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Tennessee - Homemaker Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

In Tennessee, Homemaker Services are funded primarily through the OPTIONS for Community Living program and Title III-B of the Older Americans Act, administered by the Tennessee Commission on Aging and Disability (TCAD) and local Area Agencies on Aging and Disability (AAADs). The service provides general household support, such as meal preparation, laundry, shopping, and light housekeeping, for adults aged 60 and over or adults with physical disabilities who are at risk of entering long-term care facilities.

Tennessee does not issue a distinct "Homemaker Service" license. Instead, providers typically operate under a Home Care Organization license issued by the Health Facilities Commission (formerly under the Department of Health) or contract directly with regional AAADs as non-medical personal care or homemaker agencies. The most significant structural precondition is that providers must secure a contract with their regional AAAD to receive referrals and reimbursement for OPTIONS and Title III-B services.

1. Service Definition and Scope

Homemaker services in Tennessee are designed to assist individuals with Instrumental Activities of Daily Living (IADLs) when they are unable to perform these tasks themselves. The goal is to maintain a safe and healthy living environment, preventing premature institutionalization.

The scope of services generally includes routine household tasks. It does not include hands-on personal care (which is covered under Personal Care services) or skilled medical care.

2. Regulatory and Oversight Agencies

Oversight of Homemaker Services is split between the agency managing the funding and the agency handling facility licensure. The Tennessee Commission on Aging and Disability (TCAD) oversees the OPTIONS and Title III-B programs statewide.

Licensure for home care organizations is managed by the Tennessee Health Facilities Commission (HFC), which took over these duties from the Department of Health in 2022.

3. Gatekeeping Prerequisites: Who Can Even Apply

To provide Homemaker Services under the OPTIONS or Title III-B programs, an agency must first secure a contract with the local Area Agency on Aging and Disability (AAAD) that serves their region. AAADs manage provider networks based on regional needs and funding availability.

If an agency intends to provide skilled services or operate as a licensed Home Health Agency, they must first obtain a Certificate of Need (CON) from the Health Services and Development Agency before applying for licensure. However, non-medical homemaker agencies typically do not require a CON.

4. Licensure and Certification Requirements

Agencies providing only non-medical homemaker services may not require a full Home Health Agency license but must comply with the requirements set by the AAADs and TCAD. If the agency also provides personal care or skilled services, they must be licensed as a Home Care Organization by the Health Facilities Commission.

The licensure process involves submitting an application, paying the required fees, and passing an initial survey to ensure compliance with state regulations.

5. Medicaid Provider Enrollment

While OPTIONS is state-funded and Title III-B is federally funded, agencies may also enroll with TennCare to provide services under Medicaid waiver programs (like CHOICES). Enrollment is processed through the TennCare Provider Registration portal.

Providers must obtain a National Provider Identifier (NPI) and register with TennCare. TennCare utilizes a system called Data Spring for profile data management.

6. Staffing, Training and Background Checks

Staff providing homemaker services must meet qualifications established by TCAD and the contracting AAAD. This typically includes basic training in household management, safety, and emergency procedures.

Background checks are mandatory for all staff entering clients' homes. Agencies must maintain records of these checks and ensure staff are competent to perform assigned tasks.

7. Documentation, Policies and Records

Agencies must maintain comprehensive records for each client, including service plans, task logs, and notes on any changes in the client's condition. These records are subject to review by the AAAD and state auditors.

Policies and procedures must cover infection control, emergency preparedness, client rights, and grievance processes.

8. Billing, Rates and Claims

Reimbursement rates for OPTIONS and Title III-B services are established by TCAD and administered through the AAADs. Clients may be subject to a sliding fee scale based on their income for OPTIONS services.

Providers submit claims directly to the contracting AAAD or through the designated state system, adhering to specific billing codes and documentation requirements.

9. Approval Sequence and Timeline

The approval process begins with contacting the local AAAD to determine network need and application procedures. If licensure is required, the agency must simultaneously apply through the Health Facilities Commission.

Timelines vary based on AAAD procurement cycles and HFC survey schedules. Agencies should anticipate several months from initial application to final approval and contract execution.

10. Common Denials and Survey Findings

Applications are frequently delayed or denied due to incomplete documentation, failure to meet AAAD network needs, or lack of required policies and procedures.

During surveys or audits, common findings include incomplete client records, missing background checks, and failure to follow the approved service plan.

11. Key Contacts and Resources

Prospective providers should utilize state resources and contact their regional AAAD for specific guidance on becoming a Homemaker Service provider.

The Tennessee Commission on Aging and Disability and the Health Facilities Commission provide essential regulatory and program information.

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