consultation with the Tennessee attorney general, the Tenessese Department of Health disagreed with the FTC and decided that the benefits to the residents of Northeast Tennessee would outweigh any downsides of creating a monopoly in certain healthcare services. In order to ensure these benefits, the COPA included certain conditions that increased state supervision, accountability and transparency. After Virginia Department of Health approved the proposed merger, the new 21-hospital system was rebranded as Ballad Health.