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Tennessee · PSSA inspections · Tenn. Comp. R. & Regs. 0940-05-02-.06, .13, .21, .22
TDMHSAS checks a new Personal Support Services Agency with an electronic desk audit before it issues the first license, then makes at least one unannounced inspection a year. Here is what the desk audit is, how to get ready, which rule items TDMHSAS lists as common deficiencies, how Plans of Compliance and civil penalties work, and what the proposed rewrite of the licensing procedure rules would change.
Quick answer
Before your first license, TDMHSAS checks your agency by electronic desk audit: "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 It says initial inspections generally cover certain policies and procedures, and it does not publish which ones. Deficiencies are corrected before a license is issued. 0940-05-02-.06(5)(b)
After licensing, "The Department shall make at least one (1) unannounced inspection of each licensed facility/service yearly." 0940-05-02-.22 TDMHSAS may also enter, interview clients and copy records with or without notice. 0940-05-02-.13 If it finds non-compliance, you answer its Notice of Non-Compliance with a written Plan of Compliance by the date on the notice. 0940-05-02-.21 A rewrite proposed in September 2026 would allow remote unannounced inspections for services without an in-person site, which by our reading includes a PSSA; it is not in force. Proposed 0940-05-02-.22
TDMHSAS inspections
Checked against official sources on October 2, 2026.
The rule: "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 process page describes the general next step: "When all paperwork is received, licensing fee has been paid, and life safety inspection has been conducted, if applicable, you will be contacted by the Office of Licensure regarding a date for an on-site inspection by a Licensure surveyor." But for a PSSA it adds that initial inspections are conducted via an electronic desk audit, and that PSSAs currently do not require a life safety or fire inspection. TDMHSAS, steps 4-5
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, What does an Initial Inspection cover? Since a PSSA has no life safety inspection, by our reading the desk audit is mostly about your written policies and procedures.
Where TDMHSAS is silent. We found no TDMHSAS desk audit checklist, no list of the policies it reads, no statement of the format it wants, and nothing on whether it expects personnel files for staff hired before licensing. Neither the rules nor TDMHSAS’s pages give a time from application to desk audit or from desk audit to license. TDMHSAS, step 5
The outcome. TDMHSAS reviews the application, makes any investigations needed and reviews any inspection results. "If the review indicates compliance with all requirements for an initial license, the initial license will be issued." 0940-05-02-.06(5)(a) If it finds deficiencies, you are notified and correct them before a license is issued. 0940-05-02-.06(5)(b) The initial license lasts no more than 12 months, while TDMHSAS evaluates how you put the program rules in place. 0940-05-02-.02(1)
When TDMHSAS has your completed application and its $810 fee, it arranges any inspections needed.
A residential service, or one where clients come to your place of business, needs a fire or life safety inspection at this point. TDMHSAS says PSSAs currently do not need one.
For other services, TDMHSAS then arranges an on-site inspection by a Licensure surveyor. For a PSSA, the initial inspection is an electronic desk audit, which TDMHSAS says generally covers certain policies and procedures.
If the review finds deficiencies, TDMHSAS tells you and you correct them before a license is issued. TDMHSAS may allow a reasonable time to correct deficiencies found by inspection.
If the review shows compliance with all requirements, TDMHSAS issues an initial license for up to one year. Only then may services begin.
You may file a written request for a hearing before the Licensure Review Panel within 15 calendar days of the notice of denial.
Our practical suggestions, not rule text. Each card links the source it helps you meet and the CareRulebook manual policy that covers it.
TDMHSAS does not publish which policies the desk audit reads, so have all of them written and adopted, with an index that shows where each of the 17 policy items and 8 personnel topics is met.
0940-05-38-.06(1), .07(2)Manual: Policy 1.2
TDMHSAS publishes a list of common PSSA rule deficiencies (listed below). Check each one in your policies and forms before you send anything.
PSSA slides, slides 12-16Manual: Policy 1.5
The consumer notice, rights acknowledgement, emergency contact, medication assistance authorization and semi-annual evaluation form are client record items on the common deficiency list. Blank versions show the surveyor what each client will get.
0940-05-38-.09(1)Manual: Policy 5.1
Criminal background check results back before any client contact, Abuse Registry and Sex Offender Registry checks, references, work history, competency in the seven areas and the worker notice.
0940-05-38-.07(1); PSSA slide 34Manual: Policy 4.4
TDMHSAS says a Regional Manager can explain the next steps. Ask which policies and records the desk audit will look at, and in what format.
Become a Licensed ProviderManual: Policy 1.5
Keep the most recent Plans of Compliance in one central place, as the rule requires, with each Notice of Non-Compliance and the evidence of each correction.
