How to start an adult day care center in Tennessee
Tennessee requires a Adult day services center license, required for centers serving 5 or more people (lowered from 10 in 2017) from Tennessee Department of Human Services to operate an adult day care center.
- License required
- YesAdult day services center license, required for centers serving 5 or more people (lowered from 10 in 2017)
- Application fee
- —
- Processing time
- —
- Personal care / attendant care (hourly)
- $6.59per 15 min · $26.36/hr
- Organizations in the state
- 89NPPES, Sep 13, 2026
On this page
Tennessee adult day care center license
Tennessee requires a Adult day services center license, required for centers serving 5 or more people (lowered from 10 in 2017) from Tennessee Department of Human Services to operate an adult day care center.
- License required
- Yes
- License
- Adult day services center license, required for centers serving 5 or more people (lowered from 10 in 2017)
- Issuing agency
- Tennessee Department of Human Services
- Medicaid waiver coverage
- TDHS says the adult day program is funded through the Social Services Block Grant. HHS (2014) reported that TennCare CHOICES (1115) pays for adult day care.
Steps to get licensed in Tennessee
In order, as the licensing agency describes the process.
- Follow TDHS's 'How to Become a Licensed Adult Day Services Center' process
- Get fire, safety, environmental and food service approvals before the TDHS initial inspection (HHS 2014)
- Pass the TDHS inspection
Enrolling as a Tennessee Medicaid provider
- Program
- TennCare (Division of TennCare, Tennessee)
- Enrollment portal
- TennCare Provider Registration portal, plus Data Spring (formerly CAQH ProView) for individual providers
- Application fee
- Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. TennCare's registration pages do not list a separate state fee.
- Fingerprinting
- Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. TennCare's registration pages do not describe a separate state fingerprint process.
- Site visit
- Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. TennCare's registration pages do not describe a separate state site visit process.
- Revalidation
- Every TennCare provider enrollment must be revalidated every 3 years, more often than the federal 5-year minimum. Submitting any update in the enrollment portal resets the due date. Groups and entities see the due date at the top of their enrollment. Individual providers revalidate by submitting their Data Spring (CAQH ProView) application.
Does Tennessee require a certificate of need?
- CON program
- Yes
- Program
- Certificate of Need
- Services covered
- hospitals
- nursing homes (and nursing home bed increases beyond the lesser of 10 beds or 10% once every 3 years)
- ambulatory surgical treatment centers
- home care organizations (home health and hospice)
- residential hospice
- outpatient diagnostic centers
- rehabilitation facilities
- nonresidential substitution-based opiate treatment centers
- open heart surgery, organ transplantation, cardiac catheterization, linear accelerators
- MRI/PET initiation in counties of 175,000 or fewer; pediatric MRI in larger counties
- bed redistribution/relocation, facility relocation, hospital satellite EDs and satellite inpatient facilities
Tennessee wage floor
- State minimum wage
- $7.25 an hour
- Effective
- 2009-07-24
- Scheduled increases
- No scheduled change found in the official sources reviewed.
- HCBS 80/20 rule
- Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.
Tennessee market size
Counts from federal public files: NPPES (active organization NPIs), CMS Care Compare and CMS Medicaid enrollment.
- Adult day care clinics/centers — active organization NPIs (NPPES)
- 89 (as of Sep 13, 2026)
- Total Medicaid and CHIP enrollment (latest reported month)
- 1,384,007 (as of Jun 1, 2026)
What Tennessee Medicaid pays
Home care & personal care: published Tennessee fee-for-service rates, each linked to its source.
| Service | Code | Tennessee rate | Per hour | Rank |
|---|---|---|---|---|
| Personal care / attendant care (hourly)Agency provider | T1019 | $6.59per 15 min | $26.36 | 20 of 27 |
| Companion careAide or attendant | S5136 | $165.39per day | — | — |
| Respite care (hourly)Agency provider | S5150 | $6.59per 15 min | $26.36 | 18 of 38 |
| Respite care (daily)Agency provider | S9125 | $144.61per day | — | 28 of 34 |
| Adult day servicesClinical nurse specialist | S5100 | $3.75per 15 min | $15.00 | — |
Tennessee HCBS waivers
Medicaid home and community-based services programs that may pay for this service.
- TN Comprehensive Aggregate Cap Home and Community Based Services (CAC) Waiver (1915(c))
- TN Self-Determination Waiver Program (1915(c))
- TN Statewide Home and Community Based Services Waiver (1915(c))
- TennCare III (subsumes TennCare II) (1115)
Frequently asked questions
Do you need a license to start an adult day care center in Tennessee?
Tennessee requires a Adult day services center license, required for centers serving 5 or more people (lowered from 10 in 2017) from Tennessee Department of Human Services to operate an adult day care center.
Does Tennessee require a certificate of need for an adult day care center?
Tennessee has a certificate of need program covering: hospitals, nursing homes (and nursing home bed increases beyond the lesser of 10 beds or 10% once every 3 years), ambulatory surgical treatment centers, home care organizations (home health and hospice), residential hospice, outpatient diagnostic centers, rehabilitation facilities, nonresidential substitution-based opiate treatment centers, open heart surgery, organ transplantation, cardiac catheterization, linear accelerators, MRI/PET initiation in counties of 175,000 or fewer; pediatric MRI in larger counties, bed redistribution/relocation, facility relocation, hospital satellite EDs and satellite inpatient facilities. Check whether your service is on that list.
How do you become a Medicaid provider in Tennessee?
Enroll through TennCare Provider Registration portal, plus Data Spring (formerly CAQH ProView) for individual providers (https://www.tn.gov/tenncare/providers/provider-registration/how-to-apply.html).
What does Tennessee Medicaid pay a adult day care center?
Tennessee Medicaid pays $6.59 per 15 min for personal care / attendant care (hourly), effective Jul 1, 2025, ranking 20 of 27 states.