Tennessee - Housing Stabilization — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Tennessee does not cover a standalone "Housing Stabilization" or "Tenancy Support" service under its Medicaid program; instead, housing search, landlord mediation, and retention planning are bundled into Community Living Supports (CLS) and Supported Living under the TennCare CHOICES and Employment and Community First (ECF) CHOICES programs. Providers seeking to offer these tenancy supports must apply to deliver the broader CLS or Supported Living service categories.

Approval to deliver these bundled tenancy supports requires credentialing through the Department of Intellectual and Developmental Disabilities (DIDD) and subsequent network contracting with one or more of TennCare’s three Managed Care Organizations (MCOs). Providers cannot bill TennCare directly for these services and must secure an active MCO contract, which is subject to strict network adequacy reviews.

1. Service Definition and Scope

Because Tennessee lacks a distinct housing stabilization billing code, tenancy support activities are absorbed into Community Living Supports (CLS) and Supported Living. These services provide hands-on assistance to help members secure and maintain independent community housing.

The scope includes assisting the member with locating affordable housing, understanding lease obligations, and mediating with landlords to prevent eviction, all delivered as part of a broader independent living skills training approach.

• Service Name: Community Living Supports (CLS) and Supported Living.
• Housing Search: Included as a component of CLS to help members locate affordable, accessible housing.
• Landlord Mediation: Covered under the ongoing support components of Supported Living to prevent eviction and maintain tenancy.
• Target Population: CHOICES Group 2 and 3 members, and ECF CHOICES members with intellectual or developmental disabilities.
• Setting Requirements: Must comply fully with the federal HCBS Settings Rule, ensuring the member has a legally enforceable lease or residency agreement.

2. Regulatory and Oversight Agencies

The Department of Intellectual and Developmental Disabilities (DIDD) oversees day-to-day HCBS provider credentialing and quality monitoring for these services. TennCare serves as the single state Medicaid agency but delegates network management and claims payment to three MCOs.

Providers must interact with both state agencies for licensure and credentialing, and the MCOs for contracting and authorization.

• Division of TennCare: Single state agency overseeing the 1115 demonstration (https://www.tn.gov/tenncare.html).
• Department of Intellectual and Developmental Disabilities (DIDD): Conducts provider credentialing and quality surveys (https://www.tn.gov/didd.html).
• Wellpoint: TennCare MCO managing provider networks and authorizations (https://provider.wellpoint.com/tn/).
• BlueCare Tennessee: TennCare MCO managing provider networks and authorizations (https://bluecare.bcbst.com/).
• UnitedHealthcare Community Plan: TennCare MCO managing provider networks and authorizations (https://www.uhccommunityplan.com/tn).

3. Gatekeeping Prerequisites: Who Can Even Apply

The most critical structural precondition for new providers in Tennessee is MCO network adequacy. Because Tennessee operates under a managed care model for all HCBS, obtaining state licensure and DIDD credentialing does not guarantee a Medicaid contract.

MCOs frequently close their CLS and Supported Living networks based on regional capacity. Applicants must verify open enrollment windows with the MCOs before investing in the credentialing process.

• MCO Network Closure: MCOs (BlueCare, Wellpoint, UHC) restrict network entry based on regional capacity; applicants must secure MCO interest before expecting billable volume.
• DIDD Credentialing: Required prior to MCO contracting; applicants must submit a Letter of Intent (LOI) to DIDD during designated open application windows.
• Physical Location: Providers must maintain a physical business office located in Tennessee or within 50 miles of the state border.
• Financial Solvency: Applicants must submit two years of audited financial statements or a line of credit to DIDD to prove adequate capitalization.

4. Licensure and Certification Requirements

Tennessee does not issue a specific "Housing Stabilization" license. Providers of Supported Living and CLS must obtain a Personal Support Services Agency (PSSA) license from the Health Facilities Commission (HFC) if they provide direct personal care.

If the agency only provides purely supportive tasks (like housing search), they may operate under DIDD credentialing alone, though most CLS providers hold a PSSA license due to the bundled nature of the service.

• Licensing Agency: Tennessee Health Facilities Commission (HFC) issues the PSSA license (https://www.tn.gov/hfc.html).
• License Type: Personal Support Services Agency (PSSA) license required if hands-on personal care is provided alongside housing support.
• DIDD Certification: Providers must pass the DIDD Provider Initial Credentialing survey to be eligible for MCO contracting.
• Application Fee: PSSA licensure requires a non-refundable fee (typically $1,040) submitted to the HFC.

5. Medicaid Provider Enrollment

Enrollment is processed through TennCare's Provider Registration portal. Providers must obtain a Medicaid ID to be recognized by the state, but they bill the MCOs, not the state MMIS.

