Tennessee home health agency license: certificate of need first, then HFC licensure

What counts as home health in Tennessee, and what does not

Rule 0720-27 adopts the statutory definition of “home health service.” It means care given to a patient at home under orders recorded by a physician, made up of one or more of the following: skilled nursing, physical, occupational or speech therapy, medical social services, home health aide services, and medical supplies provided as part of those services.⁠¹ An organization that provides these services is a “home care organization.” The same term covers hospice and home medical equipment providers, and each of those has its own license and rule chapter.⁠¹⁠²

Three neighbouring activities fall outside this license:

• Homemaker services. The rule defines these as non-skilled help that needs no physician’s order, and says an agency “does not have to be licensed as a home care organization” to provide them.⁠¹ Personal support services (self-care help, household help, help reaching community activities) are licensed separately under the Department of Mental Health and Substance Abuse Services rules, chapter 0940-05-38, and need no CON.⁠⁷
• Professional support services. This means nursing and therapy for people with intellectual or developmental disabilities, provided under a state contract. HFC issues a separate Professional Support Services Provider license for it, and no CON is required.⁠²⁠⁴⁠⁷
• Sole-practice therapists. A licensed PT or OT who practices alone and treats patients at home as an incidental part of an office practice is not providing “home health service.”⁠¹

The certificate of need comes first

The HFC’s CON Basics page lists “Home Care Organization (Home Health and Hospice)” among the institutions that need a certificate of need “prior to Establishment, Licensure, or Certification.” It also lists home health as a service that needs a CON before anyone starts it.⁠⁴ The licensure application tells you the same thing: “You must first apply for a Certificate of Need (CON) from the Health Facilities Commission prior to applying for licensure.”⁠³ Your license will cover only “the geographic areas specified by the certificate of need,” so the counties you choose at the CON stage set your market for as long as you hold the license.⁠¹

The two ways around it

The CON Basics page exempts a new home health agency that is limited to:

• patients under 18, or
• patients served under the federal Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA).⁠⁴

The HF-3506 application adds the condition attached to these exemptions. Pediatric-only and EEOICPA-only agencies go straight to licensure, but they “will be required to obtain accreditation within two (2) years of initiation of services” under T.C.A. § 68-11-1607(r)(1) and (s)(3).⁠³ The application asks which counties you serve under each of these limits, and HFC publishes separate lists of licensed pediatric-only and EEOICPA-only agencies by county.⁠³⁠⁸

Don’t count on the newer county-based exemptions. Public Chapter 985, effective July 1, 2025, exempts counties with no actively licensed acute care hospital from most CON requirements. Home care organizations and hospice are expressly carved out of that exemption.⁠⁸ The CON Basics page also lists economically distressed counties with no licensed hospital (Lake and Pickett for FY2027) as an exception, but it does not say which project types that covers.⁠⁴ The CON Basics and exemptions pages say there are no actions requiring a certificate of need in Lake and Pickett Counties, and neither page carves out home care organizations the way the Public Chapter 985 exemption does.⁠⁴⁠⁸ They do not say how the licensing side treats a home health agency there, so ask HFC in writing before relying on it.

How HFC judges need

The CON board scores home health applications against the State Health Plan’s home health standards. The main points:⁠⁷

• Need formula. The need estimate for a county is 1.5% of its total population, projected three years forward from the latest Joint Annual Report (JAR) data. That estimate is then compared with the number of patients existing agencies actually serve. The plan calls this formula “admittedly a conservative one” and links that choice to home health fraud research.
• County-by-county proof. For each county, you should document things like referral sources who could not place a patient or were unhappy with existing agencies, patients who could not find services, and providers’ estimates of how many patients they would refer to you.
• Current utilization. List every existing provider in your proposed service area and how many patients each served in the latest 12 months.
• Staffing plan. Using Department of Health licensure data, show that qualified staff are available in your area. State what share of them you will employ directly and what share will come through a staffing agency.
• Community linkage, charges and quality. Include referral arrangements, your proposed average charge per visit compared with nearby agencies, a quality and readmission monitoring plan, and, where applicable, your intent to be accredited by The Joint Commission, CHAP or ACHC.
• TennCare. The standards say TennCare’s rules require Medicare certification before a home health agency can contract with TennCare’s managed care organizations (MCOs). MCOs have no obligation to contract with you, and private duty services cannot be Medicare-certified. If you are counting on TennCare patients, you should get letters from the MCOs in your region confirming that their home health panels are open.

