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Tennessee · Personal Support Services Agency license · TDMHSAS’s application
You apply for a Tennessee PSSA license on paper or web forms sent to a TDMHSAS regional office. Here are TDMHSAS’s seven steps, the four forms item by item, your own fingerprint check, TDMHSAS’s $810 fee by invoice, the electronic desk audit, the initial license, and how renewal, changes, a sale and closing work.
Quick answer
A Tennessee Personal Support Services Agency (PSSA) license comes from the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), Office of Licensure, when 50% or more of your clients will be aged or have a mental illness or substance abuse diagnosis (0940-05-38-.04(3)(a)). You send four forms to the regional office nearest the location to be licensed (TDMHSAS, step 2), and TDMHSAS sends an invoice for its fee: $810 per site for one category, TDMHSAS’s fee, not a CareRulebook price (0940-05-02-.05(1)).
There is no fire inspection. 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." (TDMHSAS, step 5). TDMHSAS says initial inspections cover certain policies and procedures, and the applicant "will be notified and must correct deficiencies before a license is issued" (0940-05-02-.06(5)(b)). Then TDMHSAS issues an initial license for up to one year, and only then may services begin (0940-05-02-.03(1)).
"Rule requires" means Tenn. Comp. R. & Regs. 0940-05-02 (licensure administration and procedures) or 0940-05-38 (the PSSA rules). "TDMHSAS asks" or "TDMHSAS says" rests on TDMHSAS’s own forms, its Become a Licensed Provider and Provider FAQ pages, or its 2025 PSSA slides. Where we add our own reading or advice, we say so.
TDMHSAS’s Become a Licensed Provider page sets out seven steps (TDMHSAS, Become a Licensed Provider). Tick them off as you go; your progress is saved in this browser only.
TDMHSAS starts by pointing applicants to its licensure rules. For a PSSA they are 0940-05-02, 0940-05-38 and parts (1) to (6) of 0940-05-06-.03. If 50% or more of your clients will be aged, or have a mental illness or substance abuse diagnosis, you apply to TDMHSAS; if 50% or more will have an intellectual or developmental disability, to the Department of Disability and Aging instead.
The Initial Application (MH-4385), a Fact Sheet (MH-4386) for each location, the Background Check and Privacy Statement form, and the Financial Statement, to the West, Middle or East regional office nearest the location to be licensed. The four forms, item by item.
TDMHSAS sends an invoice once it has your forms, with the fee amount and mailing instructions. For one category at one site the fee is $810, TDMHSAS’s fee, not a CareRulebook price. It is non-refundable, and no license is issued until it is paid.
TDMHSAS says PSSAs currently do not need a life safety or fire inspection, so there is nothing to book here.
When the paperwork is in and the fee is paid, the Office of Licensure contacts you about a date. For a PSSA the initial inspection is an electronic desk audit, and TDMHSAS says initial inspections cover certain policies and procedures. What to have ready.
Once the inspection is done and any deficiencies are corrected, TDMHSAS issues an initial license for up to one year. Services may not start before the license is issued.
TDMHSAS points new and recently licensed PSSAs to its PSSA Provider Information slides, with its common deficiencies, the tasks a PSSA may not do and its reading of the background check and reference rules.
Each card says whether the item comes from the rules or from TDMHSAS’s forms and guidance.
Rule requires
You attest in writing, when you apply and at every renewal, to the category of the majority of your clients. On TDMHSAS’s Fact Sheet the PSSA box asks whether 50% or more will be aged or have a mental health or substance abuse diagnosis, or have an intellectual or developmental disability.
TDMHSAS asks
The application uses the proprietors’ names or the corporate name registered with the Tennessee Secretary of State, and a corporation sends its charter certified by the Secretary of State. The Fact Sheet asks for the name the public will know, which is printed on the license.
Rule requires; TDMHSAS asks
An owner for a proprietorship or partnership, or for example the chief executive officer for a corporation. They need proof of citizenship or legal immigration status and a fingerprint background check, and they answer the application’s history questions. Your own background check.
0940-05-02-.04(3)(c); MH-4385, items 3 and 7The licensee and the person responsible →
TDMHSAS asks
People who can vouch that the responsible person is of reputable character and able to run a service for vulnerable people. They may not be related by marriage, blood or a shared business venture.
TDMHSAS asks
The application asks for a written description of the services you will provide. Our suggestion: use the same words as the description of services in your policies, which is item (a) of the 17 the rules list.
Rule says
A list of the counties you will serve and the address where you will keep employee and client records. The rule says "should".
TDMHSAS says
Not one of the four forms, but the desk audit covers certain policies and procedures and TDMHSAS does not publish which. Our suggestion: have every policy the rules list written and adopted before you send the forms.
Rule requires
The licensee must have proof of liability insurance for the agency, its workers and others who provide services; no minimum is set. None of the four forms asks for it, so by our reading it must be in place before services start rather than with the application.
TDMHSAS’s process page lists four forms: the Initial Application, the Fact Sheet, the Background Check and Privacy Statement Form, and the Financial Statement (TDMHSAS, step 2). "TDMHSAS Licensing forms are available in both printable PDF and web-based formats." (TDMHSAS, Licensing Forms) The rules add that applications are made on TDMHSAS’s forms and "must be submitted in writing, legible, with all the information requested on the application" (0940-05-02-.04(2)), because TDMHSAS uses them "to determine the applicant’s responsible and reputable character and the applicant’s ability to meet the minimum standards for the operation of a facility or service" (0940-05-02-.04(2)).
| Form | What it asks for | Source |
|---|---|---|
| Initial Application (MH-4385)Every applicant | Applicant and organizational structure (items 2 and 5); the person with overall responsibility and any management firm, whose contract goes with the application (item 3); the contact for invoices and compliance documents (item 4); governing body members for a corporation or association (item 6); background and history (item 7); personal details (item 8); three references (item 9); accreditation, optional (item 10); financial resources, which item 11 says applies only to office-based opiate treatment applicants; a written description of services (item 12); the fee (item 13); and the signed certification. | MH-4385 (rev. 05/15/2020) |
| Fact Sheet (MH-4386)Each location | One for each location. Tick purpose (a), a new applicant, and give the name as it will appear on the license, the address, county and whether the site is inside city limits. Item 4 is the category: tick Personal Support Services Agency and answer the client-mix question. Item 5 names the site manager and asks about any felony conviction or pending charge. Items 6 to 22, about buildings and occupancy, do not apply to PSSAs: mark them N/A. | MH-4386 (rev. 10/27/2025) |
| Background Check and Non-Criminal Justice Privacy Rights formThe responsible person | For the person named in item 3 of the application and any other applicant listed in item 2. TDMHSAS publishes it as a printable PDF and a web form. We could not read the text of the PDF we saved, so we do not describe its contents here. | MH-4385, item 7; TDMHSAS, Licensing Forms |
| Financial Statement (MH-4466)Ask TDMHSAS | TDMHSAS’s form, or another written statement, covering at least your assets, liabilities and funds available to run the service; the form also asks for monthly operating expenses and income. If you send one, it is signed, dated and sent with the application. TDMHSAS’s process page lists it for every applicant, but item 11 of the application says the financial solvency item applies only to opiate treatment applicants. Ask your regional office whether a PSSA must send it. | Financial Statement form; MH-4385, item 11 |
A new applicant ticks the first purpose on the Fact Sheet, and an Initial Application must go with it. (MH-4386, item 2(a)) "A separate Fact Sheet is required for each location." (MH-4386, Instructions) The rules require a written attestation of the category of the majority of your clients, on a form developed by the department you apply to (0940-05-38-.04(3)). By our reading the Fact Sheet’s PSSA question is that form (MH-4386, item 4); TDMHSAS has not said whether it also expects a separate attestation, so ask your regional office.
The Fact Sheet also has a "Non-Medical Home Health" box beside the PSSA box (MH-4386, item 4). We found no TDMHSAS rule or definition for that category, so if you provide non-medical home care, ask your regional office which box to tick.
The rules ask the application to show, for the person or people responsible for running the service, "including Social Security number and date of birth, place of residence during the past five years and place of birth, proof of citizenship or evidence of legal immigration status, and criminal background check" (0940-05-02-.04(3)(c)). On TDMHSAS’s form that becomes:
TDMHSAS does not publish what the fingerprint check costs; the individual pays (MH-4385, item 7). These checks are for the people who run the agency. Your caregivers’ checks come later, before any of them has contact with a client: background checks for caregivers.
Our suggestion: keep a copy of everything you send and a note of the date, and send a complete set at once, since the invoice follows only once TDMHSAS has the forms.
These are TDMHSAS’s fees from its licensure rules. They are paid to the state and are not CareRulebook prices.
| TDMHSAS fee | Amount | Source |
|---|---|---|
| License, one distinct category (a PSSA), per site, with each initial and renewal application | $810 | 0940-05-02-.05(1) |
| License, two distinct categories at one site | $1,010 | 0940-05-02-.05(1) |
| Onsite inspection other than the initial or annual one (maximum) | $50 | 0940-05-02-.23(1) |
The proposed rewrite of 0940-05-02 keeps the $810 amount and says "An Initial License inspection will not be scheduled or completed, absent exigent circumstances, by the Department without first having the site’s applicable fees paid and registered as such by the Department" (proposed 0940-05-02-.05(2)). That is not in force, but it matches TDMHSAS’s current steps. The full cost and timeline →
Step 5
When. "Upon receipt of the completed application and the required fees, the Department will arrange for needed inspections of the proposed site or sites, when applicable." (0940-05-02-.06(4)) TDMHSAS’s page says that when all paperwork is received and the fee is paid, "you will be contacted by the Office of Licensure regarding a date for an on-site inspection by a Licensure surveyor", and that for a PSSA the initial inspection is "conducted via an electronic desk audit" (TDMHSAS, step 5).
What it covers. TDMHSAS says: "Generally (with a few exceptions), life safety and environment/ancillary services are inspected as well as certain policies and procedures." (TDMHSAS). For a PSSA, life safety does not apply (TDMHSAS, step 4), which leaves the policies and procedures. TDMHSAS does not publish which ones, or a desk audit checklist; it says "A Regional Manager can provide an in-depth explanation of the next steps."
What TDMHSAS commonly cites. Its own list of common PSSA deficiencies includes three policy items: the lift and gait belt policy, the rights and grievance statement and the policy on cooperating with investigations, along with client and personnel records such as the medication assistance authorization, the consumer notice and semi-annual client evaluations (PSSA slides, slides 12-16). It also says an agency should only be cited for policy rules listed in its applicable rules (PSSA slides, slide 38).
Our suggestion. Have all 17 policy items in 0940-05-38-.06(1) and all 8 personnel-policy topics in .07(2) written, adopted and dated before you send the forms, with a short index showing where each is met (0940-05-38-.06(1), .07(2)). Have your blank client and personnel forms ready too: the consumer notice, worker notice, fee agreement, rights acknowledgement and semi-annual evaluation form. Ask the Regional Manager which policies the audit will look at and in what format to send them. The 17 policy items and 8 personnel topics, and the desk audit and later inspections in detail.
What the proposed rewrite would add. Before an initial license TDMHSAS "may review policies, procedures, personnel files, service recipient records, attestations, accreditation, certification, virtual review materials, or other documentation sufficient to determine compliance" (proposed 0940-05-02-.06(5)). It is not in force; by our reading it would put into the rule what the desk audit already does.
CareRulebook
CareRulebook’s Tennessee manual is built on the 17 policy items, the 8 personnel topics and every other requirement in 0940-05-38, 0940-05-02 and 0940-05-06-.03, written from your answers, with the rule quoted under each policy, the forms the records rules need, and a crosswalk that shows the desk audit where each item is met. Read every policy and adopt it before you apply.
$199CareRulebook founding price for the first 50 Tennessee agencies, then $249. Not a TDMHSAS fee.
