How to start a home care agency in Tennessee

Tennessee requires a Personal Support Services Agency (PSSA) license from Tennessee Department of Mental Health and Substance Abuse Services, Office of Licensure (agencies whose clients are mostly aged or have mental illness/SUD); Department of Disability and Aging (formerly DIDD) Office of Licensure for agencies serving mostly people with intellectual/developmental disabilities to operate a home care agency. Fee: $810.

License required

Yes

License

Personal Support Services Agency (PSSA) license

Issuing agency

Tennessee Department of Mental Health and Substance Abuse Services, Office of Licensure (agencies whose clients are mostly aged or have mental illness/SUD); Department of Disability and Aging (formerly DIDD) Office of Licensure for agencies serving mostly people with intellectual/developmental disabilities

Fee

$810

Fee details

$810 per site for one distinct category of service (non-residential fee schedule, TN Comp. R. & Regs. 0940-05-02-.05); more if the site holds more categories ($1,010 for two, up to $1,620 for more than four). Inspection fees are charged separately. All fees non-refundable.

Renewal

Same per-site schedule applies to each renewal application.

Insurance and bonds

Proof of liability insurance covering the agency, workers and others providing services; drivers transporting clients need vehicle liability coverage documented (amounts not set in the rule).

Regulation

T.C.A. Title 33, ch. 2, part 4; Tenn. Comp. R. & Regs. 0940-05-38 and 0940-05-02 (DMHSAS); 0465-02-17 and 0465-02-02 (DDA)

1. Determine the licensing department from the client mix: 50%+ aged or mental illness/SUD goes to DMHSAS; 50%+ intellectual/developmental disability goes to DDA
2. Submit the application with a written attestation of the client-base categorization and the fee
3. List the counties served and the address where employee and client records are kept
4. Adopt required written policies (services, emergencies, abuse reporting, rights, medication assistance, transportation, etc.) and obtain liability insurance
5. Department reviews and inspects; renew with a new attestation and fee

Staffing

• Licensee designates an individual responsible for agency operations
• Workers: criminal background check (T.C.A. 33-2-1202), plus checks of the TN Abuse Registry and sex offender registry before client contact and annually
• Annual performance evaluations; current roster of all workers including on-call/back-up

Training

• Before working: demonstrated competency in observing/reporting changes, abuse and neglect prevention and reporting, client rights, universal precautions and infection control, personal hygiene assistance, client safety, and emergency procedures
• Medication assistance training by or under a registered nurse for workers who give medication reminders/assistance
• Job-related training at least annually, plus client-specific training

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 →

Model

MCO-chosen

State vendor

Sandata (BlueCare); CareBridge (Wellpoint, UnitedHealthcare); Therap (DDA waiver services)

Services in scope

• personal care (CHOICES, ECF CHOICES)
• attendant care
• 1915(c) waiver services
• private duty nursing
• home health

Alternate EVV allowed

Yes

Program

https://www.tn.gov/content/dam/tn/tenncare/documents/EVVMemoToMCOsAndHHAProviders2023.pdf

Tennessee EVV requirements →

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.

Personal care / in-home supportive care organizations — active organization NPIs (NPPES)

1,418 (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 →