Build your Tennessee policy manual

Which TDMHSAS regional office serves your licensed site?

Applications go to the regional office nearest the location to be licensed (TDMHSAS, Become a Licensed Provider).

Who will pay for your services?

Each client record documents who pays (0940-05-38-.09(1)(i)). This manual covers the TDMHSAS license rules; a payer's contract terms (such as TennCare credentialing or electronic visit verification) are not covered.

Which group will make up the majority (50% or more) of your clients?

An agency where 50% or more of clients are aged or have a mental illness or substance abuse diagnosis is licensed by TDMHSAS (0940-05-38-.04(3)(a)). If 50% or more will have an intellectual or developmental disability, the license comes from the Department of Disability and Aging instead, and this manual is not for you.

Will some clients (fewer than half) have an intellectual or developmental disability?

The licensing department is set by the larger population you serve (0940-05-38-.04(3)). Policy 1.3 sets how you count your client mix and what you do if it changes.

Will you serve children under 18?

Everyone in Tennessee must report suspected child abuse or neglect (T.C.A. 37-1-403(i)(1), as the Department of Children's Services quotes it). Policy 3.1 adds the child abuse hotline when you answer yes.

Will you help clients with self-care (bathing, dressing, toileting, eating, mobility, transfers)?

Self-care assistance is a personal support service (0940-05-38-.01(1)(a)).

Will you help with household tasks (housekeeping, laundry, meals, shopping, bill paying, telephones)?

Household assistance is itself a personal support service (0940-05-38-.01(1)(b)). Housekeeping alone, with no other help with major life activities, is exempt from the license (0940-05-38-.03(2)(c)).

Will you help clients take part in community activities (outings, social, recreational or personal activities)?

Personal assistance to access community activities is a personal support service (0940-05-38-.01(1)(c)).

Will a registered nurse give education services (consultation about a chronic condition)?

Optional. Education services are consultation by a registered nurse to the client or primary family caregiver concerning a chronic condition (0940-05-38-.01(6)).

Will workers give medication assistance (reminders and opening packaging)?

Medication assistance means reminders and opening medication packaging, never giving medication (0940-05-38-.01(9)). It needs written authorization from the client, RN-supervised training before any worker assists, and procedures for collecting medication information (0940-05-38-.06(1)(l), .08(1)(b)).

Will staff certified in medication administration give medications?

Since Public Chapter 730 (2024), PSSA staff who complete a TDMHSAS-approved program (the Department of Disability and Aging's classes) may administer medication in the client's home. TDMHSAS asks you to notify your surveyor, keep each certificate on file and develop a Medication Safety Policy; it has not yet filed rules. Policy 2.12 is built from that request and is labelled as recommended until rules exist.

Will clients ride in vehicles driven by your workers?

Vehicles are kept safe, drivers hold a Tennessee driver's license and vehicles carry liability insurance for occupants, all documented (0940-05-38-.06(1)(m)).

Will your workers or agency handle clients' money?

Every agency has a policy on receiving and spending money for clients (0940-05-38-.06(1)(j)). Holding client funds brings a separate federally insured account and an annual report to the client (0940-05-06-.03(4), (6)).

Will workers use Hoyer lifts or gait belts?

Every agency needs a policy on lifts and gait belts: used only after training, for getting in or out of bed, a chair, the toilet or shower, never as therapy (0940-05-38-.06(1)(n)). TDMHSAS lists this policy among the most common PSSA deficiencies.

Who gives workers consultation about clients' care?

Consultation may come from a registered nurse, other agency staff or the primary family caregiver (0940-05-38-.07(2)(g)). No nurse is required unless you offer medication assistance or education services.

Will your workers be employees or subcontractors?

The worker notice and the consumer notice say whether the agency is an employer or a contractor and who is responsible for wages, taxes, workers' compensation and overtime (0940-05-38-.07(1)(h), .09(1)(p)). Check the employment tests with a Tennessee lawyer before using subcontractors.

How will you run criminal background checks?

TDMHSAS accepts fingerprint checks or a check by a state-licensed private investigation company (PSSA slides, slide 11). Results must be back before any direct contact with clients, in TDMHSAS's reading.

Who pays for the criminal background check?

The saved rules do not say who pays for a worker's check. Choose one and apply it to everyone.

Will you repeat each worker's criminal background check every two years?

Rule 0940-05-38-.07(2)(c) mentions a check "every two (2) years", but TDMHSAS says it will not enforce that part (PSSA slides, slide 8). Once in your policy, TDMHSAS can expect you to follow it. The yearly Abuse Registry and Sex Offender Registry checks are required either way.

How do you count each worker's yearly training?

Workers receive training on job-related topics at least annually (0940-05-38-.08(1)(c)). No hour minimum is set.

Who gives your workers their training before they start?

Before working with clients, workers show basic competency in seven areas, documented by the agency (0940-05-38-.08(1)(a)), and have documented training in self-care, household management, community living and service methods (0940-05-38-.07(2)(f)).

Who answers calls when the office is closed?

Clients need a way to report a worker who has not arrived, and workers need access to consultation, whenever services are given (0940-05-38-.06(1)(c), .07(2)(g)).

How will you keep client and personnel records?

"Written" records may be in any generally accepted format, electronic or paper (0940-05-38-.01(11)).

Include recommended practices?

Some policies end with practical steps that go beyond Tennessee's rules, such as TB screening, CPR training and a yearly policy review, each labelled as not a TDMHSAS requirement. Once adopted they are your policies and TDMHSAS can expect you to follow them, so leave them out if you won't.