How to start a home care agency in Tennessee (PSSA license, 2026)

TDMHSAS "is authorized to license facilities and services operated for the provision of mental health, substance abuse, and personal support services in the State of Tennessee by T.C.A. Title 33, Chapter 2, Part 4." (0940-05-02-.01(1)). Personal support services are one or more of four things, given in the client’s permanent or temporary home (0940-05-38-.01(1)):

• Self-care: "assistance with tasks such as eating, dressing, toileting, bathing, mobility, transfer assistance and other services and supports to maintain health and wellness".
• Household help: "assistance with tasks such as housekeeping, laundry, meal planning, meal preparation, shopping, bill paying, and use of telecommunication devices" (.01(1)(b)).
• Community access: "Personal assistance to service recipients to access community activities such as transportation, social, recreational or other personal activities" (.01(1)(c)).
• Education services, which only a registered nurse gives (.01(6)).

The clients are people with substantial limits in two or more major life activities, served at home, who depend on personal support to carry out major life activities but do not need nursing-level services for an acute illness or injury (0940-05-38-.01(2)). An agency is any business that provides these services, and the rule adds: "Agency includes all entities that employ or subcontract with individuals who provide personal support services to service recipients" (.01(3)). Providing personal support services without a license is unlawful and may bring civil or criminal sanctions (0940-05-02-.03(1)).

Three state bodies license care in the home in Tennessee, and the PSSA license itself can come from either of two departments. "To provide personal support services, an agency needs a license from either the Department of Mental Health and Substance Abuse Services or the Department of Intellectual and Developmental Disabilities." (0940-05-38-.04(1)). The Department of Intellectual and Developmental Disabilities is now the Department of Disability and Aging (DDA).

One license, not two. The statute, as rewritten by Public Chapter 110 in 2015, says an agency serving both groups "shall not be required to obtain a license from both departments"; the larger population decides, and for new applicants that is "the larger population anticipated to be served by the agency at the time of licensure application" (T.C.A. 33-2-403(c), Public Chapter 110 (2015)). Either department’s licensee may also serve people with physical or other disabilities (0940-05-38-.04(2)).

The attestation. You attest in writing to the category of the majority of your clients when you apply, on TDMHSAS’s Fact Sheet, and again with every renewal (0940-05-38-.04(3)-(4); Fact Sheet, item 4). You then serve only clients who will not take you outside that category (0940-05-38-.05(5)), and one of the 17 required policies covers how you categorize the majority of your clients. The rules do not say how the 50% is counted (people, hours, or at application only); ask your regional office if your client mix is close.

Clients do not need nursing-level care, and TDMHSAS’s PSSA slides list tasks a PSSA may not do. Some of the limits founders ask about:

1. The forms

TDMHSAS’s process page says: "Complete and submit the following forms ... to Regional Office of Licensure nearest the location to be licensed." (Become a Licensed Provider, step 2). The four forms are the Initial Application (MH-4385), the Fact Sheet (MH-4386), the Background Check and Privacy Statement Form, and the Financial Statement, in printable PDF or web form (TDMHSAS, Licensing Forms). What they ask for:

• Who applies. The owner, chief executive, executive director or another governing body member responsible for the agency’s standards, policies and procedures (MH-4385, Instructions).
• Background of the person responsible. For the person with overall responsibility (and any other applicants listed), TDMHSAS needs proof of citizenship or legal immigration, a Background Information Check form, a Non-Criminal Justice Privacy Rights Statement and a TBI fingerprint check (or FBI fingerprints or a licensed private investigator check covering current and previous states). The individual pays for it. (MH-4385, item 7)
• Three character references who can vouch for that person: "Individuals providing a reference may not be related to the applicant by marriage, blood, or in a vested business venture." (MH-4385, item 9)
• Company documents. A corporation’s charter certified by the Tennessee Secretary of State, and any contract with a management firm (MH-4385, items 3 and 6).
• A written description of your services, and a Fact Sheet for each location (MH-4385, item 12). Fact Sheet items 6 to 22, about buildings, occupancy and food service, do not apply to PSSAs, so mark them N/A; item 5 asks about the site manager, including any felony conviction or pending charge (MH-4386).
• Counties and records address. "The agency should submit to the licensing department a list of the counties in which they provide services and the address at which the agency maintains its employee and service recipient records." (0940-05-38-.04(6))
• A signed certification that the application is true and that you "agree to comply with the rules promulgated under Tennessee Code Annotated, Title 33, Chapter 2, Part 4" (MH-4385).

