Tenn. Code Ann. § 71-5-107 — TN Code / Title 71 / Chapter 5 / Section 71-5-107
Kinds of medical services
Status: in_force

(a) Medical assistance, including demonstration projects and programs designed to enhance the efficient and economic operation of the medicaid program, shall be provided to those classes of individuals determined to be eligible under § 71-5-106 . This medical assistance, in the amount, scope, and duration determined by the commissioner of health and to the extent permitted by federal law, may include: (1) Inpatient hospital services, other than services in an institution for tuberculosis or mental diseases; (2) Outpatient hospital services; (3) Other laboratory and X-ray services; (4) Skilled nursing home services, other than services in an institution for tuberculosis or mental diseases; (5) Physicians' services, whether furnished in the office, the patient's home, a hospital, a skilled nursing home, or elsewhere; (6) Drugs; (7) Inpatient hospital services for individuals sixty-five (65) years of age or over in an institution for tuberculosis or mental diseases, and inpatient hospital services for individuals under twenty-one (21) years of age in institutions for mental diseases, or in case of an individual who was receiving such inpatient services for mental disease in the period immediately preceding the date on which such individual becomes twenty-one (21) years of age: (A) The date on which such individual no longer requires the services; or (B) If earlier, the date such individual becomes twenty-two (22) years of age; (8) Nonmedical nursing care shall be rendered in accordance with the tenets and practice of a recognized church or religious denomination to any indigent person otherwise qualified for assistance under this part who depends upon healing by prayer or spiritual means alone in accordance with the tenets and practice of such church or religious denomination; (9) Skilled nursing home services for individuals sixty-five (65) years of age or over in institutions for tuberculosis or mental diseases; (10) Medical screening, diagnostic and treatment services for eligible categorically connected individuals under twenty-one (21) years of age; (11) Psychiatric clinic services in approved facilities; (12) (A) Home health care services provided in the recipient's home. The services may follow the recipient into the community subject to subdivision (a)(12)(B); (B) Home health nurses or aides may accompany a recipient outside the home during the course of delivery of prior approved home health nurse or home health aide services if all of the following criteria are met: (i) The home health nurse or home health aide shall not transport the recipient; (ii) The home health agency shall have discretion as to whether or not to accompany a recipient outside the home. The circumstance under which a home health agency may exercise such discretion shall include, without limitation, when the home health agency has concern regarding any of the following: (a) The scheduling or safety of the transportation; (b) The health or safety of their employee or the recipient; (c) The ability to safely and effectively deliver services in the alternative setting; and (d) The additional expense that would be required to accompany a patient outside the home; (iii) Additional visits or hours of care will not be approved for coverage for the purpose of accompanying a recipient outside the home. Services will be limited to services to which the recipient would be entitled if the services were provided exclusively at the recipient's place of residence; and (iv) No additional reimbursement shall be paid to the home health agency in association with the decision of a home health agency to accompany a patient outside the home; (C) Nothing in this subdivision (a)(12) is intended to create an entitlement to services outside the home; (D) A home health agency shall not be subject to any claims or cause of action as result of exercising its discretion under this subdivision (a)(12); (13) Transportation for approved emergency medical examination or treatment, or both; (14) Intellectual disability and rehabilitation services; (15) Intermediate care facilities services; (16) Medical services rendered by community or neighborhood health organizations or clinics, including organizations or clinics where some or all of the medical services are provided by medical students presently enrolled in a medical school accredited by the Association of American Medical Colleges or licensed registered nurses, or both, and where such students or licensed registered nurses are under the direction of a licensed physician or physicians; (17) Family planning services and supplies; (18) Basic dental care services; (19) Medical and surgical services rendered by ambulatory surgical treatment centers; (20) Services rendered by rural health clinics; (21) Medical assistance and home- and community-based services to those eligible being served through a health care financing administration (HCFA) approved waiver designed to provide more efficient and economical alternatives to institutional care; (22) Services by nurse anesthetists who are registered by the Tennessee board of nursing, who have completed an advance course in anesthesia, and who hold a current certification from the American Association of Nurse Anesthetists as a nurse anesthetist; (23) Nurse midwife services performed by a person who is licensed by the Tennessee board of nursing as a registered nurse under the authority of the Nursing Practice Act, compiled in title 63, chapter 7, and certified by the American College of Nurse Midwives as a certified nurse midwife; (24) Services provided by certified pediatric nurse practitioners and certified family nurse practitioners as required by federal law; (25) (A) Sickle cell disease management services and public education campaign activities specifically related to sickle cell disease, as authorized by 42 U.S.C. § 1396d(a)(27) and (x) , with reimbursement in accordance with any applicable state plan amendment; (B) Any contract between a managed care organization (MCO) and the bureau of TennCare to provide medical assistance pursuant to this part shall be appropriately revised or amended in order to comply with the implementation of subdivision (a)(25)(A); (26) Language interpreter services, which may include: (A) Sign language interpreter services when such services are necessary to help recipients who are deaf or hard of hearing obtain covered services; and (B) Spoken language interpreter services to all recipients with limited English proficiency; (27) Services within the practice of chiropractic performed by a person who is authorized by title 63, chapter 4, to engage in the practice of chiropractic; and (28) Rapid whole genome sequencing. As used in this subdivision (a)(28), "rapid whole genome sequencing": (A) Means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes that returns the preliminary positive results within seven (7) days and final results within fifteen (15) days from the date of receipt of the sample by the lab performing the test; and (B) Includes patient-only whole genome sequencing, duo whole genome sequencing of the patient and one (1) biological parent, and trio whole genome sequencing of the patient and both biological parents. (b) With respect to recipients determined to be "medically needy," all or a part of the medical services outlined in subsection (a) may be provided, and may, within applicable federal legislation and regulations, be of lesser amounts, duration and scope than medical services provided other medicaid recipients in order to ensure that an expenditure of state funds shall not exceed the amount provided for the operation of the medicaid program. (c) When the amount, duration, and scope of medical services is lessened so as to no longer include intermediate care facility services, the commissioner of health, with approval of the commissioner of human services, may continue to provide intermediate care facility services to those recipients who have been determined to be medically indigent and placed in a medicaid certified intermediate care facility bed at the time such change in the amount, duration, and scope of medical services is made. (d) The department shall assist in the development of a demonstration project, which would provide cost effective alternatives to long-term care under the Omnibus Budget Reconciliation Act of 1981, to the extent permissible under the federal law, for institutional and residential homes that provide domiciliary care for the aged and mentally disabled, which project would include the Foster-Group Care Home Association. The development of such demonstration project shall begin on July 1, 1982. (e) The bureau of TennCare shall have the authority to implement a comprehensive disease management program for certain enrollees of the TennCare program to the extent permitted under federal law and the TennCare waiver. The bureau, through its authority to promulgate rules and regulations, may identify enrollees eligible to participate and the disease categories to be included in the comprehensive disease management program. The bureau, also through its authority to promulgate rules and regulations, may put in place requirements regarding the continued participation of enrollees in the program. (f) Subject to the availability of funding earmarked for such programs in the general appropriations act and to the extent permitted under federal law and the TennCare waiver, the bureau of TennCare shall have the authority to create in whole or in part and administer a program to be named "The TennCare safety net" which will provide two different components to assist eligible TennCare enrollees: (1) Certain medical providers in Tennessee shall provide non-emergency health care services without co-payment requirements to certain specified TennCare enrollees. Such services are intended to include only services that are both medically necessary and within the scope of TennCare benefits for the particular enrollee but for which the enrollee cannot meet the co-payment requirements. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including which enrollees are eligible to participate in this program, allowable benefits under the program, designation of both urban and rural providers who participate in this program, and a funding methodology pursuant to which such providers shall be compensated; (2) (A) A TennCare foundation will be established that will accept and review applications for medical assistance submitted on behalf of certain specified TennCare enrollees. The members of the foundation shall be appointed by the governor, who shall determine the size and composition of the foundation's membership. The governor should strive to ensure that the membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities. Terms for the members will be staggered and the length of terms will be detailed by the governor in making initial or subsequent appointments. The governor shall appoint the chair and vice-chair. For the purposes of administration and availability of records, the TennCare foundation shall be located within the bureau of TennCare; staff assistance shall be provided by the bureau of TennCare or by another entity, should the governor so determine. At the discretion of the governor, the foundation may be placed within another appropriate agency, may create or be reconstituted as a nonprofit entity, or may be terminated at any time; and (B) Applications for medical assistance from the foundation are not intended, and should not be used, as a means to circumvent or avoid the benefit limits established by the bureau of TennCare. It is expected that these applications will be submitted to address special, unforeseen, or exceptional circumstances. Such applications must be submitted by a licensed medical provider who is treating the enrollee and shall request the provision of medically necessary health care services recommended or prescribed by the enrollee's treating provider that are beyond the scope of benefits provided through the TennCare program benefit package for which the enrollee is eligible. For the purposes of this subsection (f), "beyond the scope of benefits" means a benefit that is covered within limits by TennCare but for which the enrollee has exceeded the covered limits of that benefit. It does not include benefits that are not covered to any extent under TennCare for the applicant. The foundation will not consider matters of eligibility for the TennCare program. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including the process for making application to this foundation, which enrollees are eligible to apply, and a mechanism for determining which applications will be reviewed by the foundation. The foundation will not have rule-making authority; (C) (i) Notwithstanding the availability of assistance from the foundation, no enrollee has an expectation of or an entitlement to assistance from the foundation; (ii) There exists no right of appeal regarding an application for assistance; and (iii) Because the level of funding provided to the foundation is limited, the foundation may not be able to fully or partially fund all applications. The decisions of which applications to fund will be solely within the discretion of the foundation; (D) Nothing in this subsection (f) shall be construed to require a contested case hearing as set forth in the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, nor shall any determinations made by the foundation be considered final orders from which appeals can be taken. The consideration of applications provided for by this subdivision (f)(2)(D) shall not constitute hearings as set forth in the Uniform Administrative Procedures Act; (E) The foundation shall consider applications and determine in its sole discretion and without requirement for written findings whether the application should be granted in whole or in part. The foundation's determination on an enrollee's application shall have no binding precedential effect on the consideration of any other enrollees' applications; (F) In the event that a matter being considered by the foundation presents a real or apparent conflict of interest for any staff or member, such staff or member shall disclose the conflict to the chair and be recused from any official action taken on the matter; (G) Notwithstanding the open meetings law, compiled in title 8, chapter 44 or any other law to the contrary, any and all meetings of the TennCare foundation are to be considered confidential and closed to the public. Members and staff shall maintain strict standards of confidentiality in the handling of all matters before the foundation. In addition, all relevant federal and state laws regarding patient privacy and confidentiality will be adhered to. All material and information, regardless of form, medium, or method of communication, provided to or acquired by a foundation member or staff in the course of the foundation's work, shall be regarded as confidential information, shall not be disclosed, and are not public records. In addition, all material and information, regardless of form, medium, or method of communication, made or generated by a member or foundation staff in the course of the foundation's work, shall be regarded as confidential information and shall not be disclosed and are deemed not to be a public record. All necessary steps shall be taken by members and staff to safeguard the confidentiality of such material or information in conformance with federal and state law; (H) Every October 1, the foundation shall report in writing to the governor, the health and welfare committee and commerce and labor committee of the senate, and the health committee and insurance committee of the house of representatives regarding how funds allocated to the foundation were spent during the previous fiscal year. Such report shall contain the following information: (i) How many applications were received; (ii) How many applications the foundation granted; (iii) The type of services and items that were funded; and (iv) Statistical information, by gender, race, and division of the state, on who applied for and who received the funds; (I) Whether members shall receive reasonable compensation for their service on the TennCare foundation will be determined at the discretion of the governor; members may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter; (J) If any federal or state court or other tribunal with jurisdiction: (i) Determines that any aspect of subdivision (f)(2)(A), (f)(2)(B), (f)(2)(C), (f)(2)(D), (f)(2)(E), or (f)(2)(G) violates federal law, state law, or any existing court order or consent decree, and (ii) Makes effective an order enjoining compliance with any aspect of these provisions or requiring non-trivial changes in the terms or applications of these provisions, the challenged provisions may not be severed from the remainder of this subdivision (f)(2). In this event, all provisions of this subdivision (f)(2) will terminate and have no further effect. Such termination shall occur no later than ninety (90) days after the effective date of the order unless such order is stayed by the issuing court or the reviewing court pending disposition of an appeal of the order. The decision whether or not to appeal any such order will be at the sole discretion of the bureau of TennCare. This nonseverability provision shall be self-executing. If this subdivision (f)(2) is terminated while appropriated funds remain, the unused funds shall revert back to the general fund. Any payments for services or items which have been approved but not yet disbursed as of the date of termination shall be paid, but no further applications for payments shall be considered or granted after the date of termination. In the event of termination under this subsection (f), the foundation may be reinstated only by new legislative action and a new appropriation by the general assembly. (g) The bureau of TennCare shall have the authority, in collaboration with one or more medical schools located in Tennessee, to establish an evidence-based medicine initiative for the purpose of developing medical protocols and integrating standards of best practices within the delivery of TennCare services. To the extent that evidence-based medical protocols are authorized by the bureau of TennCare, such protocols shall satisfy the standard of medical necessity as set forth in § 71-5-144 . The bureau of TennCare, through its authority to promulgate rules and regulations, shall establish the parameters for the initiative, including who can participate and how the initiative is to be implemented. Amended by 2024 Tenn. Acts, ch. 1020,s 1, eff. 7/1/2024. Amended by 2021 Tenn. Acts, ch. 524, s 1, eff. 1/1/2022. Amended by 2021 Tenn. Acts, ch. 64, s 121, eff. 3/29/2021. Amended by 2019 Tenn. Acts, ch. 345, s 135, eff. 5/10/2019. Amended by 2019 Tenn. Acts, ch. 329, s 6, eff. 5/8/2019. Amended by 2017 Tenn. Acts, ch. 243, s 1, eff. 7/1/2017. Amended by 2015 Tenn. Acts, ch. 122, s 1, eff. 1/1/2016. Amended by 2013 Tenn. Acts, ch. 236, s 77, eff. 4/19/2013. Acts 1968, ch. 551, § 7; 1969, ch. 326, §§ 1, 2; 1972, ch. 596, § 1; 1973, ch. 73, §§ 1, 3, 4; 1973, ch. 262, § 1; 1973, ch. 276, § 5; 1974, ch. 802, § 2; 1976, ch. 572, § 1; 1978, ch. 875, § 1; modified; T.C.A., § 14-1907; Acts 1981, ch. 225, §§ 1-4; 1981, ch. 476, § 2; 1982, ch. 740, §§ 6-8, 19; T.C.A., § 14-23-107; Acts 1987, ch. 310, §§ 1, 2; 1988, ch. 510, §§ 1, 2; 1993, ch. 183, § 1; 1998, ch. 1093, § 2; 2004, ch. 673, § 2; 2009 , ch. 471, § 1; 2011 , ch. 197, § 2; 2011 , ch. 410, § 6 (b).
(a) Medical assistance, including demonstration projects and programs designed to enhance the efficient and economic operation of the medicaid program, shall be provided to those classes of individuals determined to be eligible under § 71-5-106 . This medical assistance, in the amount, scope, and duration determined by the commissioner of health and to the extent permitted by federal law, may include: (1) Inpatient hospital services, other than services in an institution for tuberculosis or mental diseases; (2) Outpatient hospital services; (3) Other laboratory and X-ray services; (4) Skilled nursing home services, other than services in an institution for tuberculosis or mental diseases; (5) Physicians' services, whether furnished in the office, the patient's home, a hospital, a skilled nursing home, or elsewhere; (6) Drugs; (7) Inpatient hospital services for individuals sixty-five (65) years of age or over in an institution for tuberculosis or mental diseases, and inpatient hospital services for individuals under twenty-one (21) years of age in institutions for mental diseases, or in case of an individual who was receiving such inpatient services for mental disease in the period immediately preceding the date on which such individual becomes twenty-one (21) years of age: (A) The date on which such individual no longer requires the services; or (B) If earlier, the date such individual becomes twenty-two (22) years of age; (8) Nonmedical nursing care shall be rendered in accordance with the tenets and practice of a recognized church or religious denomination to any indigent person otherwise qualified for assistance under this part who depends upon healing by prayer or spiritual means alone in accordance with the tenets and practice of such church or religious denomination; (9) Skilled nursing home services for individuals sixty-five (65) years of age or over in institutions for tuberculosis or mental diseases; (10) Medical screening, diagnostic and treatment services for eligible categorically connected individuals under twenty-one (21) years of age; (11) Psychiatric clinic services in approved facilities; (12) (A) Home health care services provided in the recipient's home. The services may follow the recipient into the community subject to subdivision (a)(12)(B); (B) Home health nurses or aides may accompany a recipient outside the home during the course of delivery of prior approved home health nurse or home health aide services if all of the following criteria are met: (i) The home health nurse or home health aide shall not transport the recipient; (ii) The home health agency shall have discretion as to whether or not to accompany a recipient outside the home. The circumstance under which a home health agency may exercise such discretion shall include, without limitation, when the home health agency has concern regarding any of the following: (a) The scheduling or safety of the transportation; (b) The health or safety of their employee or the recipient; (c) The ability to safely and effectively deliver services in the alternative setting; and (d) The additional expense that would be required to accompany a patient outside the home; (iii) Additional visits or hours of care will not be approved for coverage for the purpose of accompanying a recipient outside the home. Services will be limited to services to which the recipient would be entitled if the services were provided exclusively at the recipient's place of residence; and (iv) No additional reimbursement shall be paid to the home health agency in association with the decision of a home health agency to accompany a patient outside the home; (C) Nothing in this subdivision (a)(12) is intended to create an entitlement to services outside the home; (D) A home health agency shall not be subject to any claims or cause of action as result of exercising its discretion under this subdivision (a)(12); (13) Transportation for approved emergency medical examination or treatment, or both; (14) Intellectual disability and rehabilitation services; (15) Intermediate care facilities services; (16) Medical services rendered by community or neighborhood health organizations or clinics, including organizations or clinics where some or all of the medical services are provided by medical students presently enrolled in a medical school accredited by the Association of American Medical Colleges or licensed registered nurses, or both, and where such students or licensed registered nurses are under the direction of a licensed physician or physicians; (17) Family planning services and supplies; (18) Basic dental care services; (19) Medical and surgical services rendered by ambulatory surgical treatment centers; (20) Services rendered by rural health clinics; (21) Medical assistance and home- and community-based services to those eligible being served through a health care financing administration (HCFA) approved waiver designed to provide more efficient and economical alternatives to institutional care; (22) Services by nurse anesthetists who are registered by the Tennessee board of nursing, who have completed an advance course in anesthesia, and who hold a current certification from the American Association of Nurse Anesthetists as a nurse anesthetist; (23) Nurse midwife services performed by a person who is licensed by the Tennessee board of nursing as a registered nurse under the authority of the Nursing Practice Act, compiled in title 63, chapter 7, and certified by the American College of Nurse Midwives as a certified nurse midwife; (24) Services provided by certified pediatric nurse practitioners and certified family nurse practitioners as required by federal law; (25) (A) Sickle cell disease management services and public education campaign activities specifically related to sickle cell disease, as authorized by 42 U.S.C. § 1396d(a)(27) and (x) , with reimbursement in accordance with any applicable state plan amendment; (B) Any contract between a managed care organization (MCO) and the bureau of TennCare to provide medical assistance pursuant to this part shall be appropriately revised or amended in order to comply with the implementation of subdivision (a)(25)(A); (26) Language interpreter services, which may include: (A) Sign language interpreter services when such services are necessary to help recipients who are deaf or hard of hearing obtain covered services; and (B) Spoken language interpreter services to all recipients with limited English proficiency; (27) Services within the practice of chiropractic performed by a person who is authorized by title 63, chapter 4, to engage in the practice of chiropractic; and (28) Rapid whole genome sequencing. As used in this subdivision (a)(28), "rapid whole genome sequencing": (A) Means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes that returns the preliminary positive results within seven (7) days and final results within fifteen (15) days from the date of receipt of the sample by the lab performing the test; and (B) Includes patient-only whole genome sequencing, duo whole genome sequencing of the patient and one (1) biological parent, and trio whole genome sequencing of the patient and both biological parents.
