Tennessee personal support services agency (PSSA) license for non-medical home care

What counts as personal support services

Rule 0940-05-38-.01 defines personal support services as one or more of four things delivered in a person’s permanent or temporary residence ⁠¹:

• Self-care assistance: eating, dressing, toileting, bathing, mobility, transfers and other supports to maintain health and wellness.
• Household assistance: housekeeping, laundry, meal planning and preparation, shopping, bill paying and help using telecommunication devices.
• Personal assistance with community access: transportation and social, recreational or other personal activities.
• Education services: consultation by a registered nurse with the client or the primary family caregiver about a chronic condition.

The client, called a “service recipient,” must have substantial limitations in two or more major life activities because of a chronic condition, illness, injury, age or disability. Major life activities include self-care, mobility, learning and capacity for independent living. The client must also depend on these supports without needing nursing-level services for an acute episode ⁠¹. The rule’s definition of “agency” covers sole proprietors, partnerships, corporations, LLCs and LLPs. It also covers every entity that employs or subcontracts with workers, so a staffing model built on 1099 contractors still needs the license ⁠¹.

No one may begin delivering services until the department issues the license. Operating without one is unlawful and can bring civil or criminal sanctions under T.C.A. §§ 33-2-404 through 33-2-417 ⁠².

The exemptions are narrow

Rule 0940-05-38-.03(2) exempts only these cases ⁠¹:

1. One client only

   A person serving a single client who has no business arrangement with anyone else. The exemption is lost the moment you “hold out to the public,” which the rule defines as advertising, public notice or self-promotion of your availability.

2. Your own family only

3. Housekeeping only

   , with no other help with major life activities.

4. Transportation only

   , with no other help.

5. Services in homeless shelters

6. Delivery only

   , such as dry-cleaning, food, medication or medical equipment delivery.

7. Licensed home care organizations

   under T.C.A. Title 68, Chapter 11, Part 2.

DDA’s PSSA chapter repeats the same seven exemptions ⁠⁷.

Where a PSSA ends and home health begins

A PSSA is non-medical. TDMHSAS’s 2025 provider guidance lists tasks a PSSA worker may not do under the license. These include taking blood pressure or other vital signs, blood-sugar checks, insulin or oral medication administration, filling medication planners, changing dressings, catheter and ostomy care, feeding tubes, ventilator management, and applying ointments of any kind, which has been prohibited since 2007 ⁠⁴. If you want your staff to deliver skilled care under physician orders, you need a home care organization license from the Health Facilities Commission instead. That license carries a $1,404 annual fee ⁠¹⁰ and requires a certificate of need, apart from narrow exceptions such as organizations limited to patients under 18 ⁠¹¹. See the Tennessee home health license guide. A licensed home care organization does not need a separate PSSA license ⁠¹.

Choosing TDMHSAS or DDA: the 50% attestation

Rule 0940-05-38-.04 says an agency needs a license from either the Department of Mental Health and Substance Abuse Services (TDMHSAS) or the department the rule still calls the Department of Intellectual and Developmental Disabilities. That licensing role now sits with the Office of Licensure at the Department of Disability and Aging (DDA), which lists “Personal Support Services” among the services it licenses ⁠¹⁠⁶. The dividing line is your client mix ⁠¹:

You sign a written attestation of your client mix, on the department’s own form, with the initial application and again at every renewal. You renew only with the department that covers 50% or more of your clients ⁠¹. An agency licensed by either department may also serve people with physical or other disabilities ⁠¹. You must also have a written policy on how you categorize your client base, and you may accept only clients who will not push you outside your licensed category ⁠¹. A senior home care startup will almost always fall under TDMHSAS. An agency built around people with intellectual or developmental disabilities, including Medicaid waiver work, will fall under DDA.

Applying through TDMHSAS

TDMHSAS’s published process for a new PSSA runs like this ⁠³:

1. Read the rules

   These are Chapter 0940-05-02 (licensure administration), Chapter 0940-05-38 (PSSA program requirements) and the financial management rule 0940-05-06-.03(1)-(6), which all apply to PSSAs ⁠¹⁠³.

2. Submit four forms to the regional office for your county

   They are the Initial Application, the Fact Sheet, the Background Check and Privacy Statement form, and the Financial Statement. Each is available as a printable PDF or a web form ⁠³⁠⁵.

3. Pay the invoice

   TDMHSAS sends an invoice once it has received the forms ⁠³. Fees are non-refundable, and no license issues until they are paid ⁠¹⁠².

4. Skip the fire inspection

   PSSAs do not need a life safety or fire inspection from the State Fire Marshal, a local fire marshal or a codes inspector ⁠³.

5. Go through the desk audit

   Once the paperwork and fee are in, the Office of Licensure contacts you. For a PSSA, the initial inspection is an electronic desk audit rather than an on-site survey ⁠³.