The Financial Statement. Item 11 of the Initial Application (financial solvency) says it applies only to office-based opiate treatment applicants, although TDMHSAS’s process page lists the Financial Statement among the forms for everyone. Ask the regional office whether a PSSA must send one. (MH-4385, item 11) If you send one, it covers the assets, liabilities and funds available to run the service (Financial Statement form).

Applications go to the regional office: West (Memphis, 901-543-7442), Middle (Nashville, 615-532-6590) or East (Knoxville, 865-594-6551), open weekdays 8 a.m. to 4:30 p.m. (TDMHSAS regional contacts). TDMHSAS also takes documents and payments in person at its Middle Tennessee office on Tuesdays and Thursdays (TDMHSAS, Licensing). Accreditation is not required (MH-4385, item 10).

2. The invoice

"You will be sent an invoice once the above forms have been received by the Office of Licensure." (Become a Licensed Provider, step 3) The fees.

3. The electronic desk audit

"Personal Support Services Agencies (PSSAs), D.U.I. Schools, and Non-Residential Office-Based Opiate Treatment offices (OBOTs) currently do not require a life safety/fire inspection." (step 4) Instead, "Initial inspections for Personal Support Services Agencies (PSSAs), D.U.I. Schools, and Non-Residential Office-Based Opiate Treatment offices (OBOTs) are conducted via an electronic desk audit." (step 5). On what an initial inspection covers, TDMHSAS says: "Generally (with a few exceptions), life safety and environment/ancillary services are inspected as well as certain policies and procedures." (TDMHSAS). It does not publish which policies, or a desk audit checklist; it says a Regional Manager can explain the next steps. Ask the Regional Manager which policies the desk audit will look at.

Our suggestion: send the desk audit every policy the rules list, with a short index that shows where each of the 17 items and 8 personnel topics is met. TDMHSAS’s own list of common PSSA deficiencies is a good guide to what it reads closely (below).

4. Corrections, then the initial license

"If the review indicates deficiencies, the applicant will be notified and must correct deficiencies before a license is issued" (0940-05-02-.06(5)(b)). Then: "Once the inspection is conducted and deficiencies, if any, are corrected, an Initial License will be issued for up to 1 year." (step 6). A denied applicant may ask in writing, within 15 calendar days, for a hearing before the Licensure Review Panel (0940-05-02-.06(5)(c)).

TDMHSAS points new PSSA applicants to its PSSA Provider Information slides (step 7). Much of this guide quotes them.

5. After licensing

• Inspections. "The Department shall make at least one (1) unannounced inspection of each licensed facility/service yearly." (0940-05-02-.22) TDMHSAS may enter with or without notice, talk to clients and others, and review and copy records (0940-05-02-.13).
• Plans of Compliance. When TDMHSAS finds non-compliance it issues a Notice of Non-Compliance, and you send a written Plan of Compliance by the date given, describing each corrective action and its completion date (0940-05-02-.21(2)-(3)). Keep copies of the most recent plans in a central location (0940-05-02-.21(5)).
• Full or provisional license. A full license is valid for up to 12 months and is issued when the licensee shows compliance with all applicable licensure laws and rules. (0940-05-02-.02(2)) TDMHSAS may issue a provisional license to an agency not meeting every requirement, if it is making a diligent effort, clients are not endangered, it has an acceptable compliance plan and it met last year’s plan. (0940-05-02-.02(3)) When the initial license comes up for renewal, TDMHSAS reviews the agency and issues a full license if it is in compliance, or may issue a provisional one (0940-05-02-.07(5)).
• Civil penalties. TDMHSAS may impose, per violation, per day: $500 for a first Priority 1 or critical offense and $250 for other first offenses; for a second offense of the same type within 12 months, $2,500 to $5,000 (Priority 1 or critical) or $500 to $2,500 (other offenses) (0940-05-02-.25(4)). A Priority 1 offense is a substantiated investigation involving a client’s death, neglect or physical or sexual abuse by the licensee or staff, or serious injury (0940-05-02-.25(6)).

"The licensee shall ensure that the agency is administered and operated in accordance with written policies and procedures including, but not limited to, those specified in Rule 0940-05-38-.06." (0940-05-38-.05(2)). Tennessee’s rules list them. Rule 0940-05-38-.06(1) begins "The licensee shall maintain written policies and procedures that include the following:" and gives 17 items, (a) to (q). Rule .07(2) adds: "The licensee shall have written personnel policies. The personnel policies shall, at a minimum address the following:", eight topics, (a) to (h) (0940-05-38-.07(2)).

