The Texas Health and Human Services Commission (HHSC) will issue a Certificate of Public Advantage (COPA) if:(1) it determines under the totality of the circumstances that:(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(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) the application:(A) provides specific evidence showing that the proposed merger would likely benefit the public;(B) explains in detail how the likely benefits resulting from the proposed merger agreement outweigh any disadvantages attributable to a reduction in competition; and(C) sufficiently addresses the following factors:(i) the quality and price of hospital and health care services provided to citizens of this state;(ii) the preservation of sufficient hospitals within a geographic area to ensure public access to acute care;(iii) the cost efficiency of services, resources, and equipment provided or used by the hospitals that are a party to the merger agreement;(iv) the ability of health care payors to negotiate payment and service arrangements with hospitals proposed to be merged under the agreement;(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(vi) any other factor the applicant deems relevant to HHSC's determination under Texas Health and Safety Code §314A.056.