6. Receive the initial license

   After deficiencies are corrected, the initial license is issued for up to one year ⁠³.

The application asks for background information on the applicant and on each person responsible for running the agency. That includes Social Security number, date of birth, places of residence over the past five years, place of birth, proof of citizenship or legal immigration status, a criminal background check, and personal character references ⁠². TDMHSAS uses this information to judge the applicant’s “responsible and reputable character” under T.C.A. § 33-2-406 ⁠². Rule 0940-05-38-.04(6) also asks you to list the counties you will serve and the address where employee and client records are kept ⁠¹.

TDMHSAS regional licensure offices are open weekdays from 8 a.m. to 4:30 p.m. ⁠³. Its 2025 PSSA guidance lists these offices: East Tennessee in Knoxville at (865) 594-6551, Middle Tennessee in Nashville at (615) 532-6590, and West Tennessee in Memphis at (901) 543-7442 ⁠⁴.

If the department denies the application, you have 15 calendar days from the notice to request a hearing before the Licensure Review Panel in writing ⁠².

Applying through DDA

DDA’s Office of Licensure asks new applicants for a complete packet submitted on the same day. Otherwise the application is treated as incomplete and closed at preliminary review ⁠⁶. The packet contains ⁠⁶:

• the DDA Licensure Initial Application
• the DDA Licensure Financial Statement
• the Board of Directors / Advisory Board form
• the fact sheet. Choose “Business Office with Services” or “Individually Licensed Locations”
• your agency’s policies and procedures, written to the DDA licensure rules
• an active filing with the Secretary of State (sole proprietors do not file)

A PSSA-only license at DDA does not require a business office ⁠⁶. Background checks must be national checks run through the Tennessee Bureau of Investigation or a licensed private investigator, using IdentoGO and DDA’s VECHS waiver form ⁠⁶. DDA warns that, because of volume, deciding an initial license “may take at least six months.” It assigns surveyors only once an application is complete ⁠⁶. The regional surveyor sends the fee invoice after accepting the application, and payment is due on receipt ⁠⁶. Questions go to [email protected], and DDA encourages applicants to attend its Provider Credentialing Forum ⁠⁶.

DDA’s own PSSA chapter, 0465-02-17, adds duties that TDMHSAS does not impose ⁠⁷:

• tuberculosis screening of employees under Department of Health procedures
• seizure-management orientation before staff are assigned
• First Aid and CPR training
• an Individual Support Plan written within 30 days of admission by the person’s “Circle of Support” team and reviewed every year
• locked medication storage and medication-error reporting when certified staff administer medication

Fees, as published on 2026-10-12

Both departments use the same per-site schedule for non-residential services. It is based on how many distinct categories of service you operate at a site ⁠²⁠⁸:

The rules do not name the PSSA in the schedule. Both departments say the amount is calculated and invoiced when you apply, so confirm the figure on your invoice ⁠³⁠⁶. Other charges:

• TDMHSAS: up to $50 for an on-site inspection other than the initial or annual one. Inspection invoices are due within 30 days ⁠².
• DDA: $50 per inspection or re-inspection, $100 for a change of organization name or executive director, and $300 for a relocation ⁠⁸.

The policy manual reviewers check

Because the TDMHSAS initial review is a desk audit, your written policies carry the application. Rule 0940-05-38-.06 requires written policies covering ⁠¹:

• the services you provide, with enrollment and termination criteria
• an organizational chart showing lines of authority
• what happens when a worker is absent, including notice to the client, action taken and timeframes, plus a separate alternate staffing plan
• a fee schedule
• client rights under rule .10 and a grievance procedure
• confidentiality, including no forced public thank-yous and no identifiable photos without written consent
• emergency plans for fire evacuation and natural disasters
• reporting and investigating abuse, neglect and critical incidents, including reports to the Office of Licensure
• communicable disease prevention under Department of Health procedures
• handling clients’ money
• licensure staff access to workers during investigations
• medication assistance, if offered: written client authorization, documented training before assisting, and a way to collect information about the client’s medications
• transportation, if offered: safe vehicles, a Tennessee driver’s license on file, and vehicle liability insurance covering occupants
• use of a Hoyer lift or gait belt after training, for transfers but not as therapy
• categorization of the majority of your client base
• cooperation with department investigations

You must also designate the individual responsible for operating the agency ⁠¹. TDMHSAS’s 2025 guidance says an agency should be cited only for policies the rules require ⁠⁴. Its list of common PSSA deficiencies is a useful pre-audit checklist ⁠⁴:

• missing written medication-assistance authorizations
• no policy on lifts and gait belts
• no consumer notice
• no rights statement
• no semi-annual client evaluations
• undocumented medication training by a nurse
• no emergency contact on file
• no cooperation policy
• no annual worker evaluations
• no proof of the seven pre-service competencies

TDMHSAS’s 2025 guidance also says backup coverage may not fall back on the client. If a caregiver calls in and the agency fails to send someone, the agency can be found derelict for not carrying out its backup plan ⁠⁴.