(1) Inpatient hospital services, other than services in an institution for tuberculosis or mental diseases;
(2) Outpatient hospital services;
(3) Other laboratory and X-ray services;
(4) Skilled nursing home services, other than services in an institution for tuberculosis or mental diseases;
(5) Physicians' services, whether furnished in the office, the patient's home, a hospital, a skilled nursing home, or elsewhere;
(6) Drugs;
(7) Inpatient hospital services for individuals sixty-five (65) years of age or over in an institution for tuberculosis or mental diseases, and inpatient hospital services for individuals under twenty-one (21) years of age in institutions for mental diseases, or in case of an individual who was receiving such inpatient services for mental disease in the period immediately preceding the date on which such individual becomes twenty-one (21) years of age: (A) The date on which such individual no longer requires the services; or (B) If earlier, the date such individual becomes twenty-two (22) years of age;
(A) The date on which such individual no longer requires the services; or
(B) If earlier, the date such individual becomes twenty-two (22) years of age;
(8) Nonmedical nursing care shall be rendered in accordance with the tenets and practice of a recognized church or religious denomination to any indigent person otherwise qualified for assistance under this part who depends upon healing by prayer or spiritual means alone in accordance with the tenets and practice of such church or religious denomination;
(9) Skilled nursing home services for individuals sixty-five (65) years of age or over in institutions for tuberculosis or mental diseases;
(10) Medical screening, diagnostic and treatment services for eligible categorically connected individuals under twenty-one (21) years of age;
(11) Psychiatric clinic services in approved facilities;
(12) (A) Home health care services provided in the recipient's home. The services may follow the recipient into the community subject to subdivision (a)(12)(B); (B) Home health nurses or aides may accompany a recipient outside the home during the course of delivery of prior approved home health nurse or home health aide services if all of the following criteria are met: (i) The home health nurse or home health aide shall not transport the recipient; (ii) The home health agency shall have discretion as to whether or not to accompany a recipient outside the home. The circumstance under which a home health agency may exercise such discretion shall include, without limitation, when the home health agency has concern regarding any of the following: (a) The scheduling or safety of the transportation; (b) The health or safety of their employee or the recipient; (c) The ability to safely and effectively deliver services in the alternative setting; and (d) The additional expense that would be required to accompany a patient outside the home; (iii) Additional visits or hours of care will not be approved for coverage for the purpose of accompanying a recipient outside the home. Services will be limited to services to which the recipient would be entitled if the services were provided exclusively at the recipient's place of residence; and (iv) No additional reimbursement shall be paid to the home health agency in association with the decision of a home health agency to accompany a patient outside the home; (C) Nothing in this subdivision (a)(12) is intended to create an entitlement to services outside the home; (D) A home health agency shall not be subject to any claims or cause of action as result of exercising its discretion under this subdivision (a)(12);
(A) Home health care services provided in the recipient's home. The services may follow the recipient into the community subject to subdivision (a)(12)(B);
(B) Home health nurses or aides may accompany a recipient outside the home during the course of delivery of prior approved home health nurse or home health aide services if all of the following criteria are met: (i) The home health nurse or home health aide shall not transport the recipient; (ii) The home health agency shall have discretion as to whether or not to accompany a recipient outside the home. The circumstance under which a home health agency may exercise such discretion shall include, without limitation, when the home health agency has concern regarding any of the following: (a) The scheduling or safety of the transportation; (b) The health or safety of their employee or the recipient; (c) The ability to safely and effectively deliver services in the alternative setting; and (d) The additional expense that would be required to accompany a patient outside the home; (iii) Additional visits or hours of care will not be approved for coverage for the purpose of accompanying a recipient outside the home. Services will be limited to services to which the recipient would be entitled if the services were provided exclusively at the recipient's place of residence; and (iv) No additional reimbursement shall be paid to the home health agency in association with the decision of a home health agency to accompany a patient outside the home;
(i) The home health nurse or home health aide shall not transport the recipient;
(ii) The home health agency shall have discretion as to whether or not to accompany a recipient outside the home. The circumstance under which a home health agency may exercise such discretion shall include, without limitation, when the home health agency has concern regarding any of the following: (a) The scheduling or safety of the transportation; (b) The health or safety of their employee or the recipient; (c) The ability to safely and effectively deliver services in the alternative setting; and (d) The additional expense that would be required to accompany a patient outside the home;
(a) The scheduling or safety of the transportation;
(b) The health or safety of their employee or the recipient;
(c) The ability to safely and effectively deliver services in the alternative setting; and
(d) The additional expense that would be required to accompany a patient outside the home;
(iii) Additional visits or hours of care will not be approved for coverage for the purpose of accompanying a recipient outside the home. Services will be limited to services to which the recipient would be entitled if the services were provided exclusively at the recipient's place of residence; and
(iv) No additional reimbursement shall be paid to the home health agency in association with the decision of a home health agency to accompany a patient outside the home;
(C) Nothing in this subdivision (a)(12) is intended to create an entitlement to services outside the home;
(D) A home health agency shall not be subject to any claims or cause of action as result of exercising its discretion under this subdivision (a)(12);
(13) Transportation for approved emergency medical examination or treatment, or both;
(14) Intellectual disability and rehabilitation services;
(15) Intermediate care facilities services;
(16) Medical services rendered by community or neighborhood health organizations or clinics, including organizations or clinics where some or all of the medical services are provided by medical students presently enrolled in a medical school accredited by the Association of American Medical Colleges or licensed registered nurses, or both, and where such students or licensed registered nurses are under the direction of a licensed physician or physicians;
(17) Family planning services and supplies;
(18) Basic dental care services;
(19) Medical and surgical services rendered by ambulatory surgical treatment centers;
(20) Services rendered by rural health clinics;
(21) Medical assistance and home- and community-based services to those eligible being served through a health care financing administration (HCFA) approved waiver designed to provide more efficient and economical alternatives to institutional care;
(22) Services by nurse anesthetists who are registered by the Tennessee board of nursing, who have completed an advance course in anesthesia, and who hold a current certification from the American Association of Nurse Anesthetists as a nurse anesthetist;
(23) Nurse midwife services performed by a person who is licensed by the Tennessee board of nursing as a registered nurse under the authority of the Nursing Practice Act, compiled in title 63, chapter 7, and certified by the American College of Nurse Midwives as a certified nurse midwife;
(24) Services provided by certified pediatric nurse practitioners and certified family nurse practitioners as required by federal law;
(25) (A) Sickle cell disease management services and public education campaign activities specifically related to sickle cell disease, as authorized by 42 U.S.C. § 1396d(a)(27) and (x) , with reimbursement in accordance with any applicable state plan amendment; (B) Any contract between a managed care organization (MCO) and the bureau of TennCare to provide medical assistance pursuant to this part shall be appropriately revised or amended in order to comply with the implementation of subdivision (a)(25)(A);
(A) Sickle cell disease management services and public education campaign activities specifically related to sickle cell disease, as authorized by 42 U.S.C. § 1396d(a)(27) and (x) , with reimbursement in accordance with any applicable state plan amendment;
(B) Any contract between a managed care organization (MCO) and the bureau of TennCare to provide medical assistance pursuant to this part shall be appropriately revised or amended in order to comply with the implementation of subdivision (a)(25)(A);
(26) Language interpreter services, which may include: (A) Sign language interpreter services when such services are necessary to help recipients who are deaf or hard of hearing obtain covered services; and (B) Spoken language interpreter services to all recipients with limited English proficiency;
(A) Sign language interpreter services when such services are necessary to help recipients who are deaf or hard of hearing obtain covered services; and
(B) Spoken language interpreter services to all recipients with limited English proficiency;
(27) Services within the practice of chiropractic performed by a person who is authorized by title 63, chapter 4, to engage in the practice of chiropractic; and
(28) Rapid whole genome sequencing. As used in this subdivision (a)(28), "rapid whole genome sequencing": (A) Means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes that returns the preliminary positive results within seven (7) days and final results within fifteen (15) days from the date of receipt of the sample by the lab performing the test; and (B) Includes patient-only whole genome sequencing, duo whole genome sequencing of the patient and one (1) biological parent, and trio whole genome sequencing of the patient and both biological parents.
(A) Means an investigation of the entire human genome, including coding and non-coding regions and mitochondrial deoxyribonucleic acid, to identify disease-causing genetic changes that returns the preliminary positive results within seven (7) days and final results within fifteen (15) days from the date of receipt of the sample by the lab performing the test; and
(B) Includes patient-only whole genome sequencing, duo whole genome sequencing of the patient and one (1) biological parent, and trio whole genome sequencing of the patient and both biological parents.
(b) With respect to recipients determined to be "medically needy," all or a part of the medical services outlined in subsection (a) may be provided, and may, within applicable federal legislation and regulations, be of lesser amounts, duration and scope than medical services provided other medicaid recipients in order to ensure that an expenditure of state funds shall not exceed the amount provided for the operation of the medicaid program.
(c) When the amount, duration, and scope of medical services is lessened so as to no longer include intermediate care facility services, the commissioner of health, with approval of the commissioner of human services, may continue to provide intermediate care facility services to those recipients who have been determined to be medically indigent and placed in a medicaid certified intermediate care facility bed at the time such change in the amount, duration, and scope of medical services is made.
(d) The department shall assist in the development of a demonstration project, which would provide cost effective alternatives to long-term care under the Omnibus Budget Reconciliation Act of 1981, to the extent permissible under the federal law, for institutional and residential homes that provide domiciliary care for the aged and mentally disabled, which project would include the Foster-Group Care Home Association. The development of such demonstration project shall begin on July 1, 1982.
(e) The bureau of TennCare shall have the authority to implement a comprehensive disease management program for certain enrollees of the TennCare program to the extent permitted under federal law and the TennCare waiver. The bureau, through its authority to promulgate rules and regulations, may identify enrollees eligible to participate and the disease categories to be included in the comprehensive disease management program. The bureau, also through its authority to promulgate rules and regulations, may put in place requirements regarding the continued participation of enrollees in the program.
(f) Subject to the availability of funding earmarked for such programs in the general appropriations act and to the extent permitted under federal law and the TennCare waiver, the bureau of TennCare shall have the authority to create in whole or in part and administer a program to be named "The TennCare safety net" which will provide two different components to assist eligible TennCare enrollees: (1) Certain medical providers in Tennessee shall provide non-emergency health care services without co-payment requirements to certain specified TennCare enrollees. Such services are intended to include only services that are both medically necessary and within the scope of TennCare benefits for the particular enrollee but for which the enrollee cannot meet the co-payment requirements. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including which enrollees are eligible to participate in this program, allowable benefits under the program, designation of both urban and rural providers who participate in this program, and a funding methodology pursuant to which such providers shall be compensated; (2) (A) A TennCare foundation will be established that will accept and review applications for medical assistance submitted on behalf of certain specified TennCare enrollees. The members of the foundation shall be appointed by the governor, who shall determine the size and composition of the foundation's membership. The governor should strive to ensure that the membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities. Terms for the members will be staggered and the length of terms will be detailed by the governor in making initial or subsequent appointments. The governor shall appoint the chair and vice-chair. For the purposes of administration and availability of records, the TennCare foundation shall be located within the bureau of TennCare; staff assistance shall be provided by the bureau of TennCare or by another entity, should the governor so determine. At the discretion of the governor, the foundation may be placed within another appropriate agency, may create or be reconstituted as a nonprofit entity, or may be terminated at any time; and (B) Applications for medical assistance from the foundation are not intended, and should not be used, as a means to circumvent or avoid the benefit limits established by the bureau of TennCare. It is expected that these applications will be submitted to address special, unforeseen, or exceptional circumstances. Such applications must be submitted by a licensed medical provider who is treating the enrollee and shall request the provision of medically necessary health care services recommended or prescribed by the enrollee's treating provider that are beyond the scope of benefits provided through the TennCare program benefit package for which the enrollee is eligible. For the purposes of this subsection (f), "beyond the scope of benefits" means a benefit that is covered within limits by TennCare but for which the enrollee has exceeded the covered limits of that benefit. It does not include benefits that are not covered to any extent under TennCare for the applicant. The foundation will not consider matters of eligibility for the TennCare program. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including the process for making application to this foundation, which enrollees are eligible to apply, and a mechanism for determining which applications will be reviewed by the foundation. The foundation will not have rule-making authority; (C) (i) Notwithstanding the availability of assistance from the foundation, no enrollee has an expectation of or an entitlement to assistance from the foundation; (ii) There exists no right of appeal regarding an application for assistance; and (iii) Because the level of funding provided to the foundation is limited, the foundation may not be able to fully or partially fund all applications. The decisions of which applications to fund will be solely within the discretion of the foundation; (D) Nothing in this subsection (f) shall be construed to require a contested case hearing as set forth in the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, nor shall any determinations made by the foundation be considered final orders from which appeals can be taken. The consideration of applications provided for by this subdivision (f)(2)(D) shall not constitute hearings as set forth in the Uniform Administrative Procedures Act; (E) The foundation shall consider applications and determine in its sole discretion and without requirement for written findings whether the application should be granted in whole or in part. The foundation's determination on an enrollee's application shall have no binding precedential effect on the consideration of any other enrollees' applications; (F) In the event that a matter being considered by the foundation presents a real or apparent conflict of interest for any staff or member, such staff or member shall disclose the conflict to the chair and be recused from any official action taken on the matter; (G) Notwithstanding the open meetings law, compiled in title 8, chapter 44 or any other law to the contrary, any and all meetings of the TennCare foundation are to be considered confidential and closed to the public. Members and staff shall maintain strict standards of confidentiality in the handling of all matters before the foundation. In addition, all relevant federal and state laws regarding patient privacy and confidentiality will be adhered to. All material and information, regardless of form, medium, or method of communication, provided to or acquired by a foundation member or staff in the course of the foundation's work, shall be regarded as confidential information, shall not be disclosed, and are not public records. In addition, all material and information, regardless of form, medium, or method of communication, made or generated by a member or foundation staff in the course of the foundation's work, shall be regarded as confidential information and shall not be disclosed and are deemed not to be a public record. All necessary steps shall be taken by members and staff to safeguard the confidentiality of such material or information in conformance with federal and state law; (H) Every October 1, the foundation shall report in writing to the governor, the health and welfare committee and commerce and labor committee of the senate, and the health committee and insurance committee of the house of representatives regarding how funds allocated to the foundation were spent during the previous fiscal year. Such report shall contain the following information: (i) How many applications were received; (ii) How many applications the foundation granted; (iii) The type of services and items that were funded; and (iv) Statistical information, by gender, race, and division of the state, on who applied for and who received the funds; (I) Whether members shall receive reasonable compensation for their service on the TennCare foundation will be determined at the discretion of the governor; members may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter; (J) If any federal or state court or other tribunal with jurisdiction: (i) Determines that any aspect of subdivision (f)(2)(A), (f)(2)(B), (f)(2)(C), (f)(2)(D), (f)(2)(E), or (f)(2)(G) violates federal law, state law, or any existing court order or consent decree, and (ii) Makes effective an order enjoining compliance with any aspect of these provisions or requiring non-trivial changes in the terms or applications of these provisions, the challenged provisions may not be severed from the remainder of this subdivision (f)(2). In this event, all provisions of this subdivision (f)(2) will terminate and have no further effect. Such termination shall occur no later than ninety (90) days after the effective date of the order unless such order is stayed by the issuing court or the reviewing court pending disposition of an appeal of the order. The decision whether or not to appeal any such order will be at the sole discretion of the bureau of TennCare. This nonseverability provision shall be self-executing. If this subdivision (f)(2) is terminated while appropriated funds remain, the unused funds shall revert back to the general fund. Any payments for services or items which have been approved but not yet disbursed as of the date of termination shall be paid, but no further applications for payments shall be considered or granted after the date of termination. In the event of termination under this subsection (f), the foundation may be reinstated only by new legislative action and a new appropriation by the general assembly.