TDMHSAS also says what it will not do: "an agency should only be cited for violation of policy rules that are listed in the applicable administrative rules for the agency." (PSSA slides, slide 38). Items marked Common deficiency are on TDMHSAS’s own list of common PSSA deficiencies (PSSA slides, slides 12-16).

Beyond the two lists

Other rules need written documents too: a consumer notice before services begin, a worker notice in each personnel file, a signed fee agreement, a written rights acknowledgement, an evaluation form each client signs at least every six months, and an alternate staffing plan in every client record (0940-05-38-.09(1); .07(1)(h)). Three of these are on TDMHSAS’s common deficiency list: the consumer notice, the rights acknowledgement and the semi-annual evaluations (PSSA slides, slides 12-16).

Where the sources are silent

• The desk audit checklist. We found no TDMHSAS list of the policies it reviews at the desk audit.
• Templates and rule text. Nothing we saved stops a policy quoting the rule it meets or starting from a template. TDMHSAS itself points agencies to the Department of Disability and Aging’s sample Medication Safety Policy (PSSA slides, slide 22). The licensee must "exercise general direction over the agency and establish policies governing the operation of the agency and the welfare of service recipients" (0940-05-38-.05(3)), so our suggestion is to write your procedures in plain words and make sure they match how you actually work.
• An older rule. A 2003 rule still in the Compilation, 0940-05-03-.26, says PSSAs follow all of 0940-05-06 and a "0940-05-36" PSSA chapter. The 2016 rule 0940-05-38-.02 and TDMHSAS’s 2025 PSSA slides apply only 0940-05-02, 0940-05-38 and 0940-05-06-.03(1)-(6). By our reading the later, specific rule controls; confirm with TDMHSAS. (0940-05-03-.26; PSSA slides, slide 6)
• The Tennessee Code. We could not save the text of the Tennessee Code Annotated. Where this guide describes a statute (background checks, records retention, abuse reporting), it relies on the rules, Public Chapters and state agency documents that quote or summarise it, and names them.

Easy to miss

• No required thank-yous. "The service recipient shall not be required to make public statements which acknowledge gratitude to the licensee or for the licensee’s services" (0940-05-38-.06(1)(f)2). By our reading, ask for testimonials only as a free choice, and never as a condition of service.
• A roster with back-up workers. "The licensee shall maintain a current roster of all personal support workers at all times including workers kept on an on-call or back-up basis." (0940-05-38-.07(4))
• Liability insurance. "The licensee shall have proof of liability insurance coverage for the agency, workers and others who provide personal support services." (0940-05-38-.07(3)) No minimum amount is set.
• Client money. If the agency holds client funds: a separate account at a federally insured institution and a report of funds held and spent at least once a year (0940-05-06-.03(4), (6)).
• Legal documents. A copy of any conservatorship or power of attorney in the client record (0940-05-38-.09(1)(q)).

Two definitions disagree: the 2003 definitions chapter says education services are given by a "licensed nurse"; the 2016 PSSA chapter says a registered nurse. By our reading the PSSA chapter controls. (0940-05-01-.15(4); 0940-05-38-.01(6))

We found no office or premises standard for a PSSA in Chapter 0940-05-38, and TDMHSAS says a PSSA needs no fire or life safety inspection (TDMHSAS, step 4). Fact Sheet items 6 to 22, about buildings and occupancy, do not apply to PSSAs (MH-4386). What the rules do tie to a place:

• The license is for an address. "Licenses are address-specific requiring a new license before a relocation may occur." (TDMHSAS Provider FAQs) "Each licensee will be issued one license for each site at which the licensee is operating a facility or service." (0940-05-02-.09)
• Posting. "The license certificate shall be posted for public viewing in a conspicuous place at the facility or service." (0940-05-02-.16)
• A complaint sign. "The licensee shall post a sign in the facility or service displaying the Department’s regional toll-free telephone number which informs service recipients, families, and the public that they may file a complaint with the Department." (0940-05-02-.20(2)) The rule was written with premises in mind and asks for a regional number; TDMHSAS publishes one statewide complaint line, 866-797-9470 (TDMHSAS Provider FAQs). Our suggestion: post it at your office and print it in every client’s rights information.
• Where records are kept. You tell TDMHSAS the counties you serve and the address where you keep employee and client records (0940-05-38-.04(6)). Records may be paper or electronic: "“Written” means, as applied to licensee’s records, any generally accepted format, including electronic or paper, used for retaining business or client records." (0940-05-38-.01(11))

Whether the licensed site can be your home, and whether the records address must be in Tennessee, is not stated in the rules we saved. Ask your regional office before you sign a lease or apply from a home address, and check local zoning separately.