TDMHSAS uses two forms for changes: the Fact Sheet for a new site, a new category or a relocation, and the Change of Status form (MH-4454) for most other changes (TDMHSAS Provider FAQs; MH-4454). Both go to your regional office.
TDMHSAS asks
The Change of Status form (MH-4454) with proof of citizenship, three character references and the background and privacy forms for the new person. The regional office schedules their fingerprinting.
MH-4454, item 1; Provider FAQsNot stated
The Change of Status form says not to use it for a site director change, and we found nothing saying how to report one. Ask your regional office.
MH-4454, item 1TDMHSAS asks
A change in the licensee’s name only goes on the Change of Status form with legal proof, such as a revised charter from the Secretary of State. A new public name for a site needs one form for each site.
MH-4454, items 2-3Rule requires; TDMHSAS asks
Licenses are address-specific, so a move needs a new license first: a Fact Sheet for the new location and a Change of Status form closing the old one. The move may not happen before the paperwork is in, the fees are paid and any inspection is done.
0940-05-02-.10; Provider FAQs; MH-4454, item 8Rule requires; TDMHSAS asks
A current licensee uses a Fact Sheet to open a new site or add a category. Each site gets its own license and pays its own fee: one category at a site is TDMHSAS’s $810 fee, two categories $1,010.
0940-05-02-.05(1), .09; MH-4386Rule says
The rule says the agency should give TDMHSAS its counties and records address, and does not say how to report a change. Our suggestion: tell your regional office in writing when either changes.
0940-05-38-.04(6)Rule requires
You serve only clients who will not take the agency outside its licensed category, and attest again at every renewal. The rules do not say how the 50% is counted. Our suggestion: if your mix is heading past 50% intellectual or developmental disability, ask TDMHSAS before renewal.
0940-05-38-.04(4), .05(5)Our suggestion: plan the sale with TDMHSAS before it closes, so the buyer’s license is in place before the buyer provides services.
Proposed · not in force · hearing November 18, 2026
On September 24, 2026 TDMHSAS filed proposed amendments rewriting every rule in Chapter 0940-05-02 (notice 09-31-26). The changes that touch applying and renewing:
What it means for a new agency. By our reading, little changes in practice: pay the invoice promptly, have your policies and records ready for review, and start serving clients once licensed, since a site that has served no one would renew to another initial license. To comment: Attend the hearing on November 18, 2026, 10:00 a.m. Central, Ground Floor Hearing Room, Andrew Jackson Building, 500 Deaderick Street, Nashville (sign up to speak at the start; state-issued ID needed), or email written comments to Krysten.Velloff@tn.gov by 4:30 p.m. CDT on Friday, December 4, 2026. Contact: Krysten Velloff, 615-881-5280. (Secretary of State hearings list)
It depends. Not with the forms: TDMHSAS lists four forms (the Initial Application, a Fact Sheet, the Background Check and Privacy Statement form and the Financial Statement), and none of them is a policy. But the initial inspection for a PSSA is an electronic desk audit that covers certain policies and procedures, and deficiencies must be corrected before a license is issued. Have every policy written and adopted when you apply, and send what the surveyor asks for.
"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."
No. No one may begin delivering services until TDMHSAS issues the license, and providing personal support services without a license is unlawful. TDMHSAS issues an initial license (up to one year) after its desk audit and after any deficiencies are corrected.
"No person, partnership, association or corporation may begin delivering services until the Department issues a license."
No. The Initial Application says accreditation is optional. An accredited agency may send proof of its status to be considered for deemed compliance with certain program rules, but it still has the yearly unannounced inspection and must cooperate with TDMHSAS investigations.
"Accreditation or certification of an applicant’s facility/service is not required in order to be approved for license."
No. A PSSA license cannot be assigned or transferred. After a change of ownership a new application must be made and a new license issued before services are provided, and the seller surrenders the old certificate. A proposed rewrite of the rules would define a change of ownership, including a change in who controls the licensee, and leave the final decision to TDMHSAS.