(1) Certain medical providers in Tennessee shall provide non-emergency health care services without co-payment requirements to certain specified TennCare enrollees. Such services are intended to include only services that are both medically necessary and within the scope of TennCare benefits for the particular enrollee but for which the enrollee cannot meet the co-payment requirements. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including which enrollees are eligible to participate in this program, allowable benefits under the program, designation of both urban and rural providers who participate in this program, and a funding methodology pursuant to which such providers shall be compensated;
(2) (A) A TennCare foundation will be established that will accept and review applications for medical assistance submitted on behalf of certain specified TennCare enrollees. The members of the foundation shall be appointed by the governor, who shall determine the size and composition of the foundation's membership. The governor should strive to ensure that the membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities. Terms for the members will be staggered and the length of terms will be detailed by the governor in making initial or subsequent appointments. The governor shall appoint the chair and vice-chair. For the purposes of administration and availability of records, the TennCare foundation shall be located within the bureau of TennCare; staff assistance shall be provided by the bureau of TennCare or by another entity, should the governor so determine. At the discretion of the governor, the foundation may be placed within another appropriate agency, may create or be reconstituted as a nonprofit entity, or may be terminated at any time; and (B) Applications for medical assistance from the foundation are not intended, and should not be used, as a means to circumvent or avoid the benefit limits established by the bureau of TennCare. It is expected that these applications will be submitted to address special, unforeseen, or exceptional circumstances. Such applications must be submitted by a licensed medical provider who is treating the enrollee and shall request the provision of medically necessary health care services recommended or prescribed by the enrollee's treating provider that are beyond the scope of benefits provided through the TennCare program benefit package for which the enrollee is eligible. For the purposes of this subsection (f), "beyond the scope of benefits" means a benefit that is covered within limits by TennCare but for which the enrollee has exceeded the covered limits of that benefit. It does not include benefits that are not covered to any extent under TennCare for the applicant. The foundation will not consider matters of eligibility for the TennCare program. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including the process for making application to this foundation, which enrollees are eligible to apply, and a mechanism for determining which applications will be reviewed by the foundation. The foundation will not have rule-making authority; (C) (i) Notwithstanding the availability of assistance from the foundation, no enrollee has an expectation of or an entitlement to assistance from the foundation; (ii) There exists no right of appeal regarding an application for assistance; and (iii) Because the level of funding provided to the foundation is limited, the foundation may not be able to fully or partially fund all applications. The decisions of which applications to fund will be solely within the discretion of the foundation; (D) Nothing in this subsection (f) shall be construed to require a contested case hearing as set forth in the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, nor shall any determinations made by the foundation be considered final orders from which appeals can be taken. The consideration of applications provided for by this subdivision (f)(2)(D) shall not constitute hearings as set forth in the Uniform Administrative Procedures Act; (E) The foundation shall consider applications and determine in its sole discretion and without requirement for written findings whether the application should be granted in whole or in part. The foundation's determination on an enrollee's application shall have no binding precedential effect on the consideration of any other enrollees' applications; (F) In the event that a matter being considered by the foundation presents a real or apparent conflict of interest for any staff or member, such staff or member shall disclose the conflict to the chair and be recused from any official action taken on the matter; (G) Notwithstanding the open meetings law, compiled in title 8, chapter 44 or any other law to the contrary, any and all meetings of the TennCare foundation are to be considered confidential and closed to the public. Members and staff shall maintain strict standards of confidentiality in the handling of all matters before the foundation. In addition, all relevant federal and state laws regarding patient privacy and confidentiality will be adhered to. All material and information, regardless of form, medium, or method of communication, provided to or acquired by a foundation member or staff in the course of the foundation's work, shall be regarded as confidential information, shall not be disclosed, and are not public records. In addition, all material and information, regardless of form, medium, or method of communication, made or generated by a member or foundation staff in the course of the foundation's work, shall be regarded as confidential information and shall not be disclosed and are deemed not to be a public record. All necessary steps shall be taken by members and staff to safeguard the confidentiality of such material or information in conformance with federal and state law; (H) Every October 1, the foundation shall report in writing to the governor, the health and welfare committee and commerce and labor committee of the senate, and the health committee and insurance committee of the house of representatives regarding how funds allocated to the foundation were spent during the previous fiscal year. Such report shall contain the following information: (i) How many applications were received; (ii) How many applications the foundation granted; (iii) The type of services and items that were funded; and (iv) Statistical information, by gender, race, and division of the state, on who applied for and who received the funds; (I) Whether members shall receive reasonable compensation for their service on the TennCare foundation will be determined at the discretion of the governor; members may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter; (J) If any federal or state court or other tribunal with jurisdiction: (i) Determines that any aspect of subdivision (f)(2)(A), (f)(2)(B), (f)(2)(C), (f)(2)(D), (f)(2)(E), or (f)(2)(G) violates federal law, state law, or any existing court order or consent decree, and (ii) Makes effective an order enjoining compliance with any aspect of these provisions or requiring non-trivial changes in the terms or applications of these provisions, the challenged provisions may not be severed from the remainder of this subdivision (f)(2). In this event, all provisions of this subdivision (f)(2) will terminate and have no further effect. Such termination shall occur no later than ninety (90) days after the effective date of the order unless such order is stayed by the issuing court or the reviewing court pending disposition of an appeal of the order. The decision whether or not to appeal any such order will be at the sole discretion of the bureau of TennCare. This nonseverability provision shall be self-executing. If this subdivision (f)(2) is terminated while appropriated funds remain, the unused funds shall revert back to the general fund. Any payments for services or items which have been approved but not yet disbursed as of the date of termination shall be paid, but no further applications for payments shall be considered or granted after the date of termination. In the event of termination under this subsection (f), the foundation may be reinstated only by new legislative action and a new appropriation by the general assembly.
(A) A TennCare foundation will be established that will accept and review applications for medical assistance submitted on behalf of certain specified TennCare enrollees. The members of the foundation shall be appointed by the governor, who shall determine the size and composition of the foundation's membership. The governor should strive to ensure that the membership is representative of the state's geographic and demographic composition with appropriate attention to the representation of women and minorities. Terms for the members will be staggered and the length of terms will be detailed by the governor in making initial or subsequent appointments. The governor shall appoint the chair and vice-chair. For the purposes of administration and availability of records, the TennCare foundation shall be located within the bureau of TennCare; staff assistance shall be provided by the bureau of TennCare or by another entity, should the governor so determine. At the discretion of the governor, the foundation may be placed within another appropriate agency, may create or be reconstituted as a nonprofit entity, or may be terminated at any time; and
(B) Applications for medical assistance from the foundation are not intended, and should not be used, as a means to circumvent or avoid the benefit limits established by the bureau of TennCare. It is expected that these applications will be submitted to address special, unforeseen, or exceptional circumstances. Such applications must be submitted by a licensed medical provider who is treating the enrollee and shall request the provision of medically necessary health care services recommended or prescribed by the enrollee's treating provider that are beyond the scope of benefits provided through the TennCare program benefit package for which the enrollee is eligible. For the purposes of this subsection (f), "beyond the scope of benefits" means a benefit that is covered within limits by TennCare but for which the enrollee has exceeded the covered limits of that benefit. It does not include benefits that are not covered to any extent under TennCare for the applicant. The foundation will not consider matters of eligibility for the TennCare program. Through its authority to promulgate rules and regulations, the bureau of TennCare will identify the parameters of this component of the TennCare safety net program, including the process for making application to this foundation, which enrollees are eligible to apply, and a mechanism for determining which applications will be reviewed by the foundation. The foundation will not have rule-making authority;
(C) (i) Notwithstanding the availability of assistance from the foundation, no enrollee has an expectation of or an entitlement to assistance from the foundation; (ii) There exists no right of appeal regarding an application for assistance; and (iii) Because the level of funding provided to the foundation is limited, the foundation may not be able to fully or partially fund all applications. The decisions of which applications to fund will be solely within the discretion of the foundation;
(i) Notwithstanding the availability of assistance from the foundation, no enrollee has an expectation of or an entitlement to assistance from the foundation;
(ii) There exists no right of appeal regarding an application for assistance; and
(iii) Because the level of funding provided to the foundation is limited, the foundation may not be able to fully or partially fund all applications. The decisions of which applications to fund will be solely within the discretion of the foundation;
(D) Nothing in this subsection (f) shall be construed to require a contested case hearing as set forth in the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, nor shall any determinations made by the foundation be considered final orders from which appeals can be taken. The consideration of applications provided for by this subdivision (f)(2)(D) shall not constitute hearings as set forth in the Uniform Administrative Procedures Act;
(E) The foundation shall consider applications and determine in its sole discretion and without requirement for written findings whether the application should be granted in whole or in part. The foundation's determination on an enrollee's application shall have no binding precedential effect on the consideration of any other enrollees' applications;
(F) In the event that a matter being considered by the foundation presents a real or apparent conflict of interest for any staff or member, such staff or member shall disclose the conflict to the chair and be recused from any official action taken on the matter;
(G) Notwithstanding the open meetings law, compiled in title 8, chapter 44 or any other law to the contrary, any and all meetings of the TennCare foundation are to be considered confidential and closed to the public. Members and staff shall maintain strict standards of confidentiality in the handling of all matters before the foundation. In addition, all relevant federal and state laws regarding patient privacy and confidentiality will be adhered to. All material and information, regardless of form, medium, or method of communication, provided to or acquired by a foundation member or staff in the course of the foundation's work, shall be regarded as confidential information, shall not be disclosed, and are not public records. In addition, all material and information, regardless of form, medium, or method of communication, made or generated by a member or foundation staff in the course of the foundation's work, shall be regarded as confidential information and shall not be disclosed and are deemed not to be a public record. All necessary steps shall be taken by members and staff to safeguard the confidentiality of such material or information in conformance with federal and state law;
(H) Every October 1, the foundation shall report in writing to the governor, the health and welfare committee and commerce and labor committee of the senate, and the health committee and insurance committee of the house of representatives regarding how funds allocated to the foundation were spent during the previous fiscal year. Such report shall contain the following information: (i) How many applications were received; (ii) How many applications the foundation granted; (iii) The type of services and items that were funded; and (iv) Statistical information, by gender, race, and division of the state, on who applied for and who received the funds;
(i) How many applications were received;
(ii) How many applications the foundation granted;
(iii) The type of services and items that were funded; and
(iv) Statistical information, by gender, race, and division of the state, on who applied for and who received the funds;
(I) Whether members shall receive reasonable compensation for their service on the TennCare foundation will be determined at the discretion of the governor; members may be reimbursed for those expenses allowed by the comprehensive travel regulations promulgated by the department of finance and administration and approved by the attorney general and reporter;
(J) If any federal or state court or other tribunal with jurisdiction: (i) Determines that any aspect of subdivision (f)(2)(A), (f)(2)(B), (f)(2)(C), (f)(2)(D), (f)(2)(E), or (f)(2)(G) violates federal law, state law, or any existing court order or consent decree, and (ii) Makes effective an order enjoining compliance with any aspect of these provisions or requiring non-trivial changes in the terms or applications of these provisions, the challenged provisions may not be severed from the remainder of this subdivision (f)(2). In this event, all provisions of this subdivision (f)(2) will terminate and have no further effect. Such termination shall occur no later than ninety (90) days after the effective date of the order unless such order is stayed by the issuing court or the reviewing court pending disposition of an appeal of the order. The decision whether or not to appeal any such order will be at the sole discretion of the bureau of TennCare. This nonseverability provision shall be self-executing. If this subdivision (f)(2) is terminated while appropriated funds remain, the unused funds shall revert back to the general fund. Any payments for services or items which have been approved but not yet disbursed as of the date of termination shall be paid, but no further applications for payments shall be considered or granted after the date of termination. In the event of termination under this subsection (f), the foundation may be reinstated only by new legislative action and a new appropriation by the general assembly.
(i) Determines that any aspect of subdivision (f)(2)(A), (f)(2)(B), (f)(2)(C), (f)(2)(D), (f)(2)(E), or (f)(2)(G) violates federal law, state law, or any existing court order or consent decree, and
(ii) Makes effective an order enjoining compliance with any aspect of these provisions or requiring non-trivial changes in the terms or applications of these provisions, the challenged provisions may not be severed from the remainder of this subdivision (f)(2). In this event, all provisions of this subdivision (f)(2) will terminate and have no further effect. Such termination shall occur no later than ninety (90) days after the effective date of the order unless such order is stayed by the issuing court or the reviewing court pending disposition of an appeal of the order. The decision whether or not to appeal any such order will be at the sole discretion of the bureau of TennCare. This nonseverability provision shall be self-executing. If this subdivision (f)(2) is terminated while appropriated funds remain, the unused funds shall revert back to the general fund. Any payments for services or items which have been approved but not yet disbursed as of the date of termination shall be paid, but no further applications for payments shall be considered or granted after the date of termination. In the event of termination under this subsection (f), the foundation may be reinstated only by new legislative action and a new appropriation by the general assembly.
(g) The bureau of TennCare shall have the authority, in collaboration with one or more medical schools located in Tennessee, to establish an evidence-based medicine initiative for the purpose of developing medical protocols and integrating standards of best practices within the delivery of TennCare services. To the extent that evidence-based medical protocols are authorized by the bureau of TennCare, such protocols shall satisfy the standard of medical necessity as set forth in § 71-5-144 . The bureau of TennCare, through its authority to promulgate rules and regulations, shall establish the parameters for the initiative, including who can participate and how the initiative is to be implemented.
Amended by 2024 Tenn. Acts, ch. 1020,s 1, eff. 7/1/2024.
Amended by 2021 Tenn. Acts, ch. 524, s 1, eff. 1/1/2022.
Amended by 2021 Tenn. Acts, ch. 64, s 121, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 345, s 135, eff. 5/10/2019.
Amended by 2019 Tenn. Acts, ch. 329, s 6, eff. 5/8/2019.
Amended by 2017 Tenn. Acts, ch. 243, s 1, eff. 7/1/2017.
Amended by 2015 Tenn. Acts, ch. 122, s 1, eff. 1/1/2016.
Amended by 2013 Tenn. Acts, ch. 236, s 77, eff. 4/19/2013.
Acts 1968, ch. 551, § 7; 1969, ch. 326, §§ 1, 2; 1972, ch. 596, § 1; 1973, ch. 73, §§ 1, 3, 4; 1973, ch. 262, § 1; 1973, ch. 276, § 5; 1974, ch. 802, § 2; 1976, ch. 572, § 1; 1978, ch. 875, § 1; modified; T.C.A., § 14-1907; Acts 1981, ch. 225, §§ 1-4; 1981, ch. 476, § 2; 1982, ch. 740, §§ 6-8, 19; T.C.A., § 14-23-107; Acts 1987, ch. 310, §§ 1, 2; 1988, ch. 510, §§ 1, 2; 1993, ch. 183, § 1; 1998, ch. 1093, § 2; 2004, ch. 673, § 2; 2009 , ch. 471, § 1; 2011 , ch. 197, § 2; 2011 , ch. 410, § 6 (b).
Tenn. Code Ann. § 71-4-2102 — TN Code / Title 71 / Chapter 4 / Section 71-4-2102
Creation of the Tennessee council for the deaf, deaf-blind and hard of hearing
Status: in_force

Effective July 1, 2013, there is hereby created the Tennessee council for the deaf, deaf-blind, and hard of hearing, which has the duty to: (1) Advocate services affecting people who are deaf, deaf-blind, and hard of hearing in the areas of public services, health care, education, vocational training, employment opportunity, emergency services, resource sharing and communication; (2) Act as a bureau of information for people who are deaf, deaf-blind, and hard of hearing to state agencies and public institutions providing health care, employment, vocational, educational services, resource sharing, and emergency services to the deaf, deaf-blind, and hard of hearing, and to local agencies and programs; (3) Collect facts and statistics and other special studies of conditions affecting the health and welfare of people who are deaf, deaf-blind, and hard of hearing in this state; (4) Provide for a mutual exchange of ideas and information on the national, state, and local levels; (5) Encourage and assist local governments and agencies in the development of programs for people who are deaf, deaf-blind, and hard of hearing; (6) Cooperate with public and private agencies and units of local, state, and federal governments in promoting coordination in programs for the deaf, deaf-blind, and hard of hearing; (7) Authorize the executive director to prepare an annual report and needs assessment to the council that reviews the status of state services for the deaf, deaf-blind, and hard of hearing. The council shall submit the approved report and needs assessment to the governor, lieutenant governor, and speaker of the house of representatives and make this report available to organizations serving the deaf, deaf-blind, and hard of hearing; and (8) Make recommendations for needed improvements and to serve as an advisory body in regard to new legislation affecting the deaf, deaf-blind, and hard of hearing. Amended by 2013 Tenn. Acts, ch. 455, s 1, eff. 7/1/2013. Acts 1978, ch. 889, § 2; T.C.A., §§ 14-2502, 14-18-102; Acts 2001, ch. 174, § 14.
Effective July 1, 2013, there is hereby created the Tennessee council for the deaf, deaf-blind, and hard of hearing, which has the duty to:
(1) Advocate services affecting people who are deaf, deaf-blind, and hard of hearing in the areas of public services, health care, education, vocational training, employment opportunity, emergency services, resource sharing and communication;
(2) Act as a bureau of information for people who are deaf, deaf-blind, and hard of hearing to state agencies and public institutions providing health care, employment, vocational, educational services, resource sharing, and emergency services to the deaf, deaf-blind, and hard of hearing, and to local agencies and programs;
(3) Collect facts and statistics and other special studies of conditions affecting the health and welfare of people who are deaf, deaf-blind, and hard of hearing in this state;
(4) Provide for a mutual exchange of ideas and information on the national, state, and local levels;
(5) Encourage and assist local governments and agencies in the development of programs for people who are deaf, deaf-blind, and hard of hearing;
(6) Cooperate with public and private agencies and units of local, state, and federal governments in promoting coordination in programs for the deaf, deaf-blind, and hard of hearing;
(7) Authorize the executive director to prepare an annual report and needs assessment to the council that reviews the status of state services for the deaf, deaf-blind, and hard of hearing. The council shall submit the approved report and needs assessment to the governor, lieutenant governor, and speaker of the house of representatives and make this report available to organizations serving the deaf, deaf-blind, and hard of hearing; and
(8) Make recommendations for needed improvements and to serve as an advisory body in regard to new legislation affecting the deaf, deaf-blind, and hard of hearing.
Amended by 2013 Tenn. Acts, ch. 455, s 1, eff. 7/1/2013.
Acts 1978, ch. 889, § 2; T.C.A., §§ 14-2502, 14-18-102; Acts 2001, ch. 174, § 14.
Tenn. Code Ann. § 71-3-502 — TN Code / Title 71 / Chapter 3 / Section 71-3-502
Licensing of child care agencies - Regulations of child care agencies - Assistance in meeting child care standards - Application for license - Provisional license - Transfer of license prohibited - Denial of license - Quality assessment and rating system - Curriculum guideline addressing personal safety
Status: in_force

(a) (1) All persons or entities operating a child care agency as defined in this part, unless exempt as provided in § 71-3-503 , must be licensed by the department as a child care agency. (2) (A) The department has the authority to issue regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 2, for the licensing of any persons or entities subject to any provisions of this part and for enforcement of appropriate standards for the health, safety and welfare of children in their care. (B) To the extent they are not inconsistent with the statutory provisions of this part, the regulations of the department that are in effect July 1, 2021, shall remain in force and effect until modified by regulatory action of the department. (3) The department's regulations of child care agencies shall be developed based upon consideration of the criteria in subdivisions (a)(3)(A)-(F). In determining whether to initially grant a license or whether to take any licensing action involving a licensed child care agency, the statutory criteria in subdivisions (a)(3)(A)-(F) may be cited and considered by the department and by the child care agency board of review as the basis for such action in addition to the regulations: (A) The safety, welfare and best interests of the children in the care of the agency; (B) The capability, training and character of the persons providing or supervising the care of the children; (C) Evidence that the expected performance of the caregivers, supervisors or management of the child care agency seeking initial licensure or renewal of licensure will be such as to protect children in care from injury, harm or the threat of injury or harm; or, during licensure, that the actual performance of any of the duties of caregivers, supervisors or management of a licensed child care agency demonstrates or has demonstrated a level of judgment that a reasonable person would exercise or would have exercised, under existing or under reasonably foreseeable circumstances, that would prevent or would have prevented injury, harm, or the threat of injury or harm, to any child in care; (D) The quality of the methods of care and instruction provided for the children; (E) The suitability of the facilities provided for the care of the children; and (F) The adequacy of the methods of administration and the management of the child care agency, the agency's personnel policies, and the financing of the agency. (4) The department shall promulgate regulations that address the following areas: (A) Training for directors and care givers as follows: (i) Preemployment training for directors, including, but not limited to, training in interviewing and evaluating care givers for service in an agency; (ii) Training for caregivers that includes, but is not limited to, preservice orientation as well as additional training within the first six (6) months of employment as provided by rule; and (iii) The department of human services shall promulgate rules that consider the prior education and experience of a registered nurse who is seeking approval under the department's rules as a director of a child care agency that operates as part of a facility licensed under title 68 as a nursing home; (B) Liability and accident insurance coverage, including minimum amounts of coverage based upon insurance industry standards, for both facilities and vehicles owned, leased or contracted for by the child care agency; provided, that this requirement shall not apply to a child care agency that is under the direct management of a self-insured administrative department of the state, a county, a municipality or any combination of those three (3); and (C) (i) Education of the parents of children in day care regarding the benefits of immunizing their children against influenza. (ii) The department of human services shall work to increase immunization awareness and participation among parents of children in child care agencies by working with the department of health in publishing on the department's website information about the benefits of annual immunization against influenza for children six (6) months of age to five (5) years of age; (iii) The department shall work with child care agencies and providers to ensure that the information is annually distributed to parents in August or September. (5) The department shall enact these regulations by emergency rule to be effective July 1, 2000; provided, however, permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act. (6) (A) The department of human services licensure rules for child care centers serving preschool children contained in Tenn. Comp. R. & Regs. 1240-4-3-.07(4)(e), and licensure rules for child care centers serving school-age children contained in Tenn. Comp. R. & Regs. 1240-4-6-.07(4)(f), and in any other portions of those rules, that were part of the amendments filed as permanent rules for each rule on September 29, 2000, enacted on December 13, 2000, and effective on July 1, 2001, and that define or reference the age groups for "infants" as being comprised of children who are six (6) weeks to twelve (12) months of age, and the age groups for "toddlers" as being comprised of children who are thirteen (13) months to twenty-three (23) months of age, shall expire on July 19, 2001. (B) "Infant" and "toddler" categories of children in the care of a child care agency licensed pursuant to this part shall be defined as follows, until otherwise modified by rule of the department: (i) "Infants" shall be comprised of children six (6) weeks to fifteen (15) months of age; and (ii) "Toddlers" shall be comprised of children twelve (12) months to thirty (30) months of age. (C) All other department rules not specifically designated to expire by subdivision (a)(6)(A), or affected by the definitions in subdivision (a)(6)(B), including, but not limited to, the definitions or references to the age range for the "2 year old" category in the care of a child care agency, descriptions or definitions of any other age groups of children, adult to child ratios, and, except as modified by chapter 436 of the Public Acts of 2001, and the effective dates of the rules, shall remain in full force and effect or shall become effective in accordance with the department's regulations. (D) The department of human services shall have authority to immediately implement emergency rules effective on July 19, 2001, or as soon thereafter as possible, to define the age groups for "infants" and "toddlers" as defined by subdivision (a)(6)(B) and to make any conforming rule changes in the text or in the adult to child supervision charts contained in Tenn. Comp. R. & Regs. 1240-4-3 or 1240-4-6 or in any other rule of the department that may be necessary to implement the changes made by this section relative to the age range definition for the "infant" and "toddler" groups. Permanent rules shall be implemented as otherwise provided by the Uniform Administrative Procedures Act. (b) (1) The department shall assist applicants or licensees in meeting the child care standards of the department unless the circumstances demonstrate that further assistance is not compatible with the continued safety, health or welfare of the children in the agency's care and that regulatory action affecting the agency's license is warranted. All costs and expenses arising from or related to meeting the child care standards of the department shall be borne entirely by the applicant or licensee; provided, the department may, in its discretion, provide from available funds for technical assistance to child care agencies, and the training of child care givers. (2) If a license is revoked or an application for licensure is denied, then the department shall offer reasonable assistance to the parent, guardian, or custodian of children in care in planning for the placement of the children in licensed child care agencies or other suitable care. (c) Application for a license to operate a child care agency shall be made in writing to the department in such manner as the department determines and shall be accompanied by the appropriate fee established by rule as provided in subsection (f). (d) (1) A person or entity that does not have an existing license may apply for a provisional license. The purpose of the provisional license is to permit the license applicant to begin the operation of a child care agency after meeting certain minimum requirements and to demonstrate during the provisional licensing period that it has the ability to attain and maintain compliance with all licensing laws and regulations. (2) An applicant shall receive a provisional license upon the presentation of satisfactory evidence that: (A) The facility that is proposed for the care of children has received fire safety and environmental safety approval, and that, after appropriate inspection, the department has determined that the site does not endanger the safety or welfare of children; (B) The applicant and the personnel who will care for the children are capable in all substantial respects of caring for the children; (C) The applicant has the ability to attain and maintain compliance with the licensing laws and regulations, both during and after the provisional licensing period; (D) The applicant, owner, director or an employee of the agency has not previously been associated in an ownership or management capacity with any child care agency that has been cited by the department for violations of this part or the department's regulations, including the agency for which the application is pending, unless the department determines that a reasonable basis exists to conclude that such individual is otherwise qualified to provide child care; and (E) The criteria in subdivision (a)(3) support the issuance of a provisional license. (3) If the department determines that any of the criteria in subdivision (d)(2) has not been, or cannot be met, then it may deny the application for a provisional license. (4) (A) If the department determines that the applicant has fully complied with subdivision (d)(2) and with all other laws and regulations governing the specific classification of child care agency for which the application was made, that the child care agency has demonstrated the ability to maintain compliance with all licensing regulations following the provisional licensure period, and that it has a reasonable likelihood of maintaining licensure, then the department shall issue a license. (B) If the applicant has not satisfactorily demonstrated compliance with the requirements for licensing as determined by the department, a license may be denied by the department. (5) The licensee shall post the license in a clearly visible location as determined by the department so that parents or other persons visiting the agency can readily view the license and all the information on the license. (6) (A) (i) The license shall describe the ownership of the child care agency, the person who is charged with the day-to-day management of the child care agency, and, if the agency is owned by a person other than the director, or if the agency is under the ownership or direction or control of any person or entity who is not also the on-site director or manager of the agency, the license shall also state the corporate or other name of the controlling person or entity, its address and telephone number where the parents, guardians or custodians may have contact regarding the agency's operations. (ii) If the child care agency is operated by a public or private nonprofit entity and is subject to the control or direction of a board of directors or other oversight authority, the license shall list the name, address and telephone number of the chair of the board or other executive head of such controlling body. (B) In order for a child care agency to offer before or after-school services under this part, the department must issue a license bearing a notation that the agency is authorized to provide before or after-school care services. An agency may not offer such services unless its license bears such notation. (7) (A) In granting any license, the department may limit the total number of children who may be enrolled in the agency regardless of the agency's physical capacity or the size of its staff. (B) Adult/child ratios and group sizes in group child care homes and child care centers may exceed requirements set by rule of the department of human services by up to ten percent (10%), rounded to the nearest whole number, for no more frequently than three (3) days per week; provided, however, infant and toddler groups may never exceed the required ratios and group sizes. (C) (i) The department may promulgate rules, under the Uniform Administrative Procedure Act, to provide for the amounts of liability coverage for any personal vehicles that are not owned, operated by, or contracted by the child care agency for the transportation of children enrolled in the agency, but which are utilized by parents, staff or volunteers only for occasional field trips for children enrolled at the agency. (ii) Such rules must provide that any vehicles not owned, operated by, or contracted for by the agency for any transportation of children enrolled at the agency, and which are utilized only as described in subdivision (d)(7)(C)(i) for field trips must provide evidence of currently effective liability coverage for such nonagency vehicles in amounts sufficient to provide adequate coverage for children being transported by such vehicles. (iii) Subject to department rule, all vehicles used by or on behalf of a child care center to provide transportation of children, that are designed to transport six (6) or more passengers, shall be equipped with a child safety monitoring device that shall prompt staff to inspect the vehicle for children before an alarm sounds. In order to facilitate the affordability of such devices for centers, the department is authorized to establish a grant program to subsidize a portion or all of the cost of such devices for centers; provided, however, that the department may only use private donations that it receives for such purpose to fund the grants. Only devices approved by the department are authorized for use on such a vehicle. This subdivision (d)(7)(C)(iii) shall not apply: (a) When all children in a vehicle are five (5) years of age and in kindergarten, or older than five (5) years of age, except that if any one (1) of such children is developmentally or physically disabled or nonambulatory then this subdivision (d)(7)(C)(iii) shall apply; or (b) To vehicles used exclusively for the provision of occasional field trips. (iv) Vehicles used by a licensed child care agency for the transportation of children shall be subject only to color and marking requirements promulgated by the department and shall be exempt from any other such requirements that may be set forth in state law or local ordinance. Color and marking requirements shall be issued by the department, in consultation with the department of safety, as deemed appropriate for the safe operation, proper identification, or registration of the vehicle. (v) Such rules shall prohibit a newly hired employee or existing employee who is full-time or part-time, or, as defined by the department, a substitute employee of a child care agency, or a contractor or other persons or entities providing any form of transportation services for compensation to a child care agency, from engaging in any form of driving services involving children in a child care agency until the employee or substitute employee has undergone a drug test and the results are negative for illegal drug use. The rules shall provide exceptions for emergency transportation requirements in limited circumstances, as deemed appropriate by the department. (8) If the department fails to issue a license within one hundred twenty (120) days of the granting of the provisional license, then the provisional license continues in effect, unless suspended, as provided in § 71-3-509 , until such determination is made. If a license is denied following the issuance of a provisional license, and if a timely appeal is made of the denial of a license, then the provisional license remains in effect, unless suspended, until the board of review renders a decision regarding the denial of a license. (9) If a provisional license is denied or a license is denied following the issuance of a provisional license, the applicant may appeal the denial or restriction as provided in § 71-3-509 . (e) (1) Except as provided in this subsection (e), no license for a child care agency shall be transferable, and the transfer by sale or lease, or in any other manner, of the operation of the agency to any other person or entity shall void the existing license immediately and any pending appeal involving the status of the license, and the agency shall be required to close immediately. If the transferee has made application for, and is granted, a provisional license, the agency may continue operation under the direction of the new licensee. The new licensee in such circumstances may not be the transferor or any person or entity acting on behalf of the transferor. (2) If the department determines that any person or entity has transferred nominal control of an agency to any persons or entities who are determined by the department to be acting on behalf of the purported transferor in order to circumvent a history of violations of the licensing law or regulations or to otherwise attempt to circumvent the licensing law or regulations or any prior licensing actions instituted by the department, the department may deny the issuance of any license to the applicant. The denial of the license may be appealed as provided in § 71-3-509 . (3) (A) The license of any agency shall not be voided nor shall any pending appeal be voided pursuant to this subsection (e) solely for the reason that the agency is subject to judicial orders directing the transfer of control or management of a child care agency or its license to any receiver, trustee, administrator or executor of an estate, or any similarly situated person or entity. (B) If the current licensee dies, and provided that no licensing violations require the suspension, denial or revocation of the agency's license, the department may grant family members of the licensee, or administrators or executors of the licensee, a new provisional license to continue operation for a period of one hundred twenty (120) days. At the end of such period, the department shall determine whether a license should be granted to a new licensee as otherwise provided in this section. (C) Nothing in this subsection (e) shall be construed to prevent the department from taking any regulatory or judicial action as may be required pursuant to the licensing laws and regulations that may be necessary to protect the children in the care of such agency. (f) (1) Prior to January 1, 2022, the licensure application fees as they existed for child care agencies on June 30, 2021, apply. On or after January 1, 2022, licensure fees apply only to applications for provisional licenses for child care agencies licensed pursuant to this part in amounts established by rules promulgated by the department pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (2) In order to address the need for and encourage the development of extended child care for parents working during nights or on weekends, or for any other nontraditional child care needs for which the department determines that available child care is inadequate or unavailable in all or any part of the state, the department may promulgate rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, providing for alternative fee schedules in order to recognize and encourage the development of child care to meet such needs. (g) [Deleted by 2021 amendment.] (h) All licensure application fees collected by the department from family child care homes, group child care homes, child care centers and drop-in centers shall be paid into the general fund, but shall be earmarked for, and dedicated to, the department. Such earmarked fees shall be used by the department exclusively to improve child care quality in this state by funding activities that include child care provider training activities, but excluding any costs associated with conducting criminal background checks. Increased fees shall be used solely for a variety of training options, which can be accessed by agencies, organizations and individuals for grants for workshops, conferences and scholarships that improve the quality of child care in this state. (i) Notwithstanding any provisions of title 13, chapter 7, to the contrary, upon adoption of a resolution by a two-thirds (2/3) vote of the county legislative body, any zoning authority, in determining the suitability of a request for any use of property for the establishment or alteration of any child care agency, may consider the criminal background of the person or persons making a request to such board, or may consider the criminal background of any person or persons who will manage or operate such child care agency. The board may require the person to submit a fingerprint sample and a criminal history disclosure form and may submit the fingerprint sample for comparison by the Tennessee bureau of investigation pursuant to § 38-6-109 , or it may conduct the background check by other means as it deems appropriate. The zoning authority shall be responsible for all costs associated with obtaining such criminal background information. (j) (1) (A) The department shall establish and implement a quality assessment and rating system for the purpose of evaluating, individually and collectively, child care agencies licensed or approved by the department pursuant to this part so that parents or other caretakers of children enrolled, or being considered for enrollment, at a child care agency, may make more informed decisions regarding the care of their children by comparing the quality of services offered by child care agencies, to encourage the improvement of out-of-home child care for children in this state, and to support child care providers in continuously improving the quality of services and support they provide families. The quality assessment and rating system established pursuant to this subsection (j) must be developed in a manner easily usable by parents or other caretakers of children to make informed choices related to child care. (B) For purposes of this subsection (j), "child care agencies" includes child care centers, group child care homes, and family child care homes. (2) (A) The department shall promulgate rules establishing the quality assessment and rating system under this subsection (j). Each child care agency must receive a quality assessment and rating evaluation after the rules establishing the quality assessment and rating system under this subsection (j) become effective, and annually thereafter. This quality assessment and rating system must include an annual evaluation of each child care agency by the department and must reflect key indicators of performance comparison among all child care agencies in this state, which may include information related to the following: (i) Health and safety practices; and (ii) Teacher-child interactions. (B) The department shall not discriminate or fail to recognize the credentials of any accrediting agency based upon religious affiliation, race, age, color, sex, or national origin. (C) Upon completion, the quality assessment and rating results of each child care agency must be available on the department's website and posted in a clear and visible location at each child care agency for review by the parents or other caretakers of children enrolled, or being considered for enrollment, at the child care agency. (3) Any child care agency that accepts the department's child care assistance subsidy payments may receive higher subsidy payments or other financial performance incentives, as determined by the department, based upon the child care agency's quality assessment and rating results, subject to available funding in the department's budget. (4) The commissioner and the comptroller of the treasury may, in their discretion, conduct audits of the records of any child care providers as necessary to verify that the expenditures by a child care provider of state or federal child care subsidy funds are being made according to state or federal requirements. (5) A child care agency is subject to denial or revocation of the agency's license by the department and may also be subject to a civil penalty of five hundred dollars ($500) imposed by the department if the child care agency knowingly: (A) Provides false information or fails to provide any information to the department, the comptroller, or their agents or designees that is required or necessary to perform any of the requirements of this title or to enforce state or federal law or regulations, or child care subsidy or licensing requirements; (B) Fails to allow entrance by any person designated by the department to perform the evaluation required by this subsection (j); or (C) Continues to display expired or revoked quality assessment and rating results after written notice by the department. (k) The department is authorized to review possible dangers to children and workers in child care facilities from carbon monoxide gas and to issue such rules and regulations as it may deem necessary. (l) (1) The department of human services shall make available to child care providers licensed by the department a curriculum guideline in any suitable format addressing personal safety containing a component related to the prevention of child sexual abuse and shall allow child care providers licensed by the department to choose terminology and instructional methods that accomplish the goal of providing clear, effective and appropriate instruction in personal safety. The department is encouraged to distribute a sample curriculum that is developmentally-appropriate and age-appropriate, child-friendly and family-friendly, and designed to be acceptable to a broad range of providers, parents and legal guardians. (2) The personal safety curriculum that will be implemented by the child care provider must be made available so parents and legal guardians have the opportunity to review it and so parents and legal guardians will be aware of this component of the child care provider's curriculum. The department shall develop a standard notification form to be provided to the parents or legal guardians by the child care agency. The notification form shall contain the following information: (A) The method of instruction and sample terminology used in the personal safety/child sexual abuse curriculum; (B) The availability of the instructional materials for review by the parents or legal guardians; and (C) A place for the parents or legal guardians to sign acknowledging they have been provided an opportunity to review the personal safety curriculum, have been notified of the child sexual abuse/personal safety curriculum for their child and the individual record for each child shall include a copy of the signed notification form. (3) If a parent has questions regarding the personal safety component of the quality early childhood education curriculum, then the provider or a representative of the provider shall meet with the parent and discuss the personal safety component of the curriculum. (4) The department of human services is expressly authorized and directed to implement by emergency rules, effective October 1, 2008, a rule regarding implementation of this requirement for the personal safety curriculum; provided, that any permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act. Amended by 2021 Tenn. Acts, ch. 280, Secs.s 2, s 3, s 4, s 5, s 6, s 7, s 8, s 9, s 10, s 11, s 12, s 13, s 14, s 15, s 16, s 17, s 18, s 19, s 20, s 21 eff. 7/1/2021. Amended by 2021 Tenn. Acts, ch. 280, s 1, eff. 7/1/2021. Amended by 2016 Tenn. Acts, ch. 839, s 13, eff. 7/1/2016. Acts 2000, ch. 981, § 3; 2001, ch. 453, §§ 3 - 6, 24, 25; 2003 , ch. 170, § 2; 2004, ch. 696, § 1; 2005, ch. 151, §§ 2 - 7; 2005, ch. 453, §§ 1, 2; 2006, ch. 906, § 1; 2008 , ch. 687, § 1; 2008 , ch. 1032, § 1; 2009 , ch. 566, § 12; 2010 , ch. 789, §§ 1 - 3; 2010 , ch. 1132, § 1; 2011 , ch. 410, § 3 (ii).
(a) (1) All persons or entities operating a child care agency as defined in this part, unless exempt as provided in § 71-3-503 , must be licensed by the department as a child care agency. (2) (A) The department has the authority to issue regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 2, for the licensing of any persons or entities subject to any provisions of this part and for enforcement of appropriate standards for the health, safety and welfare of children in their care. (B) To the extent they are not inconsistent with the statutory provisions of this part, the regulations of the department that are in effect July 1, 2021, shall remain in force and effect until modified by regulatory action of the department. (3) The department's regulations of child care agencies shall be developed based upon consideration of the criteria in subdivisions (a)(3)(A)-(F). In determining whether to initially grant a license or whether to take any licensing action involving a licensed child care agency, the statutory criteria in subdivisions (a)(3)(A)-(F) may be cited and considered by the department and by the child care agency board of review as the basis for such action in addition to the regulations: (A) The safety, welfare and best interests of the children in the care of the agency; (B) The capability, training and character of the persons providing or supervising the care of the children; (C) Evidence that the expected performance of the caregivers, supervisors or management of the child care agency seeking initial licensure or renewal of licensure will be such as to protect children in care from injury, harm or the threat of injury or harm; or, during licensure, that the actual performance of any of the duties of caregivers, supervisors or management of a licensed child care agency demonstrates or has demonstrated a level of judgment that a reasonable person would exercise or would have exercised, under existing or under reasonably foreseeable circumstances, that would prevent or would have prevented injury, harm, or the threat of injury or harm, to any child in care; (D) The quality of the methods of care and instruction provided for the children; (E) The suitability of the facilities provided for the care of the children; and (F) The adequacy of the methods of administration and the management of the child care agency, the agency's personnel policies, and the financing of the agency. (4) The department shall promulgate regulations that address the following areas: (A) Training for directors and care givers as follows: (i) Preemployment training for directors, including, but not limited to, training in interviewing and evaluating care givers for service in an agency; (ii) Training for caregivers that includes, but is not limited to, preservice orientation as well as additional training within the first six (6) months of employment as provided by rule; and (iii) The department of human services shall promulgate rules that consider the prior education and experience of a registered nurse who is seeking approval under the department's rules as a director of a child care agency that operates as part of a facility licensed under title 68 as a nursing home; (B) Liability and accident insurance coverage, including minimum amounts of coverage based upon insurance industry standards, for both facilities and vehicles owned, leased or contracted for by the child care agency; provided, that this requirement shall not apply to a child care agency that is under the direct management of a self-insured administrative department of the state, a county, a municipality or any combination of those three (3); and (C) (i) Education of the parents of children in day care regarding the benefits of immunizing their children against influenza. (ii) The department of human services shall work to increase immunization awareness and participation among parents of children in child care agencies by working with the department of health in publishing on the department's website information about the benefits of annual immunization against influenza for children six (6) months of age to five (5) years of age; (iii) The department shall work with child care agencies and providers to ensure that the information is annually distributed to parents in August or September. (5) The department shall enact these regulations by emergency rule to be effective July 1, 2000; provided, however, permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act. (6) (A) The department of human services licensure rules for child care centers serving preschool children contained in Tenn. Comp. R. & Regs. 1240-4-3-.07(4)(e), and licensure rules for child care centers serving school-age children contained in Tenn. Comp. R. & Regs. 1240-4-6-.07(4)(f), and in any other portions of those rules, that were part of the amendments filed as permanent rules for each rule on September 29, 2000, enacted on December 13, 2000, and effective on July 1, 2001, and that define or reference the age groups for "infants" as being comprised of children who are six (6) weeks to twelve (12) months of age, and the age groups for "toddlers" as being comprised of children who are thirteen (13) months to twenty-three (23) months of age, shall expire on July 19, 2001. (B) "Infant" and "toddler" categories of children in the care of a child care agency licensed pursuant to this part shall be defined as follows, until otherwise modified by rule of the department: (i) "Infants" shall be comprised of children six (6) weeks to fifteen (15) months of age; and (ii) "Toddlers" shall be comprised of children twelve (12) months to thirty (30) months of age. (C) All other department rules not specifically designated to expire by subdivision (a)(6)(A), or affected by the definitions in subdivision (a)(6)(B), including, but not limited to, the definitions or references to the age range for the "2 year old" category in the care of a child care agency, descriptions or definitions of any other age groups of children, adult to child ratios, and, except as modified by chapter 436 of the Public Acts of 2001, and the effective dates of the rules, shall remain in full force and effect or shall become effective in accordance with the department's regulations. (D) The department of human services shall have authority to immediately implement emergency rules effective on July 19, 2001, or as soon thereafter as possible, to define the age groups for "infants" and "toddlers" as defined by subdivision (a)(6)(B) and to make any conforming rule changes in the text or in the adult to child supervision charts contained in Tenn. Comp. R. & Regs. 1240-4-3 or 1240-4-6 or in any other rule of the department that may be necessary to implement the changes made by this section relative to the age range definition for the "infant" and "toddler" groups. Permanent rules shall be implemented as otherwise provided by the Uniform Administrative Procedures Act.
(1) All persons or entities operating a child care agency as defined in this part, unless exempt as provided in § 71-3-503 , must be licensed by the department as a child care agency.
(2) (A) The department has the authority to issue regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 2, for the licensing of any persons or entities subject to any provisions of this part and for enforcement of appropriate standards for the health, safety and welfare of children in their care. (B) To the extent they are not inconsistent with the statutory provisions of this part, the regulations of the department that are in effect July 1, 2021, shall remain in force and effect until modified by regulatory action of the department.
(A) The department has the authority to issue regulations pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 2, for the licensing of any persons or entities subject to any provisions of this part and for enforcement of appropriate standards for the health, safety and welfare of children in their care.
(B) To the extent they are not inconsistent with the statutory provisions of this part, the regulations of the department that are in effect July 1, 2021, shall remain in force and effect until modified by regulatory action of the department.
(3) The department's regulations of child care agencies shall be developed based upon consideration of the criteria in subdivisions (a)(3)(A)-(F). In determining whether to initially grant a license or whether to take any licensing action involving a licensed child care agency, the statutory criteria in subdivisions (a)(3)(A)-(F) may be cited and considered by the department and by the child care agency board of review as the basis for such action in addition to the regulations: (A) The safety, welfare and best interests of the children in the care of the agency; (B) The capability, training and character of the persons providing or supervising the care of the children; (C) Evidence that the expected performance of the caregivers, supervisors or management of the child care agency seeking initial licensure or renewal of licensure will be such as to protect children in care from injury, harm or the threat of injury or harm; or, during licensure, that the actual performance of any of the duties of caregivers, supervisors or management of a licensed child care agency demonstrates or has demonstrated a level of judgment that a reasonable person would exercise or would have exercised, under existing or under reasonably foreseeable circumstances, that would prevent or would have prevented injury, harm, or the threat of injury or harm, to any child in care; (D) The quality of the methods of care and instruction provided for the children; (E) The suitability of the facilities provided for the care of the children; and (F) The adequacy of the methods of administration and the management of the child care agency, the agency's personnel policies, and the financing of the agency.
(A) The safety, welfare and best interests of the children in the care of the agency;
(B) The capability, training and character of the persons providing or supervising the care of the children;
(C) Evidence that the expected performance of the caregivers, supervisors or management of the child care agency seeking initial licensure or renewal of licensure will be such as to protect children in care from injury, harm or the threat of injury or harm; or, during licensure, that the actual performance of any of the duties of caregivers, supervisors or management of a licensed child care agency demonstrates or has demonstrated a level of judgment that a reasonable person would exercise or would have exercised, under existing or under reasonably foreseeable circumstances, that would prevent or would have prevented injury, harm, or the threat of injury or harm, to any child in care;
(D) The quality of the methods of care and instruction provided for the children;
(E) The suitability of the facilities provided for the care of the children; and
(F) The adequacy of the methods of administration and the management of the child care agency, the agency's personnel policies, and the financing of the agency.
(4) The department shall promulgate regulations that address the following areas: (A) Training for directors and care givers as follows: (i) Preemployment training for directors, including, but not limited to, training in interviewing and evaluating care givers for service in an agency; (ii) Training for caregivers that includes, but is not limited to, preservice orientation as well as additional training within the first six (6) months of employment as provided by rule; and (iii) The department of human services shall promulgate rules that consider the prior education and experience of a registered nurse who is seeking approval under the department's rules as a director of a child care agency that operates as part of a facility licensed under title 68 as a nursing home; (B) Liability and accident insurance coverage, including minimum amounts of coverage based upon insurance industry standards, for both facilities and vehicles owned, leased or contracted for by the child care agency; provided, that this requirement shall not apply to a child care agency that is under the direct management of a self-insured administrative department of the state, a county, a municipality or any combination of those three (3); and (C) (i) Education of the parents of children in day care regarding the benefits of immunizing their children against influenza. (ii) The department of human services shall work to increase immunization awareness and participation among parents of children in child care agencies by working with the department of health in publishing on the department's website information about the benefits of annual immunization against influenza for children six (6) months of age to five (5) years of age; (iii) The department shall work with child care agencies and providers to ensure that the information is annually distributed to parents in August or September.
(A) Training for directors and care givers as follows: (i) Preemployment training for directors, including, but not limited to, training in interviewing and evaluating care givers for service in an agency; (ii) Training for caregivers that includes, but is not limited to, preservice orientation as well as additional training within the first six (6) months of employment as provided by rule; and (iii) The department of human services shall promulgate rules that consider the prior education and experience of a registered nurse who is seeking approval under the department's rules as a director of a child care agency that operates as part of a facility licensed under title 68 as a nursing home;
(i) Preemployment training for directors, including, but not limited to, training in interviewing and evaluating care givers for service in an agency;
(ii) Training for caregivers that includes, but is not limited to, preservice orientation as well as additional training within the first six (6) months of employment as provided by rule; and
(iii) The department of human services shall promulgate rules that consider the prior education and experience of a registered nurse who is seeking approval under the department's rules as a director of a child care agency that operates as part of a facility licensed under title 68 as a nursing home;
(B) Liability and accident insurance coverage, including minimum amounts of coverage based upon insurance industry standards, for both facilities and vehicles owned, leased or contracted for by the child care agency; provided, that this requirement shall not apply to a child care agency that is under the direct management of a self-insured administrative department of the state, a county, a municipality or any combination of those three (3); and
(C) (i) Education of the parents of children in day care regarding the benefits of immunizing their children against influenza. (ii) The department of human services shall work to increase immunization awareness and participation among parents of children in child care agencies by working with the department of health in publishing on the department's website information about the benefits of annual immunization against influenza for children six (6) months of age to five (5) years of age; (iii) The department shall work with child care agencies and providers to ensure that the information is annually distributed to parents in August or September.
(i) Education of the parents of children in day care regarding the benefits of immunizing their children against influenza.
(ii) The department of human services shall work to increase immunization awareness and participation among parents of children in child care agencies by working with the department of health in publishing on the department's website information about the benefits of annual immunization against influenza for children six (6) months of age to five (5) years of age;
(iii) The department shall work with child care agencies and providers to ensure that the information is annually distributed to parents in August or September.
(5) The department shall enact these regulations by emergency rule to be effective July 1, 2000; provided, however, permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act.
(6) (A) The department of human services licensure rules for child care centers serving preschool children contained in Tenn. Comp. R. & Regs. 1240-4-3-.07(4)(e), and licensure rules for child care centers serving school-age children contained in Tenn. Comp. R. & Regs. 1240-4-6-.07(4)(f), and in any other portions of those rules, that were part of the amendments filed as permanent rules for each rule on September 29, 2000, enacted on December 13, 2000, and effective on July 1, 2001, and that define or reference the age groups for "infants" as being comprised of children who are six (6) weeks to twelve (12) months of age, and the age groups for "toddlers" as being comprised of children who are thirteen (13) months to twenty-three (23) months of age, shall expire on July 19, 2001. (B) "Infant" and "toddler" categories of children in the care of a child care agency licensed pursuant to this part shall be defined as follows, until otherwise modified by rule of the department: (i) "Infants" shall be comprised of children six (6) weeks to fifteen (15) months of age; and (ii) "Toddlers" shall be comprised of children twelve (12) months to thirty (30) months of age. (C) All other department rules not specifically designated to expire by subdivision (a)(6)(A), or affected by the definitions in subdivision (a)(6)(B), including, but not limited to, the definitions or references to the age range for the "2 year old" category in the care of a child care agency, descriptions or definitions of any other age groups of children, adult to child ratios, and, except as modified by chapter 436 of the Public Acts of 2001, and the effective dates of the rules, shall remain in full force and effect or shall become effective in accordance with the department's regulations. (D) The department of human services shall have authority to immediately implement emergency rules effective on July 19, 2001, or as soon thereafter as possible, to define the age groups for "infants" and "toddlers" as defined by subdivision (a)(6)(B) and to make any conforming rule changes in the text or in the adult to child supervision charts contained in Tenn. Comp. R. & Regs. 1240-4-3 or 1240-4-6 or in any other rule of the department that may be necessary to implement the changes made by this section relative to the age range definition for the "infant" and "toddler" groups. Permanent rules shall be implemented as otherwise provided by the Uniform Administrative Procedures Act.
(A) The department of human services licensure rules for child care centers serving preschool children contained in Tenn. Comp. R. & Regs. 1240-4-3-.07(4)(e), and licensure rules for child care centers serving school-age children contained in Tenn. Comp. R. & Regs. 1240-4-6-.07(4)(f), and in any other portions of those rules, that were part of the amendments filed as permanent rules for each rule on September 29, 2000, enacted on December 13, 2000, and effective on July 1, 2001, and that define or reference the age groups for "infants" as being comprised of children who are six (6) weeks to twelve (12) months of age, and the age groups for "toddlers" as being comprised of children who are thirteen (13) months to twenty-three (23) months of age, shall expire on July 19, 2001.
(B) "Infant" and "toddler" categories of children in the care of a child care agency licensed pursuant to this part shall be defined as follows, until otherwise modified by rule of the department: (i) "Infants" shall be comprised of children six (6) weeks to fifteen (15) months of age; and (ii) "Toddlers" shall be comprised of children twelve (12) months to thirty (30) months of age.
(i) "Infants" shall be comprised of children six (6) weeks to fifteen (15) months of age; and
(ii) "Toddlers" shall be comprised of children twelve (12) months to thirty (30) months of age.
(C) All other department rules not specifically designated to expire by subdivision (a)(6)(A), or affected by the definitions in subdivision (a)(6)(B), including, but not limited to, the definitions or references to the age range for the "2 year old" category in the care of a child care agency, descriptions or definitions of any other age groups of children, adult to child ratios, and, except as modified by chapter 436 of the Public Acts of 2001, and the effective dates of the rules, shall remain in full force and effect or shall become effective in accordance with the department's regulations.
(D) The department of human services shall have authority to immediately implement emergency rules effective on July 19, 2001, or as soon thereafter as possible, to define the age groups for "infants" and "toddlers" as defined by subdivision (a)(6)(B) and to make any conforming rule changes in the text or in the adult to child supervision charts contained in Tenn. Comp. R. & Regs. 1240-4-3 or 1240-4-6 or in any other rule of the department that may be necessary to implement the changes made by this section relative to the age range definition for the "infant" and "toddler" groups. Permanent rules shall be implemented as otherwise provided by the Uniform Administrative Procedures Act.
(b) (1) The department shall assist applicants or licensees in meeting the child care standards of the department unless the circumstances demonstrate that further assistance is not compatible with the continued safety, health or welfare of the children in the agency's care and that regulatory action affecting the agency's license is warranted. All costs and expenses arising from or related to meeting the child care standards of the department shall be borne entirely by the applicant or licensee; provided, the department may, in its discretion, provide from available funds for technical assistance to child care agencies, and the training of child care givers. (2) If a license is revoked or an application for licensure is denied, then the department shall offer reasonable assistance to the parent, guardian, or custodian of children in care in planning for the placement of the children in licensed child care agencies or other suitable care.
(1) The department shall assist applicants or licensees in meeting the child care standards of the department unless the circumstances demonstrate that further assistance is not compatible with the continued safety, health or welfare of the children in the agency's care and that regulatory action affecting the agency's license is warranted. All costs and expenses arising from or related to meeting the child care standards of the department shall be borne entirely by the applicant or licensee; provided, the department may, in its discretion, provide from available funds for technical assistance to child care agencies, and the training of child care givers.
(2) If a license is revoked or an application for licensure is denied, then the department shall offer reasonable assistance to the parent, guardian, or custodian of children in care in planning for the placement of the children in licensed child care agencies or other suitable care.
(c) Application for a license to operate a child care agency shall be made in writing to the department in such manner as the department determines and shall be accompanied by the appropriate fee established by rule as provided in subsection (f).
(d) (1) A person or entity that does not have an existing license may apply for a provisional license. The purpose of the provisional license is to permit the license applicant to begin the operation of a child care agency after meeting certain minimum requirements and to demonstrate during the provisional licensing period that it has the ability to attain and maintain compliance with all licensing laws and regulations. (2) An applicant shall receive a provisional license upon the presentation of satisfactory evidence that: (A) The facility that is proposed for the care of children has received fire safety and environmental safety approval, and that, after appropriate inspection, the department has determined that the site does not endanger the safety or welfare of children; (B) The applicant and the personnel who will care for the children are capable in all substantial respects of caring for the children; (C) The applicant has the ability to attain and maintain compliance with the licensing laws and regulations, both during and after the provisional licensing period; (D) The applicant, owner, director or an employee of the agency has not previously been associated in an ownership or management capacity with any child care agency that has been cited by the department for violations of this part or the department's regulations, including the agency for which the application is pending, unless the department determines that a reasonable basis exists to conclude that such individual is otherwise qualified to provide child care; and (E) The criteria in subdivision (a)(3) support the issuance of a provisional license. (3) If the department determines that any of the criteria in subdivision (d)(2) has not been, or cannot be met, then it may deny the application for a provisional license. (4) (A) If the department determines that the applicant has fully complied with subdivision (d)(2) and with all other laws and regulations governing the specific classification of child care agency for which the application was made, that the child care agency has demonstrated the ability to maintain compliance with all licensing regulations following the provisional licensure period, and that it has a reasonable likelihood of maintaining licensure, then the department shall issue a license. (B) If the applicant has not satisfactorily demonstrated compliance with the requirements for licensing as determined by the department, a license may be denied by the department. (5) The licensee shall post the license in a clearly visible location as determined by the department so that parents or other persons visiting the agency can readily view the license and all the information on the license. (6) (A) (i) The license shall describe the ownership of the child care agency, the person who is charged with the day-to-day management of the child care agency, and, if the agency is owned by a person other than the director, or if the agency is under the ownership or direction or control of any person or entity who is not also the on-site director or manager of the agency, the license shall also state the corporate or other name of the controlling person or entity, its address and telephone number where the parents, guardians or custodians may have contact regarding the agency's operations. (ii) If the child care agency is operated by a public or private nonprofit entity and is subject to the control or direction of a board of directors or other oversight authority, the license shall list the name, address and telephone number of the chair of the board or other executive head of such controlling body. (B) In order for a child care agency to offer before or after-school services under this part, the department must issue a license bearing a notation that the agency is authorized to provide before or after-school care services. An agency may not offer such services unless its license bears such notation. (7) (A) In granting any license, the department may limit the total number of children who may be enrolled in the agency regardless of the agency's physical capacity or the size of its staff. (B) Adult/child ratios and group sizes in group child care homes and child care centers may exceed requirements set by rule of the department of human services by up to ten percent (10%), rounded to the nearest whole number, for no more frequently than three (3) days per week; provided, however, infant and toddler groups may never exceed the required ratios and group sizes. (C) (i) The department may promulgate rules, under the Uniform Administrative Procedure Act, to provide for the amounts of liability coverage for any personal vehicles that are not owned, operated by, or contracted by the child care agency for the transportation of children enrolled in the agency, but which are utilized by parents, staff or volunteers only for occasional field trips for children enrolled at the agency. (ii) Such rules must provide that any vehicles not owned, operated by, or contracted for by the agency for any transportation of children enrolled at the agency, and which are utilized only as described in subdivision (d)(7)(C)(i) for field trips must provide evidence of currently effective liability coverage for such nonagency vehicles in amounts sufficient to provide adequate coverage for children being transported by such vehicles. (iii) Subject to department rule, all vehicles used by or on behalf of a child care center to provide transportation of children, that are designed to transport six (6) or more passengers, shall be equipped with a child safety monitoring device that shall prompt staff to inspect the vehicle for children before an alarm sounds. In order to facilitate the affordability of such devices for centers, the department is authorized to establish a grant program to subsidize a portion or all of the cost of such devices for centers; provided, however, that the department may only use private donations that it receives for such purpose to fund the grants. Only devices approved by the department are authorized for use on such a vehicle. This subdivision (d)(7)(C)(iii) shall not apply: (a) When all children in a vehicle are five (5) years of age and in kindergarten, or older than five (5) years of age, except that if any one (1) of such children is developmentally or physically disabled or nonambulatory then this subdivision (d)(7)(C)(iii) shall apply; or (b) To vehicles used exclusively for the provision of occasional field trips. (iv) Vehicles used by a licensed child care agency for the transportation of children shall be subject only to color and marking requirements promulgated by the department and shall be exempt from any other such requirements that may be set forth in state law or local ordinance. Color and marking requirements shall be issued by the department, in consultation with the department of safety, as deemed appropriate for the safe operation, proper identification, or registration of the vehicle. (v) Such rules shall prohibit a newly hired employee or existing employee who is full-time or part-time, or, as defined by the department, a substitute employee of a child care agency, or a contractor or other persons or entities providing any form of transportation services for compensation to a child care agency, from engaging in any form of driving services involving children in a child care agency until the employee or substitute employee has undergone a drug test and the results are negative for illegal drug use. The rules shall provide exceptions for emergency transportation requirements in limited circumstances, as deemed appropriate by the department. (8) If the department fails to issue a license within one hundred twenty (120) days of the granting of the provisional license, then the provisional license continues in effect, unless suspended, as provided in § 71-3-509 , until such determination is made. If a license is denied following the issuance of a provisional license, and if a timely appeal is made of the denial of a license, then the provisional license remains in effect, unless suspended, until the board of review renders a decision regarding the denial of a license. (9) If a provisional license is denied or a license is denied following the issuance of a provisional license, the applicant may appeal the denial or restriction as provided in § 71-3-509 .
(1) A person or entity that does not have an existing license may apply for a provisional license. The purpose of the provisional license is to permit the license applicant to begin the operation of a child care agency after meeting certain minimum requirements and to demonstrate during the provisional licensing period that it has the ability to attain and maintain compliance with all licensing laws and regulations.
(2) An applicant shall receive a provisional license upon the presentation of satisfactory evidence that: (A) The facility that is proposed for the care of children has received fire safety and environmental safety approval, and that, after appropriate inspection, the department has determined that the site does not endanger the safety or welfare of children; (B) The applicant and the personnel who will care for the children are capable in all substantial respects of caring for the children; (C) The applicant has the ability to attain and maintain compliance with the licensing laws and regulations, both during and after the provisional licensing period; (D) The applicant, owner, director or an employee of the agency has not previously been associated in an ownership or management capacity with any child care agency that has been cited by the department for violations of this part or the department's regulations, including the agency for which the application is pending, unless the department determines that a reasonable basis exists to conclude that such individual is otherwise qualified to provide child care; and (E) The criteria in subdivision (a)(3) support the issuance of a provisional license.
(A) The facility that is proposed for the care of children has received fire safety and environmental safety approval, and that, after appropriate inspection, the department has determined that the site does not endanger the safety or welfare of children;
(B) The applicant and the personnel who will care for the children are capable in all substantial respects of caring for the children;
(C) The applicant has the ability to attain and maintain compliance with the licensing laws and regulations, both during and after the provisional licensing period;
(D) The applicant, owner, director or an employee of the agency has not previously been associated in an ownership or management capacity with any child care agency that has been cited by the department for violations of this part or the department's regulations, including the agency for which the application is pending, unless the department determines that a reasonable basis exists to conclude that such individual is otherwise qualified to provide child care; and
(E) The criteria in subdivision (a)(3) support the issuance of a provisional license.
(3) If the department determines that any of the criteria in subdivision (d)(2) has not been, or cannot be met, then it may deny the application for a provisional license.
(4) (A) If the department determines that the applicant has fully complied with subdivision (d)(2) and with all other laws and regulations governing the specific classification of child care agency for which the application was made, that the child care agency has demonstrated the ability to maintain compliance with all licensing regulations following the provisional licensure period, and that it has a reasonable likelihood of maintaining licensure, then the department shall issue a license. (B) If the applicant has not satisfactorily demonstrated compliance with the requirements for licensing as determined by the department, a license may be denied by the department.
(A) If the department determines that the applicant has fully complied with subdivision (d)(2) and with all other laws and regulations governing the specific classification of child care agency for which the application was made, that the child care agency has demonstrated the ability to maintain compliance with all licensing regulations following the provisional licensure period, and that it has a reasonable likelihood of maintaining licensure, then the department shall issue a license.
(B) If the applicant has not satisfactorily demonstrated compliance with the requirements for licensing as determined by the department, a license may be denied by the department.
(5) The licensee shall post the license in a clearly visible location as determined by the department so that parents or other persons visiting the agency can readily view the license and all the information on the license.
(6) (A) (i) The license shall describe the ownership of the child care agency, the person who is charged with the day-to-day management of the child care agency, and, if the agency is owned by a person other than the director, or if the agency is under the ownership or direction or control of any person or entity who is not also the on-site director or manager of the agency, the license shall also state the corporate or other name of the controlling person or entity, its address and telephone number where the parents, guardians or custodians may have contact regarding the agency's operations. (ii) If the child care agency is operated by a public or private nonprofit entity and is subject to the control or direction of a board of directors or other oversight authority, the license shall list the name, address and telephone number of the chair of the board or other executive head of such controlling body. (B) In order for a child care agency to offer before or after-school services under this part, the department must issue a license bearing a notation that the agency is authorized to provide before or after-school care services. An agency may not offer such services unless its license bears such notation.
(A) (i) The license shall describe the ownership of the child care agency, the person who is charged with the day-to-day management of the child care agency, and, if the agency is owned by a person other than the director, or if the agency is under the ownership or direction or control of any person or entity who is not also the on-site director or manager of the agency, the license shall also state the corporate or other name of the controlling person or entity, its address and telephone number where the parents, guardians or custodians may have contact regarding the agency's operations. (ii) If the child care agency is operated by a public or private nonprofit entity and is subject to the control or direction of a board of directors or other oversight authority, the license shall list the name, address and telephone number of the chair of the board or other executive head of such controlling body.
(i) The license shall describe the ownership of the child care agency, the person who is charged with the day-to-day management of the child care agency, and, if the agency is owned by a person other than the director, or if the agency is under the ownership or direction or control of any person or entity who is not also the on-site director or manager of the agency, the license shall also state the corporate or other name of the controlling person or entity, its address and telephone number where the parents, guardians or custodians may have contact regarding the agency's operations.
(ii) If the child care agency is operated by a public or private nonprofit entity and is subject to the control or direction of a board of directors or other oversight authority, the license shall list the name, address and telephone number of the chair of the board or other executive head of such controlling body.
(B) In order for a child care agency to offer before or after-school services under this part, the department must issue a license bearing a notation that the agency is authorized to provide before or after-school care services. An agency may not offer such services unless its license bears such notation.
(7) (A) In granting any license, the department may limit the total number of children who may be enrolled in the agency regardless of the agency's physical capacity or the size of its staff. (B) Adult/child ratios and group sizes in group child care homes and child care centers may exceed requirements set by rule of the department of human services by up to ten percent (10%), rounded to the nearest whole number, for no more frequently than three (3) days per week; provided, however, infant and toddler groups may never exceed the required ratios and group sizes. (C) (i) The department may promulgate rules, under the Uniform Administrative Procedure Act, to provide for the amounts of liability coverage for any personal vehicles that are not owned, operated by, or contracted by the child care agency for the transportation of children enrolled in the agency, but which are utilized by parents, staff or volunteers only for occasional field trips for children enrolled at the agency. (ii) Such rules must provide that any vehicles not owned, operated by, or contracted for by the agency for any transportation of children enrolled at the agency, and which are utilized only as described in subdivision (d)(7)(C)(i) for field trips must provide evidence of currently effective liability coverage for such nonagency vehicles in amounts sufficient to provide adequate coverage for children being transported by such vehicles. (iii) Subject to department rule, all vehicles used by or on behalf of a child care center to provide transportation of children, that are designed to transport six (6) or more passengers, shall be equipped with a child safety monitoring device that shall prompt staff to inspect the vehicle for children before an alarm sounds. In order to facilitate the affordability of such devices for centers, the department is authorized to establish a grant program to subsidize a portion or all of the cost of such devices for centers; provided, however, that the department may only use private donations that it receives for such purpose to fund the grants. Only devices approved by the department are authorized for use on such a vehicle. This subdivision (d)(7)(C)(iii) shall not apply: (a) When all children in a vehicle are five (5) years of age and in kindergarten, or older than five (5) years of age, except that if any one (1) of such children is developmentally or physically disabled or nonambulatory then this subdivision (d)(7)(C)(iii) shall apply; or (b) To vehicles used exclusively for the provision of occasional field trips. (iv) Vehicles used by a licensed child care agency for the transportation of children shall be subject only to color and marking requirements promulgated by the department and shall be exempt from any other such requirements that may be set forth in state law or local ordinance. Color and marking requirements shall be issued by the department, in consultation with the department of safety, as deemed appropriate for the safe operation, proper identification, or registration of the vehicle. (v) Such rules shall prohibit a newly hired employee or existing employee who is full-time or part-time, or, as defined by the department, a substitute employee of a child care agency, or a contractor or other persons or entities providing any form of transportation services for compensation to a child care agency, from engaging in any form of driving services involving children in a child care agency until the employee or substitute employee has undergone a drug test and the results are negative for illegal drug use. The rules shall provide exceptions for emergency transportation requirements in limited circumstances, as deemed appropriate by the department.
(A) In granting any license, the department may limit the total number of children who may be enrolled in the agency regardless of the agency's physical capacity or the size of its staff.
(B) Adult/child ratios and group sizes in group child care homes and child care centers may exceed requirements set by rule of the department of human services by up to ten percent (10%), rounded to the nearest whole number, for no more frequently than three (3) days per week; provided, however, infant and toddler groups may never exceed the required ratios and group sizes.
