How to start an assisted living facility in Tennessee

Tennessee requires a Assisted care living facility (ACLF) license; residential homes for the aged are licensed separately from Tennessee Health Facilities Commission — Board for Licensing Health Care Facilities to operate an assisted living facility. Fee: Non-refundable fee by bed capacity: under 25 beds $1,040; 25–49 $1,300; 50–74 $1,560; 75–99 $1,820; 100–124 $2,080; 125–149 $2,340; 150–174 $2,600; 175–199 $2,860. For 200+ beds: $2,860 plus $200 for each additional 25 beds or fraction. Processing time: The life safety inspection must happen within 10 days of the request (Public Chapter 1019, 2024). The health survey follows 30–45 days after the life safety survey.

License required

Yes

License

Assisted care living facility (ACLF) license; residential homes for the aged are licensed separately

Issuing agency

Tennessee Health Facilities Commission — Board for Licensing Health Care Facilities

Fee

Non-refundable fee by bed capacity: under 25 beds $1,040; 25–49 $1,300; 50–74 $1,560; 75–99 $1,820; 100–124 $2,080; 125–149 $2,340; 150–174 $2,600; 175–199 $2,860. For 200+ beds: $2,860 plus $200 for each additional 25 beds or fraction.

Processing time

The life safety inspection must happen within 10 days of the request (Public Chapter 1019, 2024). The health survey follows 30–45 days after the life safety survey.

Medicaid waiver coverage

ACLFs serving Medicaid members must meet the federal HCBS settings rule to become TennCare providers. HHS's 2015 compendium reported coverage through TennCare CHOICES (1115 managed LTSS).

Regulation

Tenn. Comp. R. & Regs. ch. 1200-08-25 (Assisted Care Living Facilities)

1. Submit a notarized application with the licensure fee, a CPA-prepared financial statement, a local business license (if required) and business entity documents
2. Have an architect or Tennessee-licensed engineer seal the plans and submit them to the HFC Plans Review Section; build or renovate after approval
3. After construction, ask the Regional Office for the life safety and health surveys
4. Pass the health survey; the surveyor makes a licensure recommendation

Program

TennCare (Division of TennCare, Tennessee)

Enrollment portal

TennCare Provider Registration portal, plus Data Spring (formerly CAQH ProView) for individual providers

Application fee

Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. TennCare's registration pages do not list a separate state fee.

Fingerprinting

Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. TennCare's registration pages do not describe a separate state fingerprint process.

Site visit

Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. TennCare's registration pages do not describe a separate state site visit process.

Revalidation

Every TennCare provider enrollment must be revalidated every 3 years, more often than the federal 5-year minimum. Submitting any update in the enrollment portal resets the due date. Groups and entities see the due date at the top of their enrollment. Individual providers revalidate by submitting their Data Spring (CAQH ProView) application.

Full Tennessee Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Tennessee Health Facilities Commission (HFC)

Services covered

• hospitals
• nursing homes (and nursing home bed increases beyond the lesser of 10 beds or 10% once every 3 years)
• ambulatory surgical treatment centers
• home care organizations (home health and hospice)
• residential hospice
• outpatient diagnostic centers
• rehabilitation facilities
• nonresidential substitution-based opiate treatment centers
• open heart surgery, organ transplantation, cardiac catheterization, linear accelerators
• MRI/PET initiation in counties of 175,000 or fewer; pediatric MRI in larger counties
• bed redistribution/relocation, facility relocation, hospital satellite EDs and satellite inpatient facilities

Tennessee certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Assisted living facilities — active organization NPIs (NPPES)

343 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,384,007 (as of Jun 1, 2026)

All Tennessee Home care Medicaid rates, ranked →

• TN Comprehensive Aggregate Cap Home and Community Based Services (CAC) Waiver (1915(c))
• TN Self-Determination Waiver Program (1915(c))
• TN Statewide Home and Community Based Services Waiver (1915(c))
• TennCare III (subsumes TennCare II) (1115)

Tennessee waivers and waiting lists →