Hiring and screening workers

Every PSSA worker must be at least 18 ⁠¹. Before hiring, and on a fixed cycle afterward, the agency must document these checks ⁠¹⁠⁴:

• Criminal background check under T.C.A. § 33-2-1202: within 10 days of employment or of a change into direct-contact duties, and every two years. TDMHSAS interprets the statute to mean the results must be in hand before the worker has direct contact with clients ⁠⁴. A check run by TBI or the FBI requires fingerprints. A check from a Tennessee-licensed private investigation company does not ⁠⁴.
• The Department of Health Abuse Registry: checked before direct contact and every year. Anyone listed may not be hired ⁠¹.
• The Tennessee Sexual Offender Registry: checked before direct contact and every year ⁠¹.
• References and work history: three personal references, one from someone who has known the applicant for at least five years, plus a continuous five-year work history ⁠¹. TDMHSAS reads § 33-2-1202 to require direct communication with at least two of the three references and with the most recent employer before hiring, and says the statute leaves no flexibility if the applicant objects to a current-employer check ⁠⁴.

The personnel file also needs:

• a signed and dated job description
• proof that the worker meets the job requirements
• the worker’s date of birth
• annual performance evaluations
• a “worker notice” ⁠¹

The worker notice states whether the agency is the employer or a contractor. It also says who pays wages, taxes, Social Security, workers’ compensation, unemployment insurance and overtime beyond 40 hours a week ⁠¹. The agency must have proof of liability insurance for itself and its workers, and must keep a current roster that includes on-call and backup staff ⁠¹.

Under TDMHSAS rules, TB testing and CPR certification are not licensure requirements, though payers or contracts may require them ⁠⁴. DDA-licensed PSSAs must provide both ⁠⁷.

Training before the first visit

Rule 0940-05-38-.08 requires documented basic competency in seven areas before a worker meets a client ⁠¹:

1. Observing, reporting and documenting changes in the client’s daily living skills.
2. Detecting, reporting and preventing abuse, neglect and exploitation.
3. Client rights.
4. Universal precautions and infection control.
5. Personal hygiene assistance.
6. Client safety.
7. Emergency and disaster procedures, including emergency transportation, emergency medical care and staff coverage.

Workers also need training specific to each client’s needs in self-care, household management and community living. They need job-related training at least once a year ⁠¹. Workers who give medication assistance need documented training performed by a registered nurse or under an RN’s general supervision, consistent with T.C.A. § 63-7-102. TDMHSAS says a physician assistant cannot approve this training ⁠¹⁠⁴. Each worker must also be able to read instructions, keep written records and communicate with the client ⁠¹.

Medication assistance, and the 2024 change

The rule allows medication assistance only ⁠¹:

• reminders
• loosening a cap
• opening a pill organizer that the client or a licensed professional filled
• placing medication within reach
• steadying a hand
• guiding the client’s hand with eye, ear or nose drops
• setting up an oxygen cannula
• applying over-the-counter creams

Injections and anything that amounts to medication administration are outside it ⁠¹.

What changed: TDMHSAS told its PSSAs that under Public Chapter 730 of 2024 it had approved a competency-based training program. The program lets certified unlicensed PSSA staff administer medication. TDMHSAS partnered with DDA to use DDA’s medication administration classes ⁠⁴. An agency that uses this allowance should notify its TDMHSAS licensure surveyor, keep each worker’s certification in the personnel file, and adopt a medication safety policy ⁠⁴. TDMHSAS said it intends to adopt further PSSA regulations on this allowance ⁠⁴. The 0940-05-38 chapter published by the Secretary of State is still the December 2022 revision ⁠¹. As of 2026-10-12 the Secretary of State’s rule index for Chapter 0940-05 still lists that December 2022 version, so ask your TDMHSAS surveyor whether the announced medication-administration rules have been filed before you rely on this allowance.

Client records and rights

Each client record must include ⁠¹:

• identifying information and an emergency contact
• a fee agreement signed before services start, listing fees, the services covered and extra charges
• signed acknowledgment of rights
• consent to services
• a written service plan based on a needs assessment, showing type, frequency, duration and amount of services
• who pays
• a log of services actually delivered, with dates and times
• incidents and illnesses
• funds handled for the client
• the alternate staffing plan
• any medication-assistance authorization
• a client evaluation of service quality at least every six months, on a form the agency designs

Before services begin, the client must also receive a written consumer notice. It must spell out who supervises the worker day to day, assigns duties, hires and fires, provides equipment, runs background and reference checks, and verifies credentials ⁠¹. Clients have rights to be fully informed in advance, to voice grievances without reprisal, to dignity, to protection from abuse, neglect and exploitation, and to help exercising their civil rights ⁠¹. TDMHSAS’s 2025 guidance says licensed providers must keep records for at least 10 years after service ends, under T.C.A. § 33-3-101(d) ⁠⁴.

