BEHAVIORAL HEALTH SERVICES PROVIDER IN TENNESSEE

Fatumata Kaba
3 days ago
3 min read

DELIVERING MENTAL HEALTH AND SUBSTANCE USE SUPPORT TO EMPOWER INDIVIDUALS THROUGH RECOVERY-ORIENTED, PERSON-CENTERED CARE

Behavioral Health Services in Tennessee provide therapeutic interventions and clinical support for individuals facing mental health conditions, behavioral challenges, and/or substance use disorders. These services are covered under TennCare (Medicaid), Employment and Community First (ECF) CHOICES, 1915(c) Waivers, and specialized programs such as Crisis Services and Children's Behavioral Health Safety Net.

1. GOVERNING AGENCIES

Agency: TennCare (Tennessee Medicaid)

Role: Manages behavioral health benefits, authorizations, and reimbursements through managed care organizations (MCOs).

Agency: Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS)

Role: Regulates community mental health providers, crisis response programs, and certifies providers of substance use treatment.

Agency: Department of Intellectual and Developmental Disabilities (DIDD)

Role: Coordinates behavioral services under HCBS waivers for individuals with I/DD.

Agency: Centers for Medicare & Medicaid Services (CMS)**

Role: Oversees Medicaid-funded behavioral health and waiver compliance standards.

2. BEHAVIORAL HEALTH SERVICES OVERVIEW

Behavioral Health services are provided in-home, in-clinic, or via telehealth and are tailored to each person’s needs, diagnosis, and functional goals. Covered services may include:

Diagnostic Assessments & Treatment Planning
Individual, Group, and Family Therapy
Behavioral Support & Functional Behavioral Assessments (FBA)
Psychiatric Services & Medication Management
Crisis Intervention & Stabilization
Substance Use Treatment & Recovery Support
Positive Behavior Support Plan (PBSP) Development
Skills Training, Peer Recovery Support, and Community Integration Counseling

All services must align with the participant’s Individual Support Plan (ISP) or treatment plan and meet medical necessity criteria.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the TN Secretary of State
Obtain EIN and Type 2 NPI
Apply as a behavioral health provider through TennCare MCOs (e.g., Amerigroup, BlueCare, UnitedHealthcare)
If serving waiver participants, enroll through DIDD as a Behavioral Services provider
For substance use treatment, obtain licensure through TDMHSAS
Maintain liability and professional insurance
Develop a Behavioral Health Services Policy & Procedure Manual

4. TENNESSEE PROVIDER ENROLLMENT PROCESS

Step 1: Business registration and licensure (clinical/organizational)

Step 2: Enroll with one or more TennCare MCO networks

Step 3: Submit staff credentials, licensure, insurance, and service descriptions

Step 4: If serving individuals under DIDD waivers, complete DIDD Behavioral Services application and meet additional training standards

Step 5: Begin service delivery upon approval and referral

5. REQUIRED DOCUMENTATION

EIN, NPI, business license
Clinical licensure and credentials of staff
Liability insurance and malpractice coverage
Behavioral Health Services Policy & Procedure Manual including:
- Clinical documentation standards
- Crisis de-escalation and response protocols
- PBSP implementation and staff training process
- HIPAA, safety, and emergency planning
- Consent forms, intake assessments, and progress note templates
- Incident reporting and outcome tracking tools

6. STAFFING REQUIREMENTS

Role: Licensed Mental Health Professional (LPC, LCSW, LMFT, etc.)

Requirements: Active TN license, experience in Medicaid billing preferred

Role: Behavior Analyst / Behavior Support Specialist (for waiver programs)

Requirements: BCBA or master's-level behaviorist trained in PBSP and FBA

Role: Psychiatric Nurse Practitioner / Psychiatrist (if offering med mgmt)

Requirements: DEA number, prescriptive authority, psychiatric background

Role: Peer Recovery Specialist or Case Manager (optional)

Requirements: State certification for peer role or training in care coordination

All staff must complete:

HIPAA and person-centered care training
Trauma-informed care and crisis intervention training
ISP and PBSP implementation standards
TennCare documentation and billing protocols

7. MEDICAID WAIVER PROGRAMS

Behavioral Health Services are supported through:

TennCare State Plan – Mental health and substance use disorder services for Medicaid-eligible individuals
ECF CHOICES – Behavior services for individuals with I/DD (behavior support, PBSP)
1915(c) Waivers – Specialized behavior services as part of habilitation and safety planning
Children’s Behavioral Health Safety Net – For non-Medicaid children in crisis
School-based Behavioral Health – Through partnership with TDMHSAS and LEAs

8. TIMELINE TO LAUNCH

Phase: Business Formation & Licensure

Timeline: 1–2 months

Phase: TennCare MCO & DIDD Enrollment

Timeline: 2–3 months

Phase: Staff Credentialing & Compliance Setup

Timeline: 30–60 days

Phase: Start of Services

Timeline: Upon plan approval or referral receipt

9. CONTACT INFORMATION

TennCare (Tennessee Medicaid Program)

Website: https://www.tn.gov/tenncare

Tennessee Department of Mental Health & Substance Abuse Services (TDMHSAS)

Website: https://www.tn.gov/behavioral-health

Tennessee Department of Intellectual and Developmental Disabilities (DIDD)

Website: https://www.tn.gov/didd

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov

BEHAVIORAL HEALTH SERVICES PROVIDER IN TENNESSEE

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — TN BEHAVIORAL HEALTH PROVIDER

WCG supports behavioral health clinics, solo practitioners, and interdisciplinary teams with entry into Tennessee’s Medicaid and waiver networks for integrated mental health support.

Scope of Work: