Adult Day Care Regulations in Tennessee

Who regulates adult day care in Tennessee

The Tennessee Department of Human Services (TDHS) licenses adult day services centers. Its authority comes from the adult day care law at T.C.A. 71-2-401 et seq., and the operating standards are in Chapter 1240-07-10, Adult Day Services Standards, last amended effective January 23, 2023. Parts of the statute were amended in 2025; confirm current requirements with TDHS.

Medicaid coverage is run by the Division of TennCare through TennCare CHOICES, which is administered by TennCare's managed care organizations (MCOs).

Types of adult day programs in Tennessee

Tennessee has one license type. An adult day services center (also called an adult day care center) provides services to five or more participants for more than three hours but less than 24 hours a day. The provider must not be related to the participants, and care follows an individualized plan to maintain or restore self-care through medical or social services. The rules do not create a separate adult day health license.

A limited respite care services program is exempt from licensure under T.C.A. 71-2-402. It must be run by a religious institution or organization, serve fewer than 15 adults at a time for no more than three days a week and six hours a day, give no medications, and register with the department.

How to get licensed in Tennessee

Any person or entity, public or private, must be licensed before providing adult day care. Based on the statute and rules, the process looks like this:

1. Apply on the department's forms with evidence that the owner, officers and day-to-day manager are of reputable and responsible character and can meet the rules.
2. Get an approved fire safety inspection and an approved environmental inspection from the appropriate officials.
3. Run fingerprint criminal background checks and registry reviews (vulnerable persons, sex offender, and abuse and neglect records) for new employees and for volunteers counted in the ratio or with unsupervised access.
4. Receive a temporary license once you show fire safety, environmental safety and any needed food service approval. The department decides on full compliance within six months and may extend the temporary license six more months.
5. Receive an annual license when compliant, and post it where visitors can see it.

Renewal applications must arrive at least 30 days before the license expires, with new fire and environmental inspections. Centers with a strong compliance record may later earn biennial or triennial licenses. Licenses cannot be transferred, so a sale voids the license and the buyer must apply.

Key requirements

• Staffing ratio: at least one direct care staff person for every eight participants, kept onsite, with at least one more staff member for off-site activities (Rule 1240-07-10-.12).
• Staff on duty: at all times, at least one staff member who reads, writes and speaks English, and at least one direct care staff member certified in CPR and trained in first aid and the center's emergency plans.
• Director: one of several education and experience combinations, from a bachelor's degree in social services, health or a related field plus one year of experience to a high school diploma plus five years of related managerial experience.
• Training: pre-service training on universal precautions, fire safety, emergency plans, infection control and reporting abuse, neglect or exploitation, plus eight hours of annual training.
• Space: at least 40 square feet of indoor activity space per participant, plus a rest area and an area to isolate ill participants (Rule 1240-07-10-.10).
• Toilets: two for the first 15 participants and one more for each additional 10, with half wheelchair accessible.
• Medication: participants may self-medicate under a written policy, or staff with medication training may supervise or assist. Errors must be reported to the department the same day (Rule 1240-07-10-.13).
• Inspections: department staff may enter a center at any time, with or without notice, and may place a noncompliant center on probation for 30 to 60 days.

Medicaid funding for adult day in Tennessee

TennCare covers adult day care through CHOICES, which the TennCare CHOICES rule describes as a managed long-term services and supports program administered by the TennCare MCOs. Adult day care is a home and community-based benefit for CHOICES Group 2 and Group 3 members, limited to 2,080 hours per calendar year per member. It is not offered through consumer direction.

TennCare's definition of adult day care requires care in a facility permanently licensed by DHS, or in an adult habilitation day facility licensed by the Department of Intellectual and Developmental Disabilities. The CHOICES health plans listed by TennCare are BlueCare, UnitedHealthcare Community Plan and Wellpoint.

Billing basics

Because CHOICES is managed care, centers are paid by the member's MCO, not directly by the state. A center must be a contract (network) provider with that MCO, and members choose from the MCO's list of participating providers. Contact each plan for its credentialing, authorization and claims requirements.

The TennCare rules reviewed for this guide do not list adult day procedure codes or address electronic visit verification for adult day care.

Other ways centers are paid

Enrolled veterans who meet VA eligibility and clinical criteria can get Adult Day Health Care through the VA, which may be provided at VA medical centers, State Veterans Homes or community organizations.

Official resources

• Tennessee Department of Human Services
• T.C.A. Title 71, Chapter 2, Part 4: Adult Day Care
• Chapter 1240-07-10: Adult Day Services Standards
• TennCare CHOICES
• Rule 1200-13-01-.05: TennCare CHOICES Program
• VA Adult Day Health Care

Frequently asked questions

Do I need a license to open an adult day center in Tennessee?

Yes, if you serve five or more unrelated adults for more than three hours a day. The Tennessee Department of Human Services issues the license, starting with a temporary license after fire and environmental inspections.

Does Tennessee Medicaid pay for adult day care?

Yes. TennCare covers adult day care for CHOICES Group 2 and Group 3 members, up to 2,080 hours per year, and centers are paid through the member's TennCare MCO.

Who inspects adult day centers in Tennessee?

The Department of Human Services inspects centers and may visit with or without notice. Fire safety and environmental inspections by the appropriate local or state officials are also required before a temporary license and each annual renewal.

Is social adult day care regulated in Tennessee?

Yes. Tennessee's license covers adult day services delivered through medical or social services, so social programs that meet the five-adult, three-hour threshold need a license. Small religious respite programs that meet the statutory conditions must register instead.