Tennessee sets topics, not hours. Workers must be 18 or older (0940-05-38-.07(2)(a)), and the agency ensures and documents that "Individuals who provide personal support services demonstrate basic competency in the following skill/knowledge areas prior to beginning work with service recipients" (0940-05-38-.08(1)(a)):

1. Observing, reporting and documenting changes in a client’s daily living skills.
2. Detecting, reporting and preventing abuse, neglect and exploitation.
3. Client rights.
4. Universal precautions and infection control.
5. Helping with personal hygiene.
6. Client safety.
7. Emergency and disaster procedures, including at least emergency transportation, emergency medical care and staff coverage (.08(1)(a)7).

• Before work, too: the language skills to read instructions, keep written records and communicate with the client, and documented training in self-care, household management, community living and service methods (0940-05-38-.07(2)(f)).
• Client-specific training, documented, for each client’s needs (.08(1)(d)).
• Every year: "Individuals who provide personal support services receive training on job related topics at least annually", with no hour minimum (.08(1)(c)), and an annual performance evaluation that at least assesses the worker’s ability to give daily supports (.07(1)(g)). Both competency before work and annual evaluations are on TDMHSAS’s common deficiency list.
• Medication assistance: documented training by, or under the general supervision of, a registered nurse before a worker assists (.08(1)(b)).
• Lifts and gait belts: used only after training (.06(1)(n)).

TDMHSAS says neither a TB skin test nor CPR certification is a licensure requirement, though a contract may require them (PSSA slides, slides 28-29).

• Criminal background check, results before contact. The personnel policy follows the rule: "all personal support services workers shall submit to a criminal background check every two (2) years or within ten (10) days of employment or within ten (10) days of a change of responsibilities that includes direct contact with or direct responsibility for service recipients, as required by T.C.A. § 33-2-1202" (0940-05-38-.07(2)(c)). TDMHSAS summarises the statute: "The background check shall be completed before allowing the person to have any direct contact with or direct responsibility for service recipients", and adds: "TDMHSAS has the interpretation that the background results shall be back and in the possession of the employer prior to employee direct contact with, or direct responsibility for, service recipients." (PSSA slides, slides 11 and 34)
• The two-year re-check is not enforced. "Because of the verbiage of this rule concerning every 2 years, Licensure will not be enforcing this part of the rule." (PSSA slides, slide 8) The checks at hiring and on a move into direct-contact duties still apply. Our suggestion: repeating the check every two years is still sensible, and if you put it in your policy, follow it.
• How. Fingerprints through the Tennessee Bureau of Investigation or the FBI, or "from a state licensed private investigation company without the use of a fingerprint sample" (PSSA slides, slide 11).
• Abuse Registry, before contact and every year. No employee or volunteer on the registry may work (0940-05-38-.07(1)(d), .07(2)(d)). The rule says the Department of Health keeps it; the Health Facilities Commission now does, with the search at internet.health.tn.gov/AbuseRegistry (HFC, Abuse Registry).
• Sex Offender Registry, before contact and every year. No one listed may work (0940-05-38-.07(1)(e), .07(2)(e)). The Tennessee Bureau of Investigation runs the registry (TBI).
• References and work history, before employment. Each file holds a continuous five-year work history and personal references from three people, one of whom has known the applicant five years (0940-05-38-.07(1)(i)-(j)). TDMHSAS reads the statute as requiring you to check them before hiring: "Agency must directly communicate with at least two (2) of the three (3) required references listed." "Agency is required to communicate with the most recent employer. There is no requirement to check with ALL places listed, only employers where the applicant has worked for more than 6 months." (PSSA slides, slides 35-36). Documented attempts, such as a voicemail or an email, count, and "relatives can qualify as personal references" (slide 39).

Each personnel file also holds a signed and dated job description, proof the worker meets its requirements, the date of birth, annual performance evaluations and the worker notice (0940-05-38-.07(1)). The worker notice says whether the agency is an employer or a contractor, and who is responsible for wages, taxes, Social Security, workers’ compensation, unemployment and overtime (.07(1)(h)).