0940-05-02-.21(5)Manual: Policy 1.5
The written policies themselves, item by item, are on the Tennessee guide.
Before a license expires, TDMHSAS tells you what to send for renewal, with its fee by invoice. 0940-05-02-.07(1)-(2) At renewal TDMHSAS reviews the service’s program performance history (and life safety conditions where they apply), and says dates for unannounced inspections are random and vary from year to year. 0940-05-02-.07(4) At renewal TDMHSAS issues a full license if all the licensee’s services comply. If not, it may issue a provisional license covering the service not in full compliance, or deny the renewal, which can be appealed in writing within 15 calendar days. 0940-05-02-.07(5) A provisional license calls for, among other things, a diligent effort to comply, no danger to clients, an acceptable compliance plan, and having substantially met the previous year’s plan, if any. 0940-05-02-.02(3)
The rules do not say what moves an agency from its initial license to a full license (the first unannounced inspection, the renewal review or a minimum number of clients). By our reading it is the renewal review under 0940-05-02-.07(5); ask your Regional Manager.
"The Department will investigate reports or suspicion of abuse, dereliction, or deficiency in the operation of a licensed service or facility." 0940-05-02-.20(1) The Office of Licensure investigates licensed and unlicensed providers after reports of inadequate care or rule violations. TDMHSAS, Licensing
Reporting abuse to Adult Protective Services and child abuse to the Department of Children’s Services is separate; see abuse and incident reporting on the guide.
TDMHSAS’s PSSA slides list its common PSSA rule deficiencies. PSSA slides, slides 12-16 It also says "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
| Rule | What it requires |
|---|---|
| 0940-05-38-.09(1)(n) | Medication assistance authorization in the record Written authorization from the client or authorized representative if the agency gives medication assistance. TDMHSAS lists it first among common deficiencies. |
| 0940-05-38-.06(1)(n) | Hoyer lifts and gait belts Policies on using devices such as a Hoyer lift or gait belt, after training, for transfers into or out of bed, chair, toilet or shower, but not as therapy. Required for every agency, and on TDMHSAS’s list of common PSSA deficiencies. |
| 0940-05-38-.09(1)(p) | Consumer notice before services A written consumer notice given before services start: the duties, responsibilities, obligations and legal liabilities of the agency, worker and client, the agency’s role as employer or contractor, and the client’s responsibility (if any) for supervising, assigning duties, hiring, firing and discipline, equipment, background checks, references and credentials. |
| 0940-05-38-.06(1)(e) | Statement of rights and grievance procedure A statement of the client rights in 0940-05-38-.10 and the grievance procedure for reported suspected rights violations. |
| 0940-05-38-.09(1)(o) | Client evaluation of quality every six months The agency develops an evaluation form; the client or legal representative evaluates service quality at least every six months and signs it. |
| 0940-05-38-.09(1)(e) | Rights acknowledgement Written acknowledgement that the client or legal representative was told the client’s rights and responsibilities and the agency’s rules affecting clients. |
| 0940-05-38-.08(1)(b) | RN-supervised medication assistance training Workers who give medication assistance get documented training by, or under the general supervision of, a registered nurse, consistent with T.C.A. 63-7-102. |
| 0940-05-38-.09(1)(c) | Emergency contact Name, address and telephone number of an emergency contact. |
| 0940-05-38-.06(1)(p) | Cooperation with TDMHSAS investigations A policy that the agency will cooperate with TDMHSAS investigating alleged abuse, neglect, mistreatment, misappropriation or exploitation. |
| 0940-05-38-.07(1)(g) | Annual performance evaluations Annual performance evaluations that at least assess the worker’s ability to give daily supports to clients. |
| 0940-05-38-.08(1)(a) | Basic competency in seven areas before work Ensure and document that workers show basic competency before working with clients in: observing, reporting and documenting changes; abuse, neglect and exploitation; client rights; universal precautions and infection control; personal hygiene help; client safety; and emergency and disaster procedures (including emergency transportation, emergency medical care and staff coverage). |
Five of the eleven are client record items, so by our reading a new agency should show the forms it will use for them at the desk audit. The medication assistance items apply only if you offer medication assistance. All 17 policy items and 8 personnel topics →
Every TDMHSAS finding follows the same path, whether it came from an inspection or an investigation. 0940-05-02-.21
| Step | What the rule says | Source |
|---|---|---|
| Notice of Non-Compliance | Given on TDMHSAS’s own form when an inspection or investigation finds non-compliance with licensure law or rules. | 0940-05-02-.21(1) |
| Your Plan of Compliance | Written, and sent by the date specified on the Notice. The rule sets no fixed number of days. | 0940-05-02-.21(2) |
| What it contains | The action taken or to be taken to correct each deficiency, and the date each corrective action is or will be completed. | 0940-05-02-.21(3) |
| TDMHSAS’s answer | In writing: whether the plan is acceptable, and why. | 0940-05-02-.21(4) |
| If it is not acceptable | TDMHSAS and the licensee may keep working toward agreement. If none is reached in a reasonable time, as TDMHSAS decides, it may impose sanctions. | 0940-05-02-.21(4) |
| Time to correct | TDMHSAS may allow a reasonable time to correct deficiencies found by inspection. | 0940-05-02-.11 |
| Keeping copies | Copies of the most recent compliance plans kept in a central location. | 0940-05-02-.21(5) |
Our suggestions. Note the due date the day the notice arrives, since the rule gives no standard period. Write one line per deficiency, with what you did or will do and a real date, and keep the evidence of each correction with the plan. If the date is too tight, ask TDMHSAS before it passes. The rules let TDMHSAS allow a reasonable time to correct deficiencies, but say nothing about extending the date for the plan itself. Under the proposed rewrite, a license could not be renewed while any Plan of Compliance is overdue. Proposed 0940-05-02-.07(6)
CareRulebook
CareRulebook’s Tennessee manual includes Policy 1.5, Desk audit, inspections and Plans of Compliance: getting ready for the desk audit and unannounced inspections, giving TDMHSAS access, and answering a Notice of Non-Compliance, with an inspection-day checklist, an inspection log and a Plan of Compliance worksheet. Every other policy the PSSA rules list comes with it.
$199CareRulebook founding price for the first 50 Tennessee agencies, then $249. Not a TDMHSAS fee.
A Plan of Compliance is the usual answer to a finding. For completeness, here is what the rules allow beyond it. TDMHSAS may impose a civil penalty in addition to, or instead of, other disciplinary action. 0940-05-02-.25(1)
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). These are TDMHSAS’s penalties, not CareRulebook charges.
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. A critical offense is a breach of a rule TDMHSAS has designated as one whose violation could result in serious harm to the client.
Today TDMHSAS staff first tell the licensee verbally that a civil penalty may be imposed; within six business days the licensee is told in writing the basis and amount. The penalty runs from the date of the written decision, and may be imposed for each day the violation continues.
In setting a daily penalty the commissioner may consider the severity of the violation and the harm or risk of harm, willfulness, the circumstances, the efforts made to comply, extraordinary enforcement costs, the public interest and whether the penalty will deter. TDMHSAS may keep working with a licensee to reach compliance, and may waive a penalty that would cause hardship where strict enforcement would not be in clients’ best interest.
Keeping and renewing a license depends on evidence of continued compliance with licensure laws and rules. Grounds include violating licensure law or rules, conduct harmful to clients, false information to TDMHSAS, and subterfuge such as reapplying through a second party after a denial. Revocations, suspensions and denials follow the Uniform Administrative Procedures Act. Summary suspension is only for an immediate threat to clients’ health, safety and welfare.
Inspection fees are invoiced and due within 30 days, or before the license expires if sooner. TDMHSAS may withhold or suspend a license until its fees are paid.
When a license is to be denied, suspended or revoked, TDMHSAS notifies state and local agencies that may help clients by coordinating placement.
Operating without a license is separate: providing personal support services without one is unlawful and may bring civil or criminal sanctions. 0940-05-02-.03(1) The rules do not list which rules TDMHSAS has designated as critical.
Proposed · not in force · hearing November 18, 2026 · comments by December 4, 2026
On September 24, 2026, TDMHSAS filed proposed amendments rewriting every rule in Chapter 0940-05-02. Notice 09-31-26 The parts that touch inspections:
The Plan of Compliance rule itself (.21) and the penalty amounts are unchanged in the proposal. Notice 09-31-26
What it means for a new agency, by our reading. Prepare for the desk audit as if personnel files and client records may be asked for, keep records where you can share them securely and quickly, and treat every Plan of Compliance deadline as firm.
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.
Accreditation is optional. Accreditation is not needed for a license; it may support "deemed" compliance with some program rules. MH-4385, item 10 A service accredited by a listed body (such as the Joint Commission or CARF) may be deemed by TDMHSAS to comply with program requirements, after sending official evidence including any cited deficiencies with the plan of correction. Deemed status does not remove the duty to correct deficiencies cited at unannounced inspections or to cooperate with investigations. 0940-05-02-.12 By our reading, deemed status would not replace the yearly unannounced inspection.