(C) (i) The department may promulgate rules, under the Uniform Administrative Procedure Act, to provide for the amounts of liability coverage for any personal vehicles that are not owned, operated by, or contracted by the child care agency for the transportation of children enrolled in the agency, but which are utilized by parents, staff or volunteers only for occasional field trips for children enrolled at the agency. (ii) Such rules must provide that any vehicles not owned, operated by, or contracted for by the agency for any transportation of children enrolled at the agency, and which are utilized only as described in subdivision (d)(7)(C)(i) for field trips must provide evidence of currently effective liability coverage for such nonagency vehicles in amounts sufficient to provide adequate coverage for children being transported by such vehicles. (iii) Subject to department rule, all vehicles used by or on behalf of a child care center to provide transportation of children, that are designed to transport six (6) or more passengers, shall be equipped with a child safety monitoring device that shall prompt staff to inspect the vehicle for children before an alarm sounds. In order to facilitate the affordability of such devices for centers, the department is authorized to establish a grant program to subsidize a portion or all of the cost of such devices for centers; provided, however, that the department may only use private donations that it receives for such purpose to fund the grants. Only devices approved by the department are authorized for use on such a vehicle. This subdivision (d)(7)(C)(iii) shall not apply: (a) When all children in a vehicle are five (5) years of age and in kindergarten, or older than five (5) years of age, except that if any one (1) of such children is developmentally or physically disabled or nonambulatory then this subdivision (d)(7)(C)(iii) shall apply; or (b) To vehicles used exclusively for the provision of occasional field trips. (iv) Vehicles used by a licensed child care agency for the transportation of children shall be subject only to color and marking requirements promulgated by the department and shall be exempt from any other such requirements that may be set forth in state law or local ordinance. Color and marking requirements shall be issued by the department, in consultation with the department of safety, as deemed appropriate for the safe operation, proper identification, or registration of the vehicle. (v) Such rules shall prohibit a newly hired employee or existing employee who is full-time or part-time, or, as defined by the department, a substitute employee of a child care agency, or a contractor or other persons or entities providing any form of transportation services for compensation to a child care agency, from engaging in any form of driving services involving children in a child care agency until the employee or substitute employee has undergone a drug test and the results are negative for illegal drug use. The rules shall provide exceptions for emergency transportation requirements in limited circumstances, as deemed appropriate by the department.
(i) The department may promulgate rules, under the Uniform Administrative Procedure Act, to provide for the amounts of liability coverage for any personal vehicles that are not owned, operated by, or contracted by the child care agency for the transportation of children enrolled in the agency, but which are utilized by parents, staff or volunteers only for occasional field trips for children enrolled at the agency.
(ii) Such rules must provide that any vehicles not owned, operated by, or contracted for by the agency for any transportation of children enrolled at the agency, and which are utilized only as described in subdivision (d)(7)(C)(i) for field trips must provide evidence of currently effective liability coverage for such nonagency vehicles in amounts sufficient to provide adequate coverage for children being transported by such vehicles.
(iii) Subject to department rule, all vehicles used by or on behalf of a child care center to provide transportation of children, that are designed to transport six (6) or more passengers, shall be equipped with a child safety monitoring device that shall prompt staff to inspect the vehicle for children before an alarm sounds. In order to facilitate the affordability of such devices for centers, the department is authorized to establish a grant program to subsidize a portion or all of the cost of such devices for centers; provided, however, that the department may only use private donations that it receives for such purpose to fund the grants. Only devices approved by the department are authorized for use on such a vehicle. This subdivision (d)(7)(C)(iii) shall not apply: (a) When all children in a vehicle are five (5) years of age and in kindergarten, or older than five (5) years of age, except that if any one (1) of such children is developmentally or physically disabled or nonambulatory then this subdivision (d)(7)(C)(iii) shall apply; or (b) To vehicles used exclusively for the provision of occasional field trips.
(a) When all children in a vehicle are five (5) years of age and in kindergarten, or older than five (5) years of age, except that if any one (1) of such children is developmentally or physically disabled or nonambulatory then this subdivision (d)(7)(C)(iii) shall apply; or
(b) To vehicles used exclusively for the provision of occasional field trips.
(iv) Vehicles used by a licensed child care agency for the transportation of children shall be subject only to color and marking requirements promulgated by the department and shall be exempt from any other such requirements that may be set forth in state law or local ordinance. Color and marking requirements shall be issued by the department, in consultation with the department of safety, as deemed appropriate for the safe operation, proper identification, or registration of the vehicle.
(v) Such rules shall prohibit a newly hired employee or existing employee who is full-time or part-time, or, as defined by the department, a substitute employee of a child care agency, or a contractor or other persons or entities providing any form of transportation services for compensation to a child care agency, from engaging in any form of driving services involving children in a child care agency until the employee or substitute employee has undergone a drug test and the results are negative for illegal drug use. The rules shall provide exceptions for emergency transportation requirements in limited circumstances, as deemed appropriate by the department.
(8) If the department fails to issue a license within one hundred twenty (120) days of the granting of the provisional license, then the provisional license continues in effect, unless suspended, as provided in § 71-3-509 , until such determination is made. If a license is denied following the issuance of a provisional license, and if a timely appeal is made of the denial of a license, then the provisional license remains in effect, unless suspended, until the board of review renders a decision regarding the denial of a license.
(9) If a provisional license is denied or a license is denied following the issuance of a provisional license, the applicant may appeal the denial or restriction as provided in § 71-3-509 .
(e) (1) Except as provided in this subsection (e), no license for a child care agency shall be transferable, and the transfer by sale or lease, or in any other manner, of the operation of the agency to any other person or entity shall void the existing license immediately and any pending appeal involving the status of the license, and the agency shall be required to close immediately. If the transferee has made application for, and is granted, a provisional license, the agency may continue operation under the direction of the new licensee. The new licensee in such circumstances may not be the transferor or any person or entity acting on behalf of the transferor. (2) If the department determines that any person or entity has transferred nominal control of an agency to any persons or entities who are determined by the department to be acting on behalf of the purported transferor in order to circumvent a history of violations of the licensing law or regulations or to otherwise attempt to circumvent the licensing law or regulations or any prior licensing actions instituted by the department, the department may deny the issuance of any license to the applicant. The denial of the license may be appealed as provided in § 71-3-509 . (3) (A) The license of any agency shall not be voided nor shall any pending appeal be voided pursuant to this subsection (e) solely for the reason that the agency is subject to judicial orders directing the transfer of control or management of a child care agency or its license to any receiver, trustee, administrator or executor of an estate, or any similarly situated person or entity. (B) If the current licensee dies, and provided that no licensing violations require the suspension, denial or revocation of the agency's license, the department may grant family members of the licensee, or administrators or executors of the licensee, a new provisional license to continue operation for a period of one hundred twenty (120) days. At the end of such period, the department shall determine whether a license should be granted to a new licensee as otherwise provided in this section. (C) Nothing in this subsection (e) shall be construed to prevent the department from taking any regulatory or judicial action as may be required pursuant to the licensing laws and regulations that may be necessary to protect the children in the care of such agency.
(1) Except as provided in this subsection (e), no license for a child care agency shall be transferable, and the transfer by sale or lease, or in any other manner, of the operation of the agency to any other person or entity shall void the existing license immediately and any pending appeal involving the status of the license, and the agency shall be required to close immediately. If the transferee has made application for, and is granted, a provisional license, the agency may continue operation under the direction of the new licensee. The new licensee in such circumstances may not be the transferor or any person or entity acting on behalf of the transferor.
(2) If the department determines that any person or entity has transferred nominal control of an agency to any persons or entities who are determined by the department to be acting on behalf of the purported transferor in order to circumvent a history of violations of the licensing law or regulations or to otherwise attempt to circumvent the licensing law or regulations or any prior licensing actions instituted by the department, the department may deny the issuance of any license to the applicant. The denial of the license may be appealed as provided in § 71-3-509 .
(3) (A) The license of any agency shall not be voided nor shall any pending appeal be voided pursuant to this subsection (e) solely for the reason that the agency is subject to judicial orders directing the transfer of control or management of a child care agency or its license to any receiver, trustee, administrator or executor of an estate, or any similarly situated person or entity. (B) If the current licensee dies, and provided that no licensing violations require the suspension, denial or revocation of the agency's license, the department may grant family members of the licensee, or administrators or executors of the licensee, a new provisional license to continue operation for a period of one hundred twenty (120) days. At the end of such period, the department shall determine whether a license should be granted to a new licensee as otherwise provided in this section. (C) Nothing in this subsection (e) shall be construed to prevent the department from taking any regulatory or judicial action as may be required pursuant to the licensing laws and regulations that may be necessary to protect the children in the care of such agency.
(A) The license of any agency shall not be voided nor shall any pending appeal be voided pursuant to this subsection (e) solely for the reason that the agency is subject to judicial orders directing the transfer of control or management of a child care agency or its license to any receiver, trustee, administrator or executor of an estate, or any similarly situated person or entity.
(B) If the current licensee dies, and provided that no licensing violations require the suspension, denial or revocation of the agency's license, the department may grant family members of the licensee, or administrators or executors of the licensee, a new provisional license to continue operation for a period of one hundred twenty (120) days. At the end of such period, the department shall determine whether a license should be granted to a new licensee as otherwise provided in this section.
(C) Nothing in this subsection (e) shall be construed to prevent the department from taking any regulatory or judicial action as may be required pursuant to the licensing laws and regulations that may be necessary to protect the children in the care of such agency.
(f) (1) Prior to January 1, 2022, the licensure application fees as they existed for child care agencies on June 30, 2021, apply. On or after January 1, 2022, licensure fees apply only to applications for provisional licenses for child care agencies licensed pursuant to this part in amounts established by rules promulgated by the department pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (2) In order to address the need for and encourage the development of extended child care for parents working during nights or on weekends, or for any other nontraditional child care needs for which the department determines that available child care is inadequate or unavailable in all or any part of the state, the department may promulgate rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, providing for alternative fee schedules in order to recognize and encourage the development of child care to meet such needs.
(1) Prior to January 1, 2022, the licensure application fees as they existed for child care agencies on June 30, 2021, apply. On or after January 1, 2022, licensure fees apply only to applications for provisional licenses for child care agencies licensed pursuant to this part in amounts established by rules promulgated by the department pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(2) In order to address the need for and encourage the development of extended child care for parents working during nights or on weekends, or for any other nontraditional child care needs for which the department determines that available child care is inadequate or unavailable in all or any part of the state, the department may promulgate rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, providing for alternative fee schedules in order to recognize and encourage the development of child care to meet such needs.
(g) [Deleted by 2021 amendment.]
(h) All licensure application fees collected by the department from family child care homes, group child care homes, child care centers and drop-in centers shall be paid into the general fund, but shall be earmarked for, and dedicated to, the department. Such earmarked fees shall be used by the department exclusively to improve child care quality in this state by funding activities that include child care provider training activities, but excluding any costs associated with conducting criminal background checks. Increased fees shall be used solely for a variety of training options, which can be accessed by agencies, organizations and individuals for grants for workshops, conferences and scholarships that improve the quality of child care in this state.
(i) Notwithstanding any provisions of title 13, chapter 7, to the contrary, upon adoption of a resolution by a two-thirds (2/3) vote of the county legislative body, any zoning authority, in determining the suitability of a request for any use of property for the establishment or alteration of any child care agency, may consider the criminal background of the person or persons making a request to such board, or may consider the criminal background of any person or persons who will manage or operate such child care agency. The board may require the person to submit a fingerprint sample and a criminal history disclosure form and may submit the fingerprint sample for comparison by the Tennessee bureau of investigation pursuant to § 38-6-109 , or it may conduct the background check by other means as it deems appropriate. The zoning authority shall be responsible for all costs associated with obtaining such criminal background information.
(j) (1) (A) The department shall establish and implement a quality assessment and rating system for the purpose of evaluating, individually and collectively, child care agencies licensed or approved by the department pursuant to this part so that parents or other caretakers of children enrolled, or being considered for enrollment, at a child care agency, may make more informed decisions regarding the care of their children by comparing the quality of services offered by child care agencies, to encourage the improvement of out-of-home child care for children in this state, and to support child care providers in continuously improving the quality of services and support they provide families. The quality assessment and rating system established pursuant to this subsection (j) must be developed in a manner easily usable by parents or other caretakers of children to make informed choices related to child care. (B) For purposes of this subsection (j), "child care agencies" includes child care centers, group child care homes, and family child care homes. (2) (A) The department shall promulgate rules establishing the quality assessment and rating system under this subsection (j). Each child care agency must receive a quality assessment and rating evaluation after the rules establishing the quality assessment and rating system under this subsection (j) become effective, and annually thereafter. This quality assessment and rating system must include an annual evaluation of each child care agency by the department and must reflect key indicators of performance comparison among all child care agencies in this state, which may include information related to the following: (i) Health and safety practices; and (ii) Teacher-child interactions. (B) The department shall not discriminate or fail to recognize the credentials of any accrediting agency based upon religious affiliation, race, age, color, sex, or national origin. (C) Upon completion, the quality assessment and rating results of each child care agency must be available on the department's website and posted in a clear and visible location at each child care agency for review by the parents or other caretakers of children enrolled, or being considered for enrollment, at the child care agency. (3) Any child care agency that accepts the department's child care assistance subsidy payments may receive higher subsidy payments or other financial performance incentives, as determined by the department, based upon the child care agency's quality assessment and rating results, subject to available funding in the department's budget. (4) The commissioner and the comptroller of the treasury may, in their discretion, conduct audits of the records of any child care providers as necessary to verify that the expenditures by a child care provider of state or federal child care subsidy funds are being made according to state or federal requirements. (5) A child care agency is subject to denial or revocation of the agency's license by the department and may also be subject to a civil penalty of five hundred dollars ($500) imposed by the department if the child care agency knowingly: (A) Provides false information or fails to provide any information to the department, the comptroller, or their agents or designees that is required or necessary to perform any of the requirements of this title or to enforce state or federal law or regulations, or child care subsidy or licensing requirements; (B) Fails to allow entrance by any person designated by the department to perform the evaluation required by this subsection (j); or (C) Continues to display expired or revoked quality assessment and rating results after written notice by the department.
(1) (A) The department shall establish and implement a quality assessment and rating system for the purpose of evaluating, individually and collectively, child care agencies licensed or approved by the department pursuant to this part so that parents or other caretakers of children enrolled, or being considered for enrollment, at a child care agency, may make more informed decisions regarding the care of their children by comparing the quality of services offered by child care agencies, to encourage the improvement of out-of-home child care for children in this state, and to support child care providers in continuously improving the quality of services and support they provide families. The quality assessment and rating system established pursuant to this subsection (j) must be developed in a manner easily usable by parents or other caretakers of children to make informed choices related to child care. (B) For purposes of this subsection (j), "child care agencies" includes child care centers, group child care homes, and family child care homes.
(A) The department shall establish and implement a quality assessment and rating system for the purpose of evaluating, individually and collectively, child care agencies licensed or approved by the department pursuant to this part so that parents or other caretakers of children enrolled, or being considered for enrollment, at a child care agency, may make more informed decisions regarding the care of their children by comparing the quality of services offered by child care agencies, to encourage the improvement of out-of-home child care for children in this state, and to support child care providers in continuously improving the quality of services and support they provide families. The quality assessment and rating system established pursuant to this subsection (j) must be developed in a manner easily usable by parents or other caretakers of children to make informed choices related to child care.
(B) For purposes of this subsection (j), "child care agencies" includes child care centers, group child care homes, and family child care homes.
(2) (A) The department shall promulgate rules establishing the quality assessment and rating system under this subsection (j). Each child care agency must receive a quality assessment and rating evaluation after the rules establishing the quality assessment and rating system under this subsection (j) become effective, and annually thereafter. This quality assessment and rating system must include an annual evaluation of each child care agency by the department and must reflect key indicators of performance comparison among all child care agencies in this state, which may include information related to the following: (i) Health and safety practices; and (ii) Teacher-child interactions. (B) The department shall not discriminate or fail to recognize the credentials of any accrediting agency based upon religious affiliation, race, age, color, sex, or national origin. (C) Upon completion, the quality assessment and rating results of each child care agency must be available on the department's website and posted in a clear and visible location at each child care agency for review by the parents or other caretakers of children enrolled, or being considered for enrollment, at the child care agency.
(A) The department shall promulgate rules establishing the quality assessment and rating system under this subsection (j). Each child care agency must receive a quality assessment and rating evaluation after the rules establishing the quality assessment and rating system under this subsection (j) become effective, and annually thereafter. This quality assessment and rating system must include an annual evaluation of each child care agency by the department and must reflect key indicators of performance comparison among all child care agencies in this state, which may include information related to the following: (i) Health and safety practices; and (ii) Teacher-child interactions.
(i) Health and safety practices; and
(ii) Teacher-child interactions.
(B) The department shall not discriminate or fail to recognize the credentials of any accrediting agency based upon religious affiliation, race, age, color, sex, or national origin.
(C) Upon completion, the quality assessment and rating results of each child care agency must be available on the department's website and posted in a clear and visible location at each child care agency for review by the parents or other caretakers of children enrolled, or being considered for enrollment, at the child care agency.
(3) Any child care agency that accepts the department's child care assistance subsidy payments may receive higher subsidy payments or other financial performance incentives, as determined by the department, based upon the child care agency's quality assessment and rating results, subject to available funding in the department's budget.
(4) The commissioner and the comptroller of the treasury may, in their discretion, conduct audits of the records of any child care providers as necessary to verify that the expenditures by a child care provider of state or federal child care subsidy funds are being made according to state or federal requirements.