We could not save the statute TDMHSAS relies on here, T.C.A. 33-2-1202, so this section quotes TDMHSAS’s own summary. Ask TDMHSAS or a Tennessee lawyer before relying on anything beyond it.

Item (h) of the 17 is a policy on "reporting and investigation of suspected or alleged abuse or neglect of a service recipient, or other critical incidents", with corrective action and reporting to TDMHSAS’s Office of Licensure and any authority the law requires (0940-05-38-.06(1)(h)). Item (p) is a policy that you will cooperate with TDMHSAS’s investigations (.06(1)(p)).

To TDMHSAS

• The rule. "The licensee must report to the Department any serious allegations or suspicion of abuse, dereliction, or deficiency in the operation of the facility or service." (0940-05-02-.20(3)) The licensee also reports significant occurrences involving the service, clients and staff (0940-05-02-.20(4)).
• The deadline today. TDMHSAS’s instructions: "Report incidents to TDMHSAS Licensure Investigation Unit by the close of the next business day after the event or the next business day after the agency was made aware of the event." Use the Reportable Incident Form with supporting documents (TDMHSAS Incident Reporting Requirements; MH-5375).
• What is reportable. Reportable incidents include a client’s death or suicide attempt while in the agency’s care, self-harm, abuse or neglect by staff (including withholding or negligently failing to provide services), sexual contact between staff and clients, theft by staff or misuse of client funds or cards, and injuries needing an ER or walk-in clinic or more than basic first aid. (TDMHSAS)
• What is not reportable. Quality-of-service grievances (handle through the grievance procedure), staff-only injuries, routine medical appointments, and medical incidents not caused by injury need not be reported. For medical incidents not caused by injury, TDMHSAS says the agency must still document how each was handled. (TDMHSAS) Deaths when the agency is not providing or scheduled to provide services are not reportable unless abuse or neglect by the caregiver is suspected to have contributed. (TDMHSAS PSSA reporting documentation)
• Missed visits. They are among the most common PSSA reports; TDMHSAS asks for your back-up staffing policy and the client’s alternate staffing plan (TDMHSAS PSSA reporting documentation), and says: "TDMHSAS feels it is not appropriate for care coverage to fall back on the client." If a worker calls in and the visit is not covered, the agency may be substantiated for not carrying out its back-up plan (PSSA slides, slide 31).

To Adult Protective Services, and for children

• Adults. The Department of Human Services says anyone who suspects a vulnerable adult is being abused, neglected or financially exploited has a "legal obligation to notify APS": 1-888-APS-TENN (1-888-277-8366), 24/7, or online, and 911 in an emergency (DHS, APS brochure 2026; DHS, Adult Protective Services). We have not saved the Adult Protection Act itself.
• Children. The PSSA client definition has no age limit. The Department of Children’s Services says: "Everyone in Tennessee is a mandated reporter. Tennessee Code Annotated 37-1-403(i) (1) requires all persons to report suspected cases of child abuse or neglect." Reports go to 1-877-237-0004 or online, and failure to report is a Class A misdemeanor (DCS, Report Child Abuse).
• Complaints. TDMHSAS investigates licensed and unlicensed providers after reports of inadequate care or rule violations (TDMHSAS, Licensing); its complaint line is 866-797-9470 (TDMHSAS Provider FAQs).

Proposed: 48 hours. The proposed rewrite of 0940-05-02 would say "reportable incidents shall be reported to the Department as soon as possible, but no later than within forty-eight (48) hours of knowledge of the event", and that reporting only to other agencies or the police does not count (proposed 0940-05-02-.20(4)). It is not in force. Until TDMHSAS says otherwise, by our reading the next-business-day instruction is the one in force; reporting as soon as you can meets both.

Medication assistance means "providing medication reminders and opening medication packaging, but does not mean giving the service recipient injections or any form of medication or medication administration" reserved for licensed nurses and others authorized under Title 63, Chapter 7 (0940-05-38-.01(9)). If you offer it, you need written authorization from the client or their representative first, documented RN-supervised training before any worker assists, and procedures for collecting information about each client’s medications (0940-05-38-.06(1)(l); .08(1)(b)). The written authorization in the client record is first on TDMHSAS’s common deficiency list (PSSA slides, slides 12-16). TDMHSAS lists filling medication planners as not allowed (slide 25).

