How to start a hospice in Tennessee

Tennessee requires a Home care organization license providing hospice services from Tennessee Health Facilities Commission (licensure and Certificate of Need) to operate a hospice. Fee: $1,404. Processing time: Request the licensure survey 30-45 days before you are ready to open; a missed survey date usually means 30+ days to reschedule. After Commission ratification the license arrives in about 7-10 days.

License required

Yes

License

Home care organization license providing hospice services

Issuing agency

Tennessee Health Facilities Commission (licensure and Certificate of Need)

Fee

$1,404

Fee details

$1,404 non-refundable licensure fee on the initial hospice application (form HF-3638, rev. 6/2024).

Processing time

Request the licensure survey 30-45 days before you are ready to open; a missed survey date usually means 30+ days to reschedule. After Commission ratification the license arrives in about 7-10 days.

Certificate of need

Required

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

Tennessee Health Facilities Commission rules for home care organizations providing hospice services; Tenn. Code Ann. Title 68, Chapter 11

1. Obtain a Certificate of Need from the Health Facilities Commission
2. Submit the notarized Hospice Services licensure application (listing counties served) with the $1,404 fee
3. 30-45 days before opening, ask the Regional Office in writing for a licensure survey
4. Pass the survey; the Regional Director signs and forwards forms to the Central Office
5. Receive an initial approval letter; the Commission ratifies at its next meeting and the license is issued

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 →

For this business

Required (licensing source)

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.

Hospice agencies (community based) — active organization NPIs (NPPES)

158 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

61 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

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

All Tennessee Hospice Medicaid rates, ranked →