Last verified: October 2026. Rules and fees change, so confirm every figure with the Tennessee Department of Mental Health and Substance Abuse Services before you file.
In Tennessee, non-medical home care for seniors is licensed as a Personal Support Services Agency (PSSA). Many guides send founders to the wrong department: for agencies serving older adults, the license comes from the Department of Mental Health and Substance Abuse Services, not the Health Facilities Commission. This guide sorts that out.
Quick facts: Tennessee home care licensing
| License name | Personal Support Services Agency (PSSA) |
| Issued by | TDMHSAS Office of Licensure (DDA if 50%+ of clients have intellectual or developmental disabilities) |
| Governing law | T.C.A. §33-2-403; Rules 0940-05-38 and 0940-05-02 |
| License fee | Invoiced by TDMHSAS after you apply; confirm the current PSSA amount with your regional office |
| License term | Up to 1 year initially, then yearly renewal |
| Inspection | Electronic desk audit, no fire or life-safety inspection |
| Medicaid | TennCare CHOICES through the MCOs |
Do you need a license for home care in Tennessee?
Yes, if you help people with significant limitations with self-care, household tasks or getting around the community. Agencies offering only housekeeping or only transportation are exempt, as is caring for a family member. Pure companionship is not named in the rule, so plan to license unless TDMHSAS confirms otherwise in writing.
Which department licenses you depends on your clients: TDMHSAS for agencies serving older adults or people with mental illness, the Department of Disability and Aging if half or more of your clients have IDD. You only need one license.
Step-by-step: how to open a home care agency in Tennessee
- Form your business, get an EIN, and write policies that meet Rule 0940-05-38.
- Send the application packet to your TDMHSAS regional office: initial application, fact sheet, background check/privacy form, financial statement and the population attestation.
- Pay the invoiced fee.
- Complete the initial inspection, an electronic desk audit for PSSAs.
- Correct any deficiencies and receive your license.
- Renew every year with an annual survey.
How much does it cost?
- TDMHSAS license fee: set in Rule 0940-05-02 and invoiced after you apply. The $1,404 figure often quoted online is the Health Facilities Commission’s home health fee, not the PSSA fee.
- Proof of liability insurance is required.
- Background and registry checks for every caregiver.
Budget separately for insurance, payroll for your first caregivers before clients pay, software, and marketing. Licensing is rarely the biggest line. See what it really costs to start a home care agency.
Caregiver requirements in Tennessee
- Age 18 or older.
- Criminal background check within 10 days of hire and every 2 years; Abuse Registry and Sex Offender Registry checks before client contact, then yearly.
- Demonstrated competency before working in abuse and neglect, client rights, infection control, hygiene, safety, emergencies and reporting changes; then annual training.
- Assisting with medications requires RN-supervised training.
How long does it take?
Because the inspection is a desk audit, many agencies are licensed in roughly 2 to 4 months.
Medicaid in Tennessee
TennCare CHOICES covers seniors 65 and over and adults 21 and over with physical disabilities. It runs through the TennCare managed care organizations (BlueCare, UnitedHealthcare Community Plan and Wellpoint), so you credential and contract with each. A PSSA license qualifies you for CHOICES personal care.
Comparing states? See the home care license requirements for every state.
Want the full playbook?
I built and run a licensed home care agency in California. The licensing steps differ state to state, but getting clients, hiring good caregivers and managing cash flow work the same way in Tennessee. The Home Care Agency Blueprint covers that side in 49 lessons. You can see the syllabus, start with the $29.99 Startup Workbook, or book a free call to map out your Tennessee launch.
FAQ
Who issues the license for a senior home care agency in Tennessee?
The Department of Mental Health and Substance Abuse Services, unless half or more of your clients have intellectual or developmental disabilities, in which case it is the Department of Disability and Aging.
Do I need a nurse?
Only if caregivers will help with medications, which requires RN-supervised training.
Is there an on-site inspection?
For a PSSA, the initial inspection is an electronic desk audit with no fire or life-safety inspection.
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