The standards document dates from the former Health Services and Development Agency (HSDA), which HFC replaced. HFC still links to it as the current home health criteria.⁠⁷ The standards are from the 2014 State Health Plan update, but HFC still posts a TennCare memo (dated 2021) that says the same thing: a home health agency must be Medicare-certified to deliver Medicaid-reimbursed home health or to be contracted by TennCare’s MCOs, and an MCO is never obligated to contract with a certified agency. The memo makes one exception, for agencies serving only children, where TennCare will consider alternative certifications or accreditations.⁠¹² Confirm the current rule with TennCare before you rely on it.

The CON calendar

HFC runs the CON process on a fixed monthly cycle through its e-application portal:⁠⁵⁠⁶⁠¹¹

1. Letter of intent, between the 1st and the 15th

   File the letter of intent in the portal. During the same window, publish it in a newspaper. For a home care organization, it must appear in each county where you will be licensed, or in a regional paper that counts as a newspaper of general circulation in each of those counties. HFC provides a home health and hospice newspaper template. A new company should choose “Other (Specify)” as the facility type and enter “Newly Formed Entity.”⁠⁵⁠¹¹

2. Application and fee by the 1st of the next month

   The filing fee is $2.25 per $1,000 of estimated project cost, with a $3,000 minimum and a $45,000 maximum. It is paid by e-check in the portal and is not refundable. Staff will not start the completeness review until the fee arrives.⁠⁶

3. Completeness review

   Answer staff’s supplemental questions within 60 calendar days of the first written request. After an application is deemed complete, you cannot change it in any substantive way.⁠⁶

4. Review cycle

   Applications deemed complete by close of business on the 14th enter the cycle that starts on the 15th. A cycle typically takes 30 days. Staff send the file to the licensing agency for comment, and the 15-member commission gets the materials about 12 days before the meeting.⁠⁵⁠⁶

5. Hearing

   You get about 10 minutes to present. Supporters and opponents, which often means existing agencies in your counties, may testify. The commission then approves, denies or defers the application.⁠⁵

6. Decision

   Letters go out within a week, and the certificate is issued within 4 weeks. Decisions can be appealed within 15 days under T.C.A. §§ 68-11-1609 and 68-11-1610.⁠⁵

A CON for a project other than a hospital or nursing home is valid for two years. The commission may extend it for good cause.⁠⁶ Once you are licensed, you can move your principal office within your licensed service area without a new CON.⁠⁴

Who must run the agency

Rule 0720-27 requires a governing body with full legal authority over services, finances and quality improvement. That body appoints an administrator who must be one of the following:⁠¹

• a licensed physician with at least one year of supervisory or administrative experience in home health, hospice or related health programs;
• a registered nurse with the same experience; or
• a person with training and experience in health service administration plus the same one year of experience.

The administrator must be accessible during normal operating hours. You must report a change of administrator within 15 days. One person may not administer more than one licensed home care organization, unless the others offer different home care services (such as hospice) under the same ownership at the same location. You also need someone authorized in writing to cover short absences.⁠¹ Administrative and supervisory functions “shall not be delegated to another agency.” You need an office with a working phone, staffed during normal business hours.⁠¹ The application asks whether the administrator has ever been convicted of a crime involving harm to a person or involving financial or business management.⁠³

Clinical staffing rules in 0720-27

You must provide at least one qualifying home health service directly through your own employees. Any other services may be arranged under written contracts. Contracts with hourly or per-visit staff must cover the specific points listed in the rule, including that only the agency accepts patients and how charges are set.⁠¹

• Nursing. Skilled nursing is provided by, or under the supervision of, an RN with no current disciplinary action. That RN must be available at all times during operating hours. The RN makes the first evaluation visit, unless therapy is the only skilled service ordered, in which case a qualified therapist may make it.⁠¹
• Physician oversight. Every patient is under a physician’s supervision and has a written plan of care and signed consent. The plan is reviewed and signed by the physician at least every 62 days, and a summary report goes to the physician on the same schedule. Plan-of-care orders may be signed electronically and sent by email.⁠¹
• Home health aides. Aides must complete 75 hours of training, including 16 clinical hours, before or during their first three months. Any aide training program must meet the federal home health aide training and competency rules. An RN assigns each aide and writes the care instructions. An RN or other professional makes a supervisory home visit at least monthly, preferably alternating between visits with the aide present and absent.⁠¹
• Therapy and social work. Therapy is provided by, or under the supervision of, a qualified therapist. Medical social services are provided by a certified master social worker, a licensed clinical social worker, or an assistant under one of them.⁠¹
• Infection control. You need an annual influenza vaccination program that offers the vaccine free to staff and keeps signed declinations on file. You also need standard precautions and a policy for testing a patient’s blood for hepatitis B and HIV, at no charge to the patient, after a staff exposure.⁠¹

Policies the surveyor will look for

The licensure application warns: “Be certain that you have given yourself plenty of time to have your policies and procedures in order.”⁠³ The rule requires written policies or programs for:⁠¹

• organizational structure and lines of authority, including control of any branch office (a branch must operate only under the licensed agency’s name);
• personnel files with license verification, references, evaluations and communicable-disease screening, plus orientation and ongoing in-service records;
• end-of-life care, pain assessment and management, and health care decision-making;
• discharge planning, led by an RN, social worker or other qualified person and starting at admission;
• HIV testing of patients and staff, and supervision of students;
• a performance improvement committee that reviews services, including contracted services, at least once a year;
• medical records: same-day clinical notes, a signed discharge summary within 7 days, and retention for at least 10 years (longer for minors);
• a written emergency response policy that follows the county’s emergency plan and covers patients on power-dependent medical equipment, plus documented contact with the county Emergency Management Agency.

You must also post the Adult Protective Services and district attorney contacts on a sign at least 11 by 17 inches, the national domestic violence hotline on a sign at least 8½ by 11 inches, “No Smoking” signs at every entrance, and a statement of your charity care policy.⁠¹ When you sign the application, you certify that you have a policy informing employees of their duty to report abuse or neglect under T.C.A. § 71-6-103.⁠³

From CON to license: the HFC steps

1. File the notarized HF-3506 application with the $1,404 fee

   The form asks which services you will offer, your CON counties, any pediatric or EEOICPA counties, proof that you can meet the agency’s financial needs, ownership and management-company details, and other facilities your owners hold.⁠³

2. Disclose five years of sanctions

   For your owners’ other facilities and any management firm, disclose any license denials, suspensions or revocations; health-program convictions; federal exclusions; Medicare or TennCare terminations; fraud settlements; corporate integrity agreements; bankruptcies; and civil money penalties of $250,000 or more. Attach documents for any “yes” answer.⁠³ The rule also bars getting a license “through a second party” after a denial.⁠¹

3. Request the survey 30 to 45 days before you are ready

   Send the request by letter to your HFC regional office. If you are not ready on survey day, rescheduling will “most likely be thirty (30) days or more.”⁠³ Any deficiencies need a plan of correction that the Board accepts.⁠¹

4. Initial approval and ratification

   The surveyor’s recommendation goes through the regional director to the central licensure unit in Nashville. That unit sends an initial approval letter, and the commission ratifies it at its next regular meeting. The license should arrive 7 to 10 business days after ratification.⁠³

Until the license is issued, you may not admit patients or present yourself to the public as an agency.⁠¹ The license is not transferable and must be posted at the agency.⁠¹

Fees as published

Medicare and TennCare in 2026

A Tennessee license does not get you paid by Medicare. On May 13, 2026, CMS imposed a six-month nationwide moratorium on Medicare enrollment of new home health agencies, branches and practice locations. CMS may extend it in six-month increments.⁠⁹ Under CMS memo QSO-26-11, initial applications filed during the moratorium are denied. Accreditation will not serve as the basis for Medicare deemed status while the moratorium lasts.⁠¹⁰ HFC now shows an alert about this on its licensure and CON pages, aimed specifically at new home health and hospice CON applicants.⁠²⁠¹¹ CMS left Medicaid moratoria to each state.⁠⁹

This matters for your CON case. HFC’s home health standards tie TennCare MCO contracting to Medicare certification and ask you to show you can stay financially viable until certification comes through.⁠⁷ The initial six months run through about November 13, 2026. CMS may extend the moratorium in six-month increments and must announce any extension or lifting in the Federal Register.⁠⁹⁠¹⁰ As of October 12, 2026, we found no extension notice; check the Federal Register and the CMS memo before you plan a Medicare enrollment date.