"A new application must be made and a new license issued before services are provided when there is a change in the ownership of a facility/service or a change of location."
No. TDMHSAS licenses are address-specific, and a new license is needed before a relocation. You send a Fact Sheet for the new location and a Change of Status form closing the old one, and the move may not happen before the paperwork is in, the fees are paid and any inspection is done.
"Licenses are address-specific requiring a new license before a relocation may occur."
No. Not for the license. TDMHSAS says PSSAs currently do not need a life safety or fire inspection, and the initial inspection is an electronic desk audit. Check local zoning and business rules separately.
"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."
Send four forms to the TDMHSAS regional office nearest your location: the Initial Application, a Fact Sheet for each location, the Background Check and Privacy Statement form, and the Financial Statement. TDMHSAS then invoices you for its fee, $810 for one category at one site. When the paperwork is in and the fee is paid, the Office of Licensure contacts you about the initial inspection, which for a PSSA is an electronic desk audit. Once any deficiencies are corrected, TDMHSAS issues an initial license for up to one year.
Partly. TDMHSAS publishes each licensing form as a printable PDF and as a web form, and the forms list each regional office’s email address and fax number as well as its postal address. The fee is paid against TDMHSAS’s invoice, which comes with mailing instructions. TDMHSAS also accepts documents and payments in person at its Middle Tennessee office on Tuesdays and Thursdays, 8:00am to 4:00pm.
Neither the rules nor TDMHSAS’s pages give a processing time. The waits come at the invoice, the scheduling of the desk audit and any corrections it asks for. Ask your regional office when you send the forms; TDMHSAS says a Regional Manager can explain the next steps.
The application asks for a fingerprint background check through the Tennessee Bureau of Investigation for the person with overall responsibility for the agency, and proof of citizenship or legal immigration status and the background and privacy forms for that person and any other applicant listed. If they choose TBI fingerprinting, the Office of Licensure schedules the appointment. An FBI fingerprint check, or a check by a state-licensed private investigator, is accepted if it covers current and previous states of residence. The individual pays for it.
The Fact Sheet asks for a street address and county, licenses are tied to an address, and you tell TDMHSAS where you keep employee and client records. Fact Sheet items 6 to 22, about buildings and occupancy, do not apply to PSSAs, and TDMHSAS says PSSAs need no fire inspection. Whether the address can be your home is not stated in the rules we saved; ask your regional office before you apply.
Nothing we found stops you hiring before the license, but no services may be delivered until TDMHSAS issues it. If you hire early, finish the checks before anyone has contact with a client. The rules require Abuse Registry and Sex Offender Registry checks before direct contact and documented competency in seven areas before work. The criminal background check is due within 10 days of employment, and TDMHSAS reads the statute as needing the results in hand before any direct contact; it also reads it as needing references checked before employment.
TDMHSAS notifies you, and within 15 calendar days of that notice you may file a written request for a hearing before the Licensure Review Panel. Grounds for denial include violating licensure law or rules, conduct harmful to clients, giving TDMHSAS false information, and subterfuge such as reapplying through a second party after a denial.
Per site. TDMHSAS issues one license for each site, and its fee is $810 for one distinct category of service at a site, or $1,010 for two, with every initial and renewal application. These are TDMHSAS’s fees, not CareRulebook prices, and they are non-refundable.
TDMHSAS has proposed a rewrite of its licensure procedure rules, Chapter 0940-05-02, which govern the application, the initial license and renewal (hearing November 18, 2026; comments by December 4, 2026). Leave your email and we will tell you when a Tennessee change affects your application or your policies.
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Colorado
The Colorado license application
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Indiana
The Indiana license application
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North Carolina
The North Carolina license application
DHSR also reviews your policies before it licenses you.
Illinois
The Illinois license application
A paper form, your policies in the envelope and a 240-day provisional license.
Washington
The Washington license application
DOH’s orientation class, a paper packet and a manual DOH approves.
Virginia
The Virginia license application
The VDH OLC Portal, 60 days before opening.
Georgia
The Georgia license application
GAHLES and a three-month provisional license.