The enrollment process requires the agency to link its NPI and taxonomy to the specific HCBS waiver services approved by DIDD.

• Enrollment Portal: TennCare Provider Registration via the state's portal (https://pdms.tenncare.tn.gov/).
• NPI Requirement: A Type 2 NPI is required for the agency, linked to an appropriate HCBS taxonomy.
• Application Fee: Subject to the federal Medicaid application fee (currently $709 for 2024) unless waived by prior Medicare enrollment.
• MCO Contracting: After receiving a TennCare Medicaid ID, the provider must execute separate contracts with BlueCare, Wellpoint, and/or UHC.

6. Staffing, Training and Background Checks

Staff providing CLS or Supported Living must meet DIDD and MCO training standards before working independently with members.

Agencies are responsible for maintaining strict personnel files demonstrating compliance with state registry checks and ongoing education requirements.

• Minimum Age: Direct support professionals (DSPs) delivering CLS must be at least 18 years old.
• Background Checks: Mandatory pre-employment checks against the Tennessee Department of Health Abuse Registry and the National Sex Offender Registry.
• Education: A high school diploma or GED is required for staff delivering Community Living Supports.
• Training: Staff must complete DIDD-mandated training on the HCBS Settings Rule, person-centered planning, and incident reporting prior to independent client contact.

7. Documentation, Policies and Records

Providers must maintain records that align strictly with the member's Person-Centered Support Plan (PCSP). Any housing search or retention activity must be explicitly authorized in this plan.

Tennessee utilizes an Electronic Visit Verification (EVV) system for in-home HCBS, which providers must use to document service delivery times.

• PCSP Alignment: All housing search and retention activities must be explicitly authorized in the member's PCSP generated by the MCO care coordinator.
• EVV Compliance: Electronic Visit Verification (EVV) via CareBridge is required for the in-home components of CLS.
• Progress Notes: Daily documentation must detail specific housing stabilization tasks performed (e.g., landlord calls, apartment tours, budget planning).
• Lease Agreements: Providers must maintain copies of the member's lease to prove compliance with HCBS Settings Rule residency protections.

8. Billing, Rates and Claims

Claims for CLS and Supported Living are submitted to the respective MCO, not directly to TennCare. Rates are established by TennCare but paid by the MCOs based on authorized units.

Providers must secure prior authorization from the MCO before initiating any billable housing support activities.

• Clearinghouse: Claims are typically routed through Availity Essentials to the respective MCOs.
• Billing Codes: Billed under CLS or Supported Living HCPCS codes (e.g., T2017 or H2016) as specified in the MCO contract.
• Rate Structure: Paid on a per-diem or 15-minute unit basis depending on the specific CLS level authorized by the MCO.
• Prior Authorization: 100% of CLS and Supported Living services require prior authorization from the MCO before service delivery.

9. Approval Sequence and Timeline

The approval process in Tennessee is highly sequential. Providers cannot apply for MCO contracts until they have cleared DIDD credentialing and obtained a TennCare Medicaid ID.

The entire process from initial licensure to first billable claim typically takes 9 to 12 months, heavily dependent on MCO network status.

• Step 1: Obtain PSSA License from HFC, if applicable (3-6 months).
• Step 2: Submit Letter of Intent and complete DIDD Credentialing (2-4 months).
• Step 3: Register in the TennCare Provider Registration portal to obtain a Medicaid ID (30-60 days).
• Step 4: Apply for MCO network inclusion and execute contracts (90-120 days, contingent on open networks).

10. Common Denials and Survey Findings

Applications and surveys frequently fail due to administrative omissions or a lack of MCO network need in the provider's target region.

During quality surveys, DIDD strictly enforces background check timelines and HCBS Settings Rule compliance.

• Network Closure Denials: MCOs rejecting applications because the region already has sufficient CLS and Supported Living providers.
• Settings Rule Violations: Failing to demonstrate that the provider's housing support policies ensure member autonomy, privacy, and lease rights.
• Background Check Gaps: Survey citations for allowing staff to work before Abuse Registry checks are fully cleared.
• EVV Non-Compliance: Claim denials due to staff failing to check in/out using the CareBridge EVV system.

11. Key Contacts and Resources

Prospective providers should monitor the DIDD and TennCare websites for updates on waiver amendments and open credentialing windows.

The MCO provider relations departments are the primary contacts for network adequacy inquiries.

• TennCare LTSS Help Desk: 1-877-224-0219 for CHOICES program questions.
• DIDD Provider Credentialing: https://www.tn.gov/didd/providers/credentialing.html
• Health Facilities Commission (HFC): https://www.tn.gov/hfc.html
• CareBridge EVV Tennessee: https://www.carebridgehealth.com/tennessee

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