Medication administration became possible in 2024. Public Chapter 730 says "An unlicensed person who is employed by a personal support service agency (PSSA) licensed under title 33 may administer medications to an individual who is incapable of self-administration in the individual’s place of residence after the unlicensed person satisfactorily completes a competency-based training program approved by the department of mental health and substance abuse services" (T.C.A. 68-1-904(c)(3), Public Chapter 730 (2024)). Certified staff still may not give intravenous, intramuscular or certain subcutaneous injectable medications (Public Chapter 730, section 3).

• The training. TDMHSAS has approved the Department of Disability and Aging’s Medication Administration classes. For PSSAs not serving people with IDD, DDA charges $50 per participant for the 20-hour class and $25 for the Test-Out renewal; certification is valid for 3 years. That is DDA’s fee, not ours (PSSA slides, slide 21). Participants pass a written test with 80% or better and show competency in at least three skills (DDA agency guidelines).
• What TDMHSAS asks of the agency. Notify the assigned TDMHSAS surveyor; keep each worker’s certificate in the personnel file; develop and implement a Medication Safety Policy (DDA has a sample); make sure staff understand the certification and its expectations. (PSSA slides, slide 22)
• Rules are promised, not filed. TDMHSAS says it intends to make PSSA-specific rules on medication administration, mostly requiring policies and procedures, and will notify licensed PSSAs when they are filed. None was filed as of October 2, 2026. (slide 22; Secretary of State pending rules)
• DDA’s sample policy. DDA’s sample covers medication prohibitions, security, program requirements, storage and labeling, MAR editing, refusals, the MAR, controlled substances, variances, disposal, family visits and self-administration. It is written for DDA providers; by our reading it needs adapting to home care. It also says: "Administration of medications to persons under the age of 18 is not covered under the exemption." (DDA sample Medication Safety Policy)

DDA’s rules for certified unlicensed personnel allow medication by oral, rectal, vaginal, eye, ear, nasal and topical routes, and subcutaneous routine insulin (with extra training) and injectable epinephrine. By our reading these rules govern PSSA staff certified through DDA’s classes; TDMHSAS has not said so in a rule. (0465-01-03-.06(1))

• Non-refundable. "Each initial and renewal application for licensure must be submitted with the appropriate fees. All fees submitted are non-refundable." (0940-05-02-.05(1))
• Extra inspections. Up to $50 for an onsite inspection other than the initial or annual one, invoiced and due within 30 days; TDMHSAS may withhold or suspend a license until fees are paid (0940-05-02-.23).
• Background checks. The person responsible for the agency, and any other applicants, pay for their own checks; TDMHSAS does not publish the amount (MH-4385, item 7).
• Insurance. Proof of liability insurance for the agency, workers and others who provide services; no minimum is set (0940-05-38-.07(3)). If workers drive clients, vehicle liability insurance too (.06(1)(m)3).

Renewal. Before the license expires, TDMHSAS tells you what to send, with fees by invoice; "All payments must be accompanied by a copy of the fee invoice before the fee will be credited to the appropriate agency or service." (0940-05-02-.07). If you file a timely, complete renewal, "the existing license does not expire until the status of the application has been determined by the Department" (0940-05-02-.15). Each renewal includes a new client-mix attestation (0940-05-38-.04(4)).

Changes, selling and closing. Licenses cannot be transferred. A new application and license are needed before services are provided after a change of ownership or location. (0940-05-02-.10) A new chief executive or executive director, a name change or a closure goes on the Change of Status form; for a closure it asks for the date, the reason and the arrangements for clients (MH-4454). The certificate is surrendered when the service closes or changes owner (0940-05-02-.17).

Timeline. Neither the rules nor TDMHSAS’s pages give a processing time from application to license (checked October 2, 2026). The waits come at the invoice, the scheduling of the desk audit and any corrections. We cannot give you a date.

TDMHSAS publishes its licensed sites as data that it says is updated daily (TDMHSAS Fast Facts). In the export we downloaded on October 1, 2026 we counted 675 Personal Support Services Agency sites under 624 distinct agency names. The largest counties were Shelby (191 sites), Davidson (98), Knox (58) and Hamilton (53) (TDMHSAS licensed sites data, our count). PSSAs licensed by the Department of Disability and Aging are not in this data.

TDMHSAS also links a searchable database of licensed providers; it refused our requests, so we could not check it (TDMHSAS, Find a Licensed Facility).