(5) A child care agency is subject to denial or revocation of the agency's license by the department and may also be subject to a civil penalty of five hundred dollars ($500) imposed by the department if the child care agency knowingly: (A) Provides false information or fails to provide any information to the department, the comptroller, or their agents or designees that is required or necessary to perform any of the requirements of this title or to enforce state or federal law or regulations, or child care subsidy or licensing requirements; (B) Fails to allow entrance by any person designated by the department to perform the evaluation required by this subsection (j); or (C) Continues to display expired or revoked quality assessment and rating results after written notice by the department.
(A) Provides false information or fails to provide any information to the department, the comptroller, or their agents or designees that is required or necessary to perform any of the requirements of this title or to enforce state or federal law or regulations, or child care subsidy or licensing requirements;
(B) Fails to allow entrance by any person designated by the department to perform the evaluation required by this subsection (j); or
(C) Continues to display expired or revoked quality assessment and rating results after written notice by the department.
(k) The department is authorized to review possible dangers to children and workers in child care facilities from carbon monoxide gas and to issue such rules and regulations as it may deem necessary.
(l) (1) The department of human services shall make available to child care providers licensed by the department a curriculum guideline in any suitable format addressing personal safety containing a component related to the prevention of child sexual abuse and shall allow child care providers licensed by the department to choose terminology and instructional methods that accomplish the goal of providing clear, effective and appropriate instruction in personal safety. The department is encouraged to distribute a sample curriculum that is developmentally-appropriate and age-appropriate, child-friendly and family-friendly, and designed to be acceptable to a broad range of providers, parents and legal guardians. (2) The personal safety curriculum that will be implemented by the child care provider must be made available so parents and legal guardians have the opportunity to review it and so parents and legal guardians will be aware of this component of the child care provider's curriculum. The department shall develop a standard notification form to be provided to the parents or legal guardians by the child care agency. The notification form shall contain the following information: (A) The method of instruction and sample terminology used in the personal safety/child sexual abuse curriculum; (B) The availability of the instructional materials for review by the parents or legal guardians; and (C) A place for the parents or legal guardians to sign acknowledging they have been provided an opportunity to review the personal safety curriculum, have been notified of the child sexual abuse/personal safety curriculum for their child and the individual record for each child shall include a copy of the signed notification form. (3) If a parent has questions regarding the personal safety component of the quality early childhood education curriculum, then the provider or a representative of the provider shall meet with the parent and discuss the personal safety component of the curriculum. (4) The department of human services is expressly authorized and directed to implement by emergency rules, effective October 1, 2008, a rule regarding implementation of this requirement for the personal safety curriculum; provided, that any permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act.
(1) The department of human services shall make available to child care providers licensed by the department a curriculum guideline in any suitable format addressing personal safety containing a component related to the prevention of child sexual abuse and shall allow child care providers licensed by the department to choose terminology and instructional methods that accomplish the goal of providing clear, effective and appropriate instruction in personal safety. The department is encouraged to distribute a sample curriculum that is developmentally-appropriate and age-appropriate, child-friendly and family-friendly, and designed to be acceptable to a broad range of providers, parents and legal guardians.
(2) The personal safety curriculum that will be implemented by the child care provider must be made available so parents and legal guardians have the opportunity to review it and so parents and legal guardians will be aware of this component of the child care provider's curriculum. The department shall develop a standard notification form to be provided to the parents or legal guardians by the child care agency. The notification form shall contain the following information: (A) The method of instruction and sample terminology used in the personal safety/child sexual abuse curriculum; (B) The availability of the instructional materials for review by the parents or legal guardians; and (C) A place for the parents or legal guardians to sign acknowledging they have been provided an opportunity to review the personal safety curriculum, have been notified of the child sexual abuse/personal safety curriculum for their child and the individual record for each child shall include a copy of the signed notification form.
(A) The method of instruction and sample terminology used in the personal safety/child sexual abuse curriculum;
(B) The availability of the instructional materials for review by the parents or legal guardians; and
(C) A place for the parents or legal guardians to sign acknowledging they have been provided an opportunity to review the personal safety curriculum, have been notified of the child sexual abuse/personal safety curriculum for their child and the individual record for each child shall include a copy of the signed notification form.
(3) If a parent has questions regarding the personal safety component of the quality early childhood education curriculum, then the provider or a representative of the provider shall meet with the parent and discuss the personal safety component of the curriculum.
(4) The department of human services is expressly authorized and directed to implement by emergency rules, effective October 1, 2008, a rule regarding implementation of this requirement for the personal safety curriculum; provided, that any permanent rules shall be promulgated pursuant to the Uniform Administrative Procedures Act.
Amended by 2021 Tenn. Acts, ch. 280, Secs.s 2, s 3, s 4, s 5, s 6, s 7, s 8, s 9, s 10, s 11, s 12, s 13, s 14, s 15, s 16, s 17, s 18, s 19, s 20, s 21 eff. 7/1/2021.
Amended by 2021 Tenn. Acts, ch. 280, s 1, eff. 7/1/2021.
Amended by 2016 Tenn. Acts, ch. 839, s 13, eff. 7/1/2016.
Acts 2000, ch. 981, § 3; 2001, ch. 453, §§ 3 - 6, 24, 25; 2003 , ch. 170, § 2; 2004, ch. 696, § 1; 2005, ch. 151, §§ 2 - 7; 2005, ch. 453, §§ 1, 2; 2006, ch. 906, § 1; 2008 , ch. 687, § 1; 2008 , ch. 1032, § 1; 2009 , ch. 566, § 12; 2010 , ch. 789, §§ 1 - 3; 2010 , ch. 1132, § 1; 2011 , ch. 410, § 3 (ii).
Tenn. Code Ann. § 71-6-125 — TN Code / Title 71 / Chapter 6 / Section 71-6-125
Vulnerable adult protective investigative team
Status: in_force

(a) By January 1, 2017, the district attorney general of each judicial district shall establish, or cause to be established, a vulnerable adult protective investigative team (VAPIT) for the purpose of: (1) Coordinating the investigation of suspected instances of abuse, neglect, or exploitation of an adult; and (2) Receiving and reviewing information generated by the multi-disciplinary adult protective services evaluation teams as established in § 71-1-110 . (b) As determined by the district attorney general, or the district attorney's designee, the VAPIT shall consist of representatives from within the judicial district, wherever appropriate, of: (1) The district attorney general, or the district attorney's designee; (2) Local law enforcement agencies; (3) The department's adult protective services section; and (4) Any other entity that the district attorney general, or the district attorney's designee, determines is necessary for the successful operation of the VAPIT. (c) Each VAPIT shall: (1) Meet regularly, as determined by the district attorney general, or the district attorney's designee; provided, that meetings shall be held at least quarterly; and (2) Conduct coordinated responses and investigations of instances of suspected abuse, neglect, or exploitation of adults. (d) (1) By January 31 of the following year, each district attorney general shall cause to be filed an annual report that summarizes the work of the VAPIT for the previous calendar year with the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives. The report may be filed electronically. (2) By January 31 of each year, the department shall report the following information from the adult protective services program to the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives: (A) The number of reports received for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (B) The number of reports assigned for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (C) The number of reports not assigned due to not meeting criteria for adult protective services investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (D) The number of final investigative dispositions of cases obtained in the current reporting year by type of disposition as follows: (i) Unsubstantiated, closed, no services provided; (ii) Substantiated, closed, client refused services; (iii) Substantiated, closed, no services provided; or (iv) Substantiated, closed, services provided; (E) Demographic information, including age and gender of clients, in cases that are included in subdivisions (d)(2)(D)(ii)-(iv); and (F) Relationship to the victim of perpetrators identified in cases that are included in subdivisions (d)(2)(D)(ii)-(iv) and that are not related only to self-neglect. (e) (1) Except as otherwise permitted by law, records, reports, and information concerning reports of abuse, neglect, or exploitation of an adult shall be kept confidential among the VAPIT's members. (2) Disclosure of the items in subdivision (e)(1) may be made to persons and entities directly involved in the administration of this section, including: (A) Attorneys, next friends, or other representatives of the adult client who are legally authorized to act in the adult client's interest; (B) Representatives of law enforcement; (C) Grand juries or courts in the exercise of official business; (D) Members of the VAPIT; and (E) Persons engaged in bona fide research or audit purposes; provided, that only information in the aggregate without identifying information may be provided for research or audit purposes and confidentiality of the data is maintained. (3) Unless necessary for the provision of medical, legal, housing, social welfare, or other services, the name of the potential or actual victim or client may only be shared outside of the VAPIT with representatives of law enforcement and organizations devoted to victims' services or advocacy. (4) If adequate resources are available, the VAPIT may maintain a database of information about past and ongoing cases; provided, that identifying information about individual victims and clients shall not be accessed by any person outside of the VAPIT. (5) Identifying information for the person who reports a case of suspected abuse, neglect, or exploitation of an adult shall be kept strictly confidential. The identifying information shall not be disclosed to any person or organization within or without the VAPIT, unless the reporting person expressly consents to disclosure. (f) Any person participating in good faith in any action or omission authorized or required under this section shall be immune from civil or criminal liability that may result by reason of such action or omission. (g) Any obligation or duty imposed upon a district attorney general by this section shall be contingent upon the availability of adequate resources. Amended by 2022 Tenn. Acts, ch. 1081, s 1, eff. 5/27/2022. Amended by 2021 Tenn. Acts, ch. 64, s 130, eff. 3/29/2021. Amended by 2019 Tenn. Acts, ch. 474, s 17, eff. 1/1/2020. Amended by 2019 Tenn. Acts, ch. 345, s 145, eff. 5/10/2019. Added by 2016 Tenn. Acts, ch. 1006, s 1, eff. 4/27/2016.
(a) By January 1, 2017, the district attorney general of each judicial district shall establish, or cause to be established, a vulnerable adult protective investigative team (VAPIT) for the purpose of: (1) Coordinating the investigation of suspected instances of abuse, neglect, or exploitation of an adult; and (2) Receiving and reviewing information generated by the multi-disciplinary adult protective services evaluation teams as established in § 71-1-110 .
(1) Coordinating the investigation of suspected instances of abuse, neglect, or exploitation of an adult; and
(2) Receiving and reviewing information generated by the multi-disciplinary adult protective services evaluation teams as established in § 71-1-110 .
(b) As determined by the district attorney general, or the district attorney's designee, the VAPIT shall consist of representatives from within the judicial district, wherever appropriate, of: (1) The district attorney general, or the district attorney's designee; (2) Local law enforcement agencies; (3) The department's adult protective services section; and (4) Any other entity that the district attorney general, or the district attorney's designee, determines is necessary for the successful operation of the VAPIT.
(1) The district attorney general, or the district attorney's designee;
(2) Local law enforcement agencies;
(3) The department's adult protective services section; and
(4) Any other entity that the district attorney general, or the district attorney's designee, determines is necessary for the successful operation of the VAPIT.
(c) Each VAPIT shall: (1) Meet regularly, as determined by the district attorney general, or the district attorney's designee; provided, that meetings shall be held at least quarterly; and (2) Conduct coordinated responses and investigations of instances of suspected abuse, neglect, or exploitation of adults.
(1) Meet regularly, as determined by the district attorney general, or the district attorney's designee; provided, that meetings shall be held at least quarterly; and
(2) Conduct coordinated responses and investigations of instances of suspected abuse, neglect, or exploitation of adults.
(d) (1) By January 31 of the following year, each district attorney general shall cause to be filed an annual report that summarizes the work of the VAPIT for the previous calendar year with the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives. The report may be filed electronically. (2) By January 31 of each year, the department shall report the following information from the adult protective services program to the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives: (A) The number of reports received for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (B) The number of reports assigned for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (C) The number of reports not assigned due to not meeting criteria for adult protective services investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (D) The number of final investigative dispositions of cases obtained in the current reporting year by type of disposition as follows: (i) Unsubstantiated, closed, no services provided; (ii) Substantiated, closed, client refused services; (iii) Substantiated, closed, no services provided; or (iv) Substantiated, closed, services provided; (E) Demographic information, including age and gender of clients, in cases that are included in subdivisions (d)(2)(D)(ii)-(iv); and (F) Relationship to the victim of perpetrators identified in cases that are included in subdivisions (d)(2)(D)(ii)-(iv) and that are not related only to self-neglect.
(1) By January 31 of the following year, each district attorney general shall cause to be filed an annual report that summarizes the work of the VAPIT for the previous calendar year with the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives. The report may be filed electronically.
(2) By January 31 of each year, the department shall report the following information from the adult protective services program to the chairs of the judiciary committee of the senate and the criminal justice committee of the house of representatives: (A) The number of reports received for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (B) The number of reports assigned for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (C) The number of reports not assigned due to not meeting criteria for adult protective services investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation; (D) The number of final investigative dispositions of cases obtained in the current reporting year by type of disposition as follows: (i) Unsubstantiated, closed, no services provided; (ii) Substantiated, closed, client refused services; (iii) Substantiated, closed, no services provided; or (iv) Substantiated, closed, services provided; (E) Demographic information, including age and gender of clients, in cases that are included in subdivisions (d)(2)(D)(ii)-(iv); and (F) Relationship to the victim of perpetrators identified in cases that are included in subdivisions (d)(2)(D)(ii)-(iv) and that are not related only to self-neglect.
(A) The number of reports received for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation;
(B) The number of reports assigned for investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation;
(C) The number of reports not assigned due to not meeting criteria for adult protective services investigation by type, such as emotional abuse, physical abuse, sexual abuse, neglect, self-neglect, and financial exploitation;
(D) The number of final investigative dispositions of cases obtained in the current reporting year by type of disposition as follows: (i) Unsubstantiated, closed, no services provided; (ii) Substantiated, closed, client refused services; (iii) Substantiated, closed, no services provided; or (iv) Substantiated, closed, services provided;
(i) Unsubstantiated, closed, no services provided;
(ii) Substantiated, closed, client refused services;
(iii) Substantiated, closed, no services provided; or
(iv) Substantiated, closed, services provided;
(E) Demographic information, including age and gender of clients, in cases that are included in subdivisions (d)(2)(D)(ii)-(iv); and
(F) Relationship to the victim of perpetrators identified in cases that are included in subdivisions (d)(2)(D)(ii)-(iv) and that are not related only to self-neglect.
(e) (1) Except as otherwise permitted by law, records, reports, and information concerning reports of abuse, neglect, or exploitation of an adult shall be kept confidential among the VAPIT's members. (2) Disclosure of the items in subdivision (e)(1) may be made to persons and entities directly involved in the administration of this section, including: (A) Attorneys, next friends, or other representatives of the adult client who are legally authorized to act in the adult client's interest; (B) Representatives of law enforcement; (C) Grand juries or courts in the exercise of official business; (D) Members of the VAPIT; and (E) Persons engaged in bona fide research or audit purposes; provided, that only information in the aggregate without identifying information may be provided for research or audit purposes and confidentiality of the data is maintained. (3) Unless necessary for the provision of medical, legal, housing, social welfare, or other services, the name of the potential or actual victim or client may only be shared outside of the VAPIT with representatives of law enforcement and organizations devoted to victims' services or advocacy. (4) If adequate resources are available, the VAPIT may maintain a database of information about past and ongoing cases; provided, that identifying information about individual victims and clients shall not be accessed by any person outside of the VAPIT. (5) Identifying information for the person who reports a case of suspected abuse, neglect, or exploitation of an adult shall be kept strictly confidential. The identifying information shall not be disclosed to any person or organization within or without the VAPIT, unless the reporting person expressly consents to disclosure.
(1) Except as otherwise permitted by law, records, reports, and information concerning reports of abuse, neglect, or exploitation of an adult shall be kept confidential among the VAPIT's members.
(2) Disclosure of the items in subdivision (e)(1) may be made to persons and entities directly involved in the administration of this section, including: (A) Attorneys, next friends, or other representatives of the adult client who are legally authorized to act in the adult client's interest; (B) Representatives of law enforcement; (C) Grand juries or courts in the exercise of official business; (D) Members of the VAPIT; and (E) Persons engaged in bona fide research or audit purposes; provided, that only information in the aggregate without identifying information may be provided for research or audit purposes and confidentiality of the data is maintained.
(A) Attorneys, next friends, or other representatives of the adult client who are legally authorized to act in the adult client's interest;
(B) Representatives of law enforcement;
(C) Grand juries or courts in the exercise of official business;
(D) Members of the VAPIT; and
(E) Persons engaged in bona fide research or audit purposes; provided, that only information in the aggregate without identifying information may be provided for research or audit purposes and confidentiality of the data is maintained.
(3) Unless necessary for the provision of medical, legal, housing, social welfare, or other services, the name of the potential or actual victim or client may only be shared outside of the VAPIT with representatives of law enforcement and organizations devoted to victims' services or advocacy.
(4) If adequate resources are available, the VAPIT may maintain a database of information about past and ongoing cases; provided, that identifying information about individual victims and clients shall not be accessed by any person outside of the VAPIT.
(5) Identifying information for the person who reports a case of suspected abuse, neglect, or exploitation of an adult shall be kept strictly confidential. The identifying information shall not be disclosed to any person or organization within or without the VAPIT, unless the reporting person expressly consents to disclosure.
(f) Any person participating in good faith in any action or omission authorized or required under this section shall be immune from civil or criminal liability that may result by reason of such action or omission.
(g) Any obligation or duty imposed upon a district attorney general by this section shall be contingent upon the availability of adequate resources.
Amended by 2022 Tenn. Acts, ch. 1081, s 1, eff. 5/27/2022.
Amended by 2021 Tenn. Acts, ch. 64, s 130, eff. 3/29/2021.
Amended by 2019 Tenn. Acts, ch. 474, s 17, eff. 1/1/2020.
Amended by 2019 Tenn. Acts, ch. 345, s 145, eff. 5/10/2019.
Added by 2016 Tenn. Acts, ch. 1006, s 1, eff. 4/27/2016.