Waivers. TDMHSAS may waive an irrelevant rule or one posing a hardship, only when strict enforcement would not be in clients’ best interest; waivers are written and reviewed by the Licensure Review Panel. 0940-05-02-.19
No. Not by TDMHSAS’s description. For other services it arranges an on-site inspection by a Licensure surveyor, but it says initial inspections for PSSAs are done as an electronic desk audit, and PSSAs currently need no life safety or fire inspection. Once you are licensed, TDMHSAS may enter with or without notice, and must make at least one unannounced inspection a year.
"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. The yearly inspection is unannounced, and the rule says dates for unannounced inspections are random and vary from year to year. TDMHSAS may also enter and review records with or without notice at any time. Keep records, policies and personnel files ready all year.
"Dates for unannounced inspections will be random varying from year to year."
No. The rule sets no fixed number of days. You send a written Plan of Compliance by the date specified on the Notice of Non-Compliance, describing each corrective action and the date it was or will be completed. Read the date on the notice as soon as it arrives.
"The licensee must submit, by the date specified on the Notice of Non-Compliance, a written Plan of Compliance in response to the Notice of Non-Compliance."
No. TDMHSAS says it should not: an agency should only be cited for policy rules listed in its applicable administrative rules. For a PSSA that means the 17 items in 0940-05-38-.06(1), the eight personnel-policy topics in .07(2), and the other written duties in 0940-05-38, 0940-05-02 and 0940-05-06-.03(1)-(6).
"No, an agency should only be cited for violation of policy rules that are listed in the applicable administrative rules for the agency."
Yes, by electronic desk audit. TDMHSAS says that once the paperwork is in and the fee is paid, the initial inspection for a Personal Support Services Agency is done as an electronic desk audit, and that initial inspections generally cover certain policies and procedures. PSSAs currently need no life safety or fire inspection. If the review finds deficiencies, you are told and must correct them before a license is issued.
TDMHSAS does not publish a list or a desk audit checklist. It says initial inspections generally cover life safety and environment and ancillary services as well as certain policies and procedures, and that a Regional Manager can explain the next steps. Our suggestion: have every policy the rules list written and adopted, with an index that shows where each of the 17 policy items and 8 personnel topics is met, and ask your Regional Manager what to send.
At least once a year, unannounced. The rule says dates for unannounced inspections are random and vary from year to year, and TDMHSAS staff may enter, talk to clients and others, and review and copy records with or without notice. TDMHSAS also investigates reports of abuse, dereliction or deficiency. A proposed rewrite of the licensing procedure rules would let TDMHSAS do the yearly inspection remotely for services without an in-person site.
Your written answer to a Notice of Non-Compliance, which TDMHSAS gives when an inspection or investigation finds a breach of licensure law or rules. The plan describes the action taken or to be taken to correct each deficiency and the date each will be completed, and is due by the date specified on the notice. TDMHSAS tells you in writing whether it is acceptable. Keep copies of the most recent plans in a central location.
Yes. TDMHSAS may impose a civil penalty for each violation, for each day it continues: $500 for a first Priority 1 or critical offense and $250 for other first offenses, rising to $2,500 to $5,000 (Priority 1 or critical) or $500 to $2,500 (other offenses) for a second offense of the same type within 12 months. These are TDMHSAS’s penalties, not CareRulebook charges. TDMHSAS may also keep working with a licensee toward compliance, and may waive a penalty that would cause hardship.
The rule in force says only that TDMHSAS makes at least one unannounced inspection a year. The proposed rewrite, with a hearing on November 18, 2026, would let TDMHSAS meet that requirement with an unannounced remote inspection (video, telephone, secure document submission, record and policy review, interviews) for services that do not deliver services in person at their licensed location, which by our reading includes a PSSA. It would not stop TDMHSAS inspecting on site. It is a proposal, not in force.
Yes. Policy 1.5, Desk audit, inspections and Plans of Compliance, covers preparing for the desk audit and for unannounced inspections, giving TDMHSAS access to records and clients, answering a Notice of Non-Compliance with a Plan of Compliance, and keeping compliance plans, with an inspection-day checklist, an inspection log and a Plan of Compliance worksheet. Policy 1.2 adds a crosswalk of the 17 policy items and 8 personnel topics to send with the manual.
TDMHSAS has proposed a rewrite of its licensure procedure rules, Chapter 0940-05-02, including remote unannounced inspections (hearing November 18, 2026). Leave your email and we will tell you when a Tennessee change affects your inspections or your policies.
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