Renewal, ownership changes and annual reporting

Licenses expire each year on the anniversary of issuance. To renew, you submit the renewal form and fee before expiration and pass periodic surveys. If you miss the deadline, you have 60 days to renew with the late penalty. After that, you must reapply as a new applicant and be inspected again.⁠¹

You must report a change of ownership, including a change in controlling interest, at least 30 days in advance. A new application and fee are required. The rule lists what counts as a change of ownership, such as a transfer of title, a lease of operations, or a change of partners. It also lists what does not, including corporate stock transfers “even when a controlling interest” changes, and management agreements where the owner keeps final authority.⁠¹

Every year you file the Joint Annual Report of Home Care Organizations. This is also the data HFC uses for the need formula. You must report abuse, neglect and misappropriation, as well as strikes, disasters, loss of vital services and fires, under T.C.A. § 68-11-211. Keep surveys, orders and audit reports for 36 months, available for public inspection.⁠¹

Recent changes

• July 1, 2022. Public Chapter 1119 moved the home health rules from the Department of Health (old chapter 1200-08-26) to the Health Facilities Commission as chapter 0720-27. Some rule text still says “Department” and “Board.”⁠¹
• July 1, 2025. Public Chapter 985 created a CON exemption for counties without a hospital, but home care organizations are excluded from it.⁠⁸
• March 18, 2026. Amendments to the disaster preparedness rule (0720-27-.14) took effect. They require a written emergency response policy covering service interruptions and power-dependent equipment in patients’ homes, plus coordination with the county EMA.⁠¹
• May 13, 2026. The CMS moratorium on new Medicare home health enrollments took effect.⁠⁹

For other care businesses in Tennessee, see the guides to the assisted-care living facility license, the home for the aged license and the adult day services center license.

Sources

1. 1
   Tennessee Secretary of State, Publications, Tenn. Comp. R. & Regs. ch. 0720-27, Standards for Home Care Organizations Providing Home Health Services (March 2026 revision) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Tennessee Health Facilities Commission, Licensure Applications Checked 12 Oct 2026 · Back to text ↑
3. 3
   Tennessee Health Facilities Commission, Application for License for Home Health Agency (HF-3506) Checked 12 Oct 2026 · Back to text ↑
4. 4
   Tennessee Health Facilities Commission, Basic Information on the Certificate of Need Program Checked 12 Oct 2026 · Back to text ↑
5. 5
   Tennessee Health Facilities Commission, CON Process and How to Apply Checked 12 Oct 2026 · Back to text ↑
6. 6
   Tennessee Health Facilities Commission, General Instructions for Applying for a Certificate of Need Checked 12 Oct 2026 · Back to text ↑
7. 7
   Tennessee Health Facilities Commission, State Health Plan Certificate of Need Standards and Criteria for Home Health Services Checked 12 Oct 2026 · Back to text ↑
8. 8
   Tennessee Health Facilities Commission, Tennessee Certificate of Need Exemption Requests Checked 12 Oct 2026 · Back to text ↑
9. 9
   Centers for Medicare & Medicaid Services, Federal Register, Announcement of Nationwide Temporary Moratoria on the Medicare Enrollment of New Home Health Agencies and Hospices Checked 12 Oct 2026 · Back to text ↑
10. 10
    Centers for Medicare & Medicaid Services, QSO-26-11-HHA/Hospice: Moratorium on Medicare enrollment of new HHAs and hospices Checked 12 Oct 2026 · Back to text ↑
11. 11
    Tennessee Health Facilities Commission, Certificate of Need Application Checked 12 Oct 2026 · Back to text ↑
12. 12
    Tennessee Health Facilities Commission and TennCare, Are you thinking about applying for a Certificate of Need to provide Home Health or Private Duty Nursing Services in Tennessee? Checked 12 Oct 2026 · Back to text ↑

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