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Tennessee - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Tennessee funds Companion Care primarily through the TennCare CHOICES and Employment and Community First (ECF) CHOICES managed care programs, requiring prospective agencies to first obtain provider credentialing through the Department of Intellectual and Developmental Disabilities (DIDD) before they can attempt to contract with the state's Managed Care Organizations (MCOs). The state does not issue a standalone "Adult Companion" license; instead, agencies typically operate under a Personal Support Services Agency (PSSA) license issued by the Department of Mental Health and Substance Abuse Services, or operate under direct DIDD credentialing for waiver-specific services.

Because Tennessee operates its long-term services and supports (LTSS) entirely through a managed care delivery system, obtaining a state license and Medicaid ID does not guarantee the ability to bill for services. Providers must successfully navigate MCO network adequacy reviews, meaning an application will only result in active billing if the regional MCOs determine there is a geographic need for additional Companion Care capacity.

1. Service Definition and Scope

In Tennessee's CHOICES and ECF CHOICES programs, Companion Care (often categorized alongside personal assistance or community integration services) provides non-medical supervision, socialization, and assistance to enable adults with physical disabilities or intellectual/developmental disabilities to remain safely in community settings. The service is designed to prevent institutionalization by offering oversight and engagement when primary caregivers are unavailable.

This service explicitly excludes medical or nursing care, and it cannot be billed concurrently with residential services like Supported Living or Medical Residential Services. It is authorized strictly according to the member's Person-Centered Support Plan (PCSP) developed by their MCO Care Coordinator.

2. Regulatory and Oversight Agencies

Oversight of Companion Care in Tennessee is divided between the state Medicaid agency, the disability services department, and the contracted MCOs. TennCare holds the ultimate authority over the Medicaid state plan and waivers, while DIDD handles the day-to-day quality monitoring and provider credentialing for HCBS.

Because services are administered through managed care, the MCOs act as the direct regulatory and payment authorities for enrolled providers, conducting their own credentialing, auditing, and network management.

3. Gatekeeping Prerequisites: Who Can Even Apply

The absolute structural prerequisite for providing Companion Care in Tennessee is MCO network inclusion. Tennessee does not operate an open-network fee-for-service system for HCBS; providers must secure a contract with at least one of the three TennCare MCOs (BlueCare, UnitedHealthcare, or Wellpoint). If the MCOs declare their networks closed for Companion Care in a specific Grand Division (West, Middle, or East Tennessee) due to adequate capacity, new providers cannot enroll to bill for this service.

Additionally, to participate in ECF CHOICES or the 1915(c) waivers, an agency must first pass the DIDD Provider Credentialing process. DIDD only accepts new provider applications during specific open enrollment windows or when a specific service need is identified, acting as a secondary gatekeeper before MCO contracting.

4. Licensure and Certification Requirements

Tennessee does not have a specific "Adult Companion" license. Agencies providing in-home companion and personal care services typically must obtain a Personal Support Services Agency (PSSA) license, unless they are exclusively providing services under a DIDD waiver that exempts them through direct DIDD credentialing.

The DIDD credentialing process requires agencies to submit extensive documentation of their business structure, financial solvency, and operational policies. Providers must demonstrate compliance with the HCBS Settings Rule and pass a readiness review.

5. Medicaid Provider Enrollment

Once licensed or credentialed by DIDD, providers must enroll in the TennCare Medicaid Management Information System (MMIS) to receive a Medicaid ID. This is done electronically through the TennCare Provider Registration portal.

Enrollment with TennCare is a prerequisite for MCO contracting, but it does not authorize the provider to bill. The provider must sign an abbreviated Medicaid agreement and then complete the full credentialing and contracting process with the individual MCOs.

6. Staffing, Training and Background Checks

Tennessee enforces strict background check and training requirements for all staff providing direct contact services like Companion Care. Agencies are responsible for ensuring all checks are completed prior to the employee's first day of direct contact with a member.

Training must align with DIDD and TennCare requirements, including specific modules on abuse/neglect reporting, person-centered practices, and the specific needs of the population served.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that align with the member's Person-Centered Support Plan (PCSP). Tennessee mandates the use of Electronic Visit Verification (EVV) for all in-home personal care and companion services to document the exact time, location, and duration of service delivery.

Agencies must also maintain robust incident management policies, reporting any critical incidents (such as abuse, neglect, or exploitation) directly to DIDD and the authorizing MCO within mandated timeframes.

8. Billing, Rates and Claims

Companion Care is not billed directly to TennCare; all claims must be submitted to the member's assigned MCO (BlueCare, UHC, or Wellpoint). Rates are established by TennCare but administered through the MCO fee schedules.

Claims must match the EVV data and the prior authorization issued by the MCO. Any discrepancy between the authorized units, the EVV log, and the submitted claim will result in a denial.

9. Approval Sequence and Timeline

Becoming a fully active Companion Care provider in Tennessee is a lengthy, multi-stage process due to the managed care structure. The process begins with state licensure or DIDD credentialing, moves to Medicaid enrollment, and concludes with MCO contracting.

Because MCOs only contract based on network need, a provider might complete DIDD credentialing and TennCare enrollment but wait months or be denied entirely at the MCO contracting stage if the network is closed.

10. Common Denials and Survey Findings

Providers frequently face application denials at the MCO level due to closed networks or failure to demonstrate a unique geographic or cultural competency need. During audits, the most common recoupments stem from EVV non-compliance.

DIDD and MCO quality monitors frequently cite agencies for failing to maintain continuous background check clearances or for delivering services that deviate from the specific goals outlined in the PCSP.

11. Key Contacts and Resources

Prospective providers must utilize the official portals and resources provided by TennCare, DIDD, and the three MCOs to navigate the enrollment and credentialing process.

Monitoring the DIDD and TennCare websites for announcements regarding open enrollment windows and policy updates is essential for maintaining compliance.

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