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Tennessee - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Respite Care Services in Tennessee are funded primarily through the TennCare CHOICES managed care program and the Employment and Community First (ECF) CHOICES program, overseen jointly by the Division of TennCare and the Department of Intellectual and Developmental Disabilities (DIDD). Providers must secure network contracts with at least one of Tennessee's three designated Managed Care Organizations (MCOs) before they can bill for services, as TennCare does not operate an open fee-for-service network for these waiver programs.

The service delivers short-term relief to unpaid primary caregivers, allowing them to step away while the member receives continuous supervision and support in their home or a community setting. Approval requires either a Home Care Organization license from the Tennessee Department of Health or direct provider certification through DIDD, followed by registration in the TennCare Provider Data Management System (PDMS) and successful MCO credentialing.

1. Service Definition and Scope

In Tennessee, Respite Care Services provide temporary, short-term relief for unpaid family members or primary caregivers who reside with and support a waiver participant. The service ensures the participant's health, safety, and welfare during the caregiver's absence.

Respite can be delivered in the participant's home, the provider's home, or a licensed facility setting, depending on the specific waiver authorization. It is not intended to replace regular day services or supported employment, but rather to sustain the primary caregiving arrangement.

2. Regulatory and Oversight Agencies

The Division of TennCare serves as the single state Medicaid agency, holding ultimate authority over the CHOICES and ECF CHOICES programs. TennCare delegates day-to-day operational oversight and provider network management to three contracted Managed Care Organizations (MCOs).

The Department of Intellectual and Developmental Disabilities (DIDD) partners with TennCare to oversee ECF CHOICES and licenses specific developmental disability providers, while the Tennessee Department of Health licenses traditional home care agencies.

3. Gatekeeping Prerequisites: Who Can Even Apply

Tennessee utilizes a fully managed care model for its HCBS waivers, meaning provider enrollment is strictly gated by MCO network needs. A provider cannot simply enroll in Medicaid and begin billing; they must be selected and contracted by BlueCare, UnitedHealthcare, or Wellpoint.

For DIDD-specific certification, providers must pass a rigorous Notice of Intent (NOI) process during open procurement windows. If an MCO network is closed for Respite Care in a specific grand division (West, Middle, or East Tennessee), new applications will not be accepted regardless of the provider's licensure status.

4. Licensure and Certification Requirements

To provide in-home respite care, agencies typically must obtain a Home Care Organization (HCO) license with a Personal Support Services designation from the Tennessee Department of Health. This requires submitting an application, paying a fee, and passing an initial state survey.

Alternatively, providers serving exclusively the I/DD population under ECF CHOICES may operate under a DIDD Provider Certification. Facility-based respite requires the facility itself (such as an Assisted Care Living Facility or Adult Day Care) to hold the appropriate site-based license.

5. Medicaid Provider Enrollment

Once licensed or certified, providers must register with TennCare through the Provider Data Management System (PDMS). This centralized portal collects ownership disclosures, licensure data, and background information.

Approval in PDMS generates a TennCare Medicaid ID, but this ID alone does not authorize billing. The provider must subsequently use this ID to complete credentialing and contracting with the individual MCOs.

6. Staffing, Training and Background Checks

Direct support professionals (DSPs) providing respite care must meet strict background and training standards before delivering services. Tennessee requires comprehensive registry checks and fingerprint-based criminal background checks.

Training must cover the specific needs of the waiver participant, incident reporting, and emergency procedures. DIDD and the MCOs mandate specific competency-based training modules for all staff.

7. Documentation, Policies and Records

Providers must maintain comprehensive records that align with the member's Person-Centered Support Plan (PCSP). Every hour of respite billed must be supported by documentation showing the caregiver was relieved and the member was supported.

Tennessee mandates the use of Electronic Visit Verification (EVV) for all in-home personal care and respite services. Providers must implement policies ensuring EVV compliance and timely incident reporting.

8. Billing, Rates and Claims

Respite providers do not bill TennCare directly; all claims are submitted to the member's assigned MCO (BlueCare, UnitedHealthcare, or Wellpoint). Rates are established by TennCare but administered through the MCO contracts.

Claims for in-home respite must be supported by EVV data. If the EVV data does not match the submitted claim, the MCO will deny the claim automatically.

9. Approval Sequence and Timeline

The approval process is sequential and cannot be expedited. Providers must first establish their business entity and obtain the necessary state license from the Department of Health or certification from DIDD.

Following licensure, the provider registers in TennCare's PDMS. Only after receiving a TennCare ID can the provider apply for MCO credentialing, which is the longest phase of the process.

10. Common Denials and Survey Findings

New providers frequently face delays during the MCO contracting phase if they apply in regions where the network is already deemed adequate. In these cases, the MCO will issue a network closure denial.

During state surveys or MCO audits, the most common citations involve lapsed staff credentials, failure to utilize EVV correctly, and missing documentation linking the service provided to the goals in the PCSP.

11. Key Contacts and Resources

Providers should rely on the official TennCare and DIDD websites for the most current waiver manuals, rate schedules, and policy updates. The MCO provider relations departments are the primary contacts for billing and contracting inquiries.

The TennCare Provider Registration portal is managed by the state's fiscal intermediary, and technical support is available for PDMS navigation.

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