How to start a behavioral health clinic in Tennessee

Tennessee requires a TDMHSAS facility license, e.g., Mental Health Outpatient Facility (0940-05-14) or Alcohol and Drug Non-Residential Rehabilitation Treatment Facility (0940-05-43) from Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) — Office of Licensure (regional offices) to operate a behavioral health clinic. Fee: Licensing fee per the TDMHSAS fee schedule; an invoice is sent after the application forms are received. Amount not captured here.

License required

Yes

License

TDMHSAS facility license, e.g., Mental Health Outpatient Facility (0940-05-14) or Alcohol and Drug Non-Residential Rehabilitation Treatment Facility (0940-05-43)

Issuing agency

Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) — Office of Licensure (regional offices)

Fee

Licensing fee per the TDMHSAS fee schedule; an invoice is sent after the application forms are received. Amount not captured here.

Renewal

Every year

Survey and inspection

On-site initial inspection before licensure; the Office of Licensure also conducts unannounced inspections of licensed facilities.

Regulation

Tenn. Comp. R. & Regs. 0940-05 (Licensure), incl. 0940-05-14 (MH outpatient) and 0940-05-43 (A&D non-residential rehabilitation)

1. Review the TDMHSAS licensure rules (Tenn. Comp. R. & Regs. 0940-05) for the license category
2. Submit the Initial Application, Fact Sheet, Background Check and Privacy Statement Form, and Financial Statement to the regional Office of Licensure nearest the site
3. Pay the licensing fee when invoiced
4. Get a life safety inspection by the State Fire Marshal, a county/city fire marshal or a private certified codes inspector (for sites clients visit)
5. Pass the on-site initial inspection by a Licensure surveyor (life safety, environment and certain policies)
6. Correct any deficiencies and receive an initial license valid for up to one year

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.

Community/behavioral health agencies and mental health clinics — active organization NPIs (NPPES)

1,011 (as of Sep 13, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

• 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 →