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

Last reviewed: 2026-08-16

In Tennessee, Respite Care Services provide short-term, temporary relief for unpaid primary caregivers of individuals enrolled in Medicaid Home and Community-Based Services (HCBS) waivers, such as TennCare CHOICES and Employment and Community First (ECF) CHOICES. The service ensures the member continues to receive necessary supervision and support in their home or a licensed facility while the primary caregiver steps away.

The single biggest structural barrier to entry for this service in Tennessee is the mandatory Managed Care Organization (MCO) contracting requirement. Tennessee operates a 100% managed care Medicaid system; enrolling with the state Medicaid agency (TennCare) does not grant you the ability to bill for services. Providers must secure active contracts with one or more of the state's three designated MCOs, which frequently enforce closed networks or moratoria based on regional network adequacy, blocking new providers from participating even if they are fully licensed and state-enrolled.

1. Service Definition and Scope

Respite care in Tennessee is defined as short-term relief provided to an unpaid primary caregiver. It is authorized under the TennCare CHOICES program for older adults and adults with physical disabilities, and the ECF CHOICES program for individuals with intellectual and developmental disabilities.

The service can be delivered in the member's primary residence or in an approved facility-based setting. It is strictly intended for caregiver relief and cannot be used as substitute childcare, nor can it be provided during hours the primary caregiver is engaged in employment.

2. Regulatory and Oversight Agencies

Oversight of respite care in Tennessee is divided among the state Medicaid agency, the licensing commission, and the managed care plans. Providers must maintain compliance with all of these entities simultaneously.

Because Tennessee utilizes a managed care model, the day-to-day authorization, quality oversight, and reimbursement of respite services are handled directly by the MCOs rather than the state.

3. Gatekeeping Prerequisites: Who Can Even Apply

Tennessee does not allow providers to simply enroll in Medicaid and begin billing for respite care. The state's managed care framework imposes strict structural preconditions that must be cleared sequentially.

If a provider cannot secure an MCO contract due to network adequacy limits, their state license and TennCare enrollment are effectively useless for Medicaid billing.

4. Licensure and Certification Requirements

Tennessee does not issue a distinct "Respite Care License." Instead, agencies must hold a license appropriate to the setting where the service is delivered, issued by the Health Facilities Commission (HFC).

For in-home respite, the most common pathway is obtaining a Personal Support Services Agency (PSSA) license, which covers non-medical assistance and caregiver relief.

5. Medicaid Provider Enrollment

Once licensed by the HFC, providers must enroll with the Division of TennCare to obtain a Medicaid Provider ID. This is done entirely online through the Provider Data Management System (PDMS).

Enrollment with TennCare establishes the provider's eligibility to participate in Medicaid but does not guarantee patient referrals or payment, which require the subsequent MCO contracting step.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) and respite workers must meet strict background and training standards outlined in Tenn. Comp. R. & Regs. 1200-13-01-.05 and DIDD provider manuals.

Agencies are responsible for maintaining continuous proof of clearance and training for all staff prior to any direct patient contact.

7. Documentation, Policies and Records

Providers must maintain comprehensive records to satisfy HFC licensure surveyors, DIDD quality assurance teams, and MCO auditors. Missing documentation can lead to immediate claim recoupments.

Tennessee strictly enforces Electronic Visit Verification (EVV) for all in-home HCBS, including respite care, to combat fraud and ensure service delivery.

8. Billing, Rates and Claims

Because TennCare is a managed care system, providers do not bill the state directly. Claims are submitted to the member's assigned MCO (Wellpoint, BlueCare, or UHC) according to their specific fee schedules.

Reimbursement rates are negotiated with the MCOs, though they generally follow a state-established minimum fee schedule for HCBS waivers.

9. Approval Sequence and Timeline

Becoming a fully billable respite provider in Tennessee is a multi-stage process that typically takes 6 to 12 months. The sequence must be followed strictly, as each step requires the approval of the previous one.

Attempting to apply for TennCare enrollment without an HFC license, or applying to an MCO without a TennCare ID, will result in immediate rejection.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied due to administrative errors or a failure to understand Tennessee's managed care landscape.

During HFC licensure surveys, agencies are most often cited for incomplete personnel files or failing to follow their own written policies.

11. Key Contacts and Resources

Providers should bookmark these official state and MCO resources for the most current manuals, fee schedules, and portal access.

Always refer to the specific MCO provider manuals for billing rules, as they supersede general state guidance in a managed care environment.

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