After licensing: inspections, renewal and changes

• Inspections. The department makes at least one unannounced inspection of each licensed service every year, and may enter or review records with or without notice ⁠². Findings come on a Notice of Non-Compliance, and you answer by the stated date with a written Plan of Compliance ⁠².
• Postings and reporting. Post the license, and a sign with the department’s toll-free complaint number, unless the department exempts you. Report serious allegations of abuse or deficiency, and other significant occurrences ⁠².
• Renewal. A full license lasts up to 12 months. The department notifies you before expiration and invoices the renewal fee ⁠². A provisional license is possible if you are making a diligent effort and have an acceptable compliance plan ⁠². If you file for renewal on time with the fee, your existing license stays in force until the department decides ⁠².
• Ownership or location changes. Licenses do not transfer. A change of ownership or location requires a new application and license before services continue ⁠². Each site gets its own license ⁠².
• Accreditation. Agencies accredited by bodies such as the Joint Commission or CARF can ask for deemed compliance status ⁠².
• Penalties. DDA may impose civil penalties of $250 per violation for a first offense, or $500 for a Priority 1 offense. Repeat offenses within 12 months cost up to $5,000 ⁠⁸. Either department may deny, suspend or revoke a license for rule violations, false information or conduct harmful to clients ⁠².

Getting paid through TennCare

Private pay is the simplest model. Medicaid-funded in-home care runs through TennCare’s CHOICES program, which defines two levels ⁠⁹:

• Personal Care Visits: hands-on help with activities of daily living, capped at four hours per visit and two visits per day, at least four hours apart.
• Attendant Care: for members who need longer or more frequent help, and it may include safety monitoring.

CHOICES services are delivered through TennCare’s managed care organizations. DDA’s July 2025 license grid lists the license an MCO provider needs for CHOICES Personal Care: a DDA or TDMHSAS PSSA license (by the 50% rule), or a Department of Health home care organization or Professional Support Services license, unless the worker is a registered Consumer Direction worker ⁠¹². The grid has no separate line for Attendant Care, so ask the MCO which license it requires for that service. If your clients will be people with intellectual or developmental disabilities, your provider enrollment runs through DDA’s credentialing process, which is separate from licensure ⁠⁶.

Related Tennessee guides: adult day services centers, assisted care living facilities, homes for the aged.

Sources

1. 1
   Tennessee Secretary of State, Division of Publications, Rule 0940-05-38: Minimum Program Requirements for Personal Support Services Agencies (December 2022 revision) Checked 12 Oct 2026 · Back to text ↑
2. 2
   Tennessee Secretary of State, Division of Publications, Rule 0940-05-02: Licensure Administration and Procedures (December 2022 revision) Checked 12 Oct 2026 · Back to text ↑
3. 3
   Tennessee Department of Mental Health and Substance Abuse Services, Become a Licensed Provider Checked 12 Oct 2026 · Back to text ↑
4. 4
   Tennessee Department of Mental Health and Substance Abuse Services, Office of Licensure, Personal Support Services Agency (PSSA) Provider Information (2025) Checked 12 Oct 2026 · Back to text ↑
5. 5
   Tennessee Department of Mental Health and Substance Abuse Services, Licensing Forms Checked 12 Oct 2026 · Back to text ↑
6. 6
   Tennessee Department of Disability and Aging, Office of Licensure: applying to become a licensed provider through DDA (FAQ) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Tennessee Secretary of State, Division of Publications, Rule 0465-02-17: Minimum Program Requirements for Intellectual and Developmental Disabilities Personal Support Services Agencies Checked 12 Oct 2026 · Back to text ↑
8. 8
   Tennessee Secretary of State, Division of Publications, Rule 0465-02-02: Licensure Administration and Procedures (DDA) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Tennessee Secretary of State, Division of Publications, Rule 1200-13-01: TennCare Long-Term Care Programs (October 2025 revision) Checked 12 Oct 2026 · Back to text ↑
10. 10
    Tennessee Secretary of State, Division of Publications, Rule 0720-27: Standards for Home Care Organizations Providing Home Health Services Checked 12 Oct 2026 · Back to text ↑
11. 11
    Tennessee Health Facilities Commission, Certificate of Need Basics Checked 12 Oct 2026 · Back to text ↑
12. 12
    Tennessee Department of Disability and Aging, Attachment 2: Program Service License/Certification Requirements (revised 6/30/25) Checked 12 Oct 2026 · Back to text ↑

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