Tennessee - Personal Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Tennessee funds Personal Assistance Services primarily through the CHOICES and Employment and Community First (ECF) CHOICES waiver programs, requiring providers to obtain a Personal Support Services Agency (PSSA) license from either the Department of Intellectual and Developmental Disabilities (DDA) or the Department of Mental Health and Substance Abuse Services (TDMHSAS), depending on the primary population served.

Before delivering services, an agency must secure a Medicaid ID through the TennCare Provider Registration Portal and subsequently execute network contracts with one or more of Tennessee's Managed Care Organizations (BlueCare, UnitedHealthcare, Wellpoint) or pass DDA credentialing if serving multiple waiver populations.

1. Service Definition and Scope

In Tennessee, Personal Assistance (also billed as Supportive Home Care or CHOICES Personal Care) provides hands-on assistance with activities of daily living (ADLs) such as bathing, dressing, and transferring.

Services are delivered in the member's home and are authorized based on medical necessity and the specific CHOICES or ECF CHOICES group assignment.

• Service Names: CHOICES Personal Care (HCBS PC), ECF Personal Assistance (ECF PA), DDA Personal Assistance (DDA PA).
• Setting: The member's own home or community setting.
• Target Population: Older adults (65+), adults with physical disabilities (21+), and individuals with intellectual/developmental disabilities.
• Consumer Direction: Members have the option to hire and manage their own workers directly instead of using a provider agency.

2. Regulatory and Oversight Agencies

Multiple state departments oversee this service depending on the provider's target demographic and waiver participation.

TennCare manages the overarching Medicaid program, while DDA, TDMHSAS, and the Department of Health handle facility and agency licensure.

• Division of TennCare: Manages Medicaid enrollment and MCO oversight (https://www.tn.gov/tenncare.html).
• Department of Intellectual and Developmental Disabilities (DDA): Licenses PSSAs and credentials multi-waiver providers (https://www.tn.gov/didd.html).
• Department of Mental Health and Substance Abuse Services (TDMHSAS): Licenses PSSAs serving primarily non-IDD populations (https://www.tn.gov/behavioral-health.html).
• Tennessee Department of Health (TDH) / Health Facilities Commission (HFC): Issues Home Care Organization and Professional Support Services Licenses (https://www.tn.gov/health.html).

3. Gatekeeping Prerequisites: Who Can Even Apply

Tennessee utilizes a managed care delivery system for its HCBS waivers, meaning licensure and Medicaid enrollment do not guarantee patient volume.

Providers must successfully credential and contract with TennCare MCOs or DDA to receive authorizations and payment.

• MCO Contracting: If only providing CHOICES services, providers must credential and contract directly with Wellpoint, BlueCare, or UnitedHealthcare.
• DDA Credentialing: Effective June 1, 2024, DDA serves as the credentialing authority for CHOICES providers who also provide 1915c and/or Katie Beckett services.
• Medicaid ID Prerequisite: Applicants must obtain a valid Medicaid ID number via TennCare before MCO or DDA credentialing can begin.
• Population Rule: The specific state department that issues the required license is strictly determined by which population makes up 50% or more of the agency's census.

4. Licensure and Certification Requirements

Agencies must obtain the correct license based on the population that makes up 50% or more of their census.

Options include a DDA PSSA license, a TDMHSAS PSSA license, or a TDH Home Care Organization/Professional Support Services License (PSSL).

• DDA PSSA License: Required if 50% or more of the population served has intellectual or developmental disabilities.
• TDMHSAS PSSA License: Required if the majority of the population served falls under mental health/substance abuse or non-IDD categories.
• TDH Home Care Organization: An alternative licensure pathway accepted for CHOICES Personal Care and ECF PA.
• Consumer Direction Workers: Do not require agency licensure but must be registered as a provider and hold a Medicaid ID.

5. Medicaid Provider Enrollment

Providers must register via the TennCare Provider Registration Portal (PDMS) to receive a Medicaid ID.

TennCare utilizes Data Spring (formerly CAQH) for universal provider data management and profile updates.

• Registration Portal: TennCare Provider Registration Portal (PDMS).
• Data Spring (CAQH): Providers must enter data into the Data Spring Universal Provider Datasource; TennCare automatically receives profile data from this system.
• Medicaid ID: Issued only after successful registration and Data Spring approval.
• Group Registration: Group practices must establish an account to manage rosters and Disclosure of Ownership declarations.

6. Staffing, Training and Background Checks

Direct support professionals must pass criminal background checks and meet training standards set by the licensing body.

Fingerprinting is processed through the TN Health Related Boards using specific OCA codes.

• Background Checks: Required under T.C.A. 63-1-116 for health-related boards.
• Fingerprinting: Processed via the Tennessee Bureau of Investigation/FBI using specific OCA codes assigned to the profession.
• Training: Staff must complete waiver-specific training as outlined in the DDA or MCO provider manuals.
• Consumer Direction: Members are the employers and are responsible for hiring and training their own workers, subject to program limitations.

7. Documentation, Policies and Records

Agencies must maintain comprehensive records including an Electronic Visit Verification (EVV) policy.

The New Provider Credentialing Application requires submission of these policies upfront.

• EVV Policy: Must be completed and submitted with the New Provider Credentialing Application for Personal Assistance services.
• Credentialing Application: Requires submission of Federal Tax ID, Medicaid ID, and licensure documentation.
• Disclosure of Ownership: Must be kept updated electronically via the TennCare registration portal.
• Service Plans: All services and supports must be determined medically necessary and documented in the member's care plan prior to provision.

8. Billing, Rates and Claims

Claims are submitted to the respective MCO (BlueCare, UHC, Wellpoint) or through the state's EVV system.

Rates are established by TennCare and vary by waiver program (CHOICES vs. ECF CHOICES).

• EVV Mandate: Personal Assistance requires Electronic Visit Verification for claims submission and payment.
• MCO Billing: Claims for CHOICES members are billed directly to the assigned health plan (BlueCare, UHC, or Wellpoint).
• Medicaid ID Requirement: Without a valid, active Medicaid ID, providers cannot receive payment for services rendered.
• Benefit Limits: Services are capped based on the CHOICES Group (1, 2, or 3) and medical necessity determinations.

9. Approval Sequence and Timeline

The process begins with obtaining the appropriate state license (DDA, TDMHSAS, or TDH).

Following licensure, the agency registers in PDMS for a Medicaid ID, then applies for MCO or DDA credentialing.

• Step 1: Apply for the appropriate agency license (PSSA or Home Care Organization) based on the 50% population rule.
• Step 2: Register in the TennCare PDMS portal to initiate Medicaid enrollment.
• Step 3: Complete the Data Spring (CAQH) profile to receive the Medicaid ID.
• Step 4: Submit the New Provider Credentialing Application to DDA (if multi-waiver) or contact MCOs directly for network contracting.

10. Common Denials and Survey Findings

Applications are frequently delayed due to incorrect licensure types based on the 50% population rule.

Survey deficiencies often involve incomplete background checks or EVV non-compliance.

• Wrong License Type: Applying to DDA when the majority population is non-IDD, or vice versa.
• Missing EVV Policy: Failure to include a compliant EVV policy with the credentialing application.
• Incomplete CAQH: Delays in Medicaid ID issuance due to missing information in the Data Spring system.
• Uncredentialed Staff: Allowing staff to provide care before background checks and Medicaid ID registration (for consumer direction) are complete.

11. Key Contacts and Resources

Primary contacts include the licensing departments and the TennCare MCOs.

Providers should utilize the PDMS portal and MCO provider manuals for ongoing guidance.

• TennCare Provider Registration Portal: https://pdms.tenncare.tn.gov/
• BlueCare Tennessee: https://bluecare.bcbst.com/plans-programs/bluecaretn
• UnitedHealthcare Community Plan: https://www.uhccommunityplan.com/tn/medicaid/choices
• Wellpoint (formerly Amerigroup): https://www.wellpoint.com/tn/medicaid/tenn-care-choices
• TN Health Facilities Commission (Licensure): https://www.tn.gov/hfc/division-of-licensure-and-regulation.html

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