[Effective 7/1/2024]

(a)

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Terms Used In Tennessee Code 68-11-202 v2

  • Adult care home: means a single family residence licensed pursuant to this part in which twenty-four-hour residential care, including assistance with activities of daily living, is provided in a homelike environment to no more than five (5) adults who are elderly or have a disability. See Tennessee Code 68-11-201
  • Ambulatory surgical treatment center: means any institution, place, or building devoted primarily to the maintenance and operation of a facility for the performance of surgical procedures or any facility in which a surgical procedure is utilized to terminate a pregnancy. See Tennessee Code 68-11-201
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
  • commission: means the health facilities commission created by §. See Tennessee Code 68-11-201
  • Commissioner: means the commissioner of health, the commissioner's authorized representative, or in the event of the commissioner's absence or a vacancy in the office of commissioner, the deputy commissioner of health. See Tennessee Code 68-11-201
  • Department: means the department of health. See Tennessee Code 68-11-201
  • Evaluation: means the determination and documentation of the physiological and functional factors that impact the selection of an appropriate seating and wheeled mobility device. See Tennessee Code 68-11-201
  • Executive director: means the executive director of the health facilities commission. See Tennessee Code 68-11-201
  • Facility: means any institution, place or building providing health care services that is required to be licensed under this chapter. See Tennessee Code 68-11-201
  • Minor: means any person who has not attained eighteen (18) years of age. See Tennessee Code 1-3-105
  • Patient: includes , but is not limited to, any person who is suffering from an acute or chronic illness or injury or who is crippled, convalescent or infirm, or who is in need of obstetrical, surgical, medical, nursing or supervisory care. See Tennessee Code 68-11-201
  • Person: means any individual, partnership, association, corporation, other business entity, state or local governmental agencies and entities, and federal agencies and entities to the extent permitted by federal law. See Tennessee Code 68-11-201
  • physician: includes a podiatrist licensed under title 63, chapter 3. See Tennessee Code 68-11-201
  • Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
  • Resident manager: means a person twenty-one (21) years of age or older who lives in an adult care home and oversees the day-to-day operation of the adult care home on behalf of the adult care home provider and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to §. See Tennessee Code 68-11-201
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Substitute caregiver: means any person twenty-one (21) years of age or older who temporarily oversees care and services in an adult care home during the short-term absence of the adult care home provider or resident manager and meets all education, training and experience requirements prescribed in this part and in regulations promulgated by the board pursuant to §. See Tennessee Code 68-11-201
  • Traumatic brain injury residential home: means a facility owned and operated by a community-based traumatic brain injury (TBI) adult care home provider in which residential care, including assistance with activities of daily living, is provided in a homelike environment to disabled adults suffering from the effects of a traumatic brain injury as defined in §. See Tennessee Code 68-11-201
  • Traumatic brain injury residential home provider: means a person twenty-one (21) years of age or older who owns and operates a traumatic brain injury residential home. See Tennessee Code 68-11-201
  • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105
(1) The commission is empowered to license and regulate hospitals, recuperation centers, nursing homes, homes for the aged, residential HIV supportive living facilities, assisted-care living facilities, home care organizations, residential hospices, birthing centers, prescribed child care centers, renal dialysis clinics, ambulatory surgical treatment centers, outpatient diagnostic centers, adult care homes, and traumatic brain injury residential homes.
(2) [Deleted by 2023 amendment.]
(b)

(1)

(A) The commission has the authority to conduct reviews of all facilities licensed under this part in order to determine compliance with fire and life safety code rules as promulgated by the commission.
(B) Chapter 102 of this title does not apply to facilities subject to review and licensure under this part.
(C) The commission has the power to adopt fire and life safety code rules to be applied to facilities licensed under this part.
(D) In adopting the rules, the commission may in its discretion adopt, in whole or in part, by reference, recognized national or regional building and fire safety codes.
(E) Adult care homes and traumatic brain injury residential homes shall meet all state and local building, sanitation, utility, and fire code requirements applicable to single family dwellings. The commission may adopt in rules more stringent standards as the commission deems necessary in order to ensure the health and safety, including adequate evacuation, of residents consistent with this part. As used in this section, “adequate evacuation” means the ability of the adult care home provider, traumatic brain injury residential home provider, resident manager, or substitute caregiver, including additional minimum staff as may be required by the commission by rule in accordance with this part, to evacuate all residents from the dwelling within five (5) minutes. Adult care home providers and traumatic brain injury residential home providers shall install smoke detectors in all resident bedrooms, hallways, or access areas that adjoin bedrooms, and common areas where residents congregate, including living or family rooms and kitchens. In addition, in multi-level homes, smoke alarms must be installed at the top of stairways. At least one (1) fire extinguisher with a minimum classification as specified by the commission must be in a visible and readily accessible location in each room, including basements, and be checked at least once a year by a qualified entity. Adult care home providers and traumatic brain injury residential home providers shall not place residents who are unable to walk without assistance or who are incapable of independent evacuation in a basement, split-level, second story, or other area that does not have an exit at ground level. There must be a second safe means of exit from all sleeping rooms. Providers whose sleeping rooms are above the first floor shall demonstrate an evacuation drill from that room, using the secondary exit, at the time of licensure, renewal, or inspection.
(2) The commission, in its evaluation of prospective rules, shall consider recommendations and professional assessments from the Tennessee society of architects and the Tennessee society of professional engineers.
(3) If rules adopted by the commission are not consistent with federal regulations for facilities participating in Titles XVIII of the federal Social Security Act (42 U.S.C. § 1395 et seq.), and XIX of the federal Social Security Act (42 U.S.C. § 1396 et seq.), then the commission shall request appropriate waivers from the federal government for facilities previously deemed in compliance.
(4) Until the commission adopts building and fire safety rules pursuant to this section, the codes and rules in effect on July 1, 1981, apply to those facilities licensed under this part. A facility that complies with the required applicable building and fire safety regulations at the time the commission adopts new codes or rules is, as long as compliance is maintained, either with or without waivers of specific provisions, considered to be in compliance with the new codes or rules.
(5)

(A) The commissioner of commerce and insurance or executive director of the health facilities commission shall review subsequently adopted codes and may recommend to the commission for adoption provisions of such codes that the commissioner or executive director deems material to the life and fire safety of residents and patients.
(B) Subdivision (b)(5)(A) applies to all appropriate facilities in the respective provider categories, including, but not limited to, nursing homes, hospitals, homes for the aged, residential HIV supportive living facilities, adult care homes, and traumatic brain injury residential homes.
(6) This section does not affect the authority of the state fire marshal regarding the prevention and investigation of fires pursuant to chapter 102 of this title.
(7) The building and life safety rules adopted by the commission are the exclusive rules applicable for those purposes. To the extent that regulations adopted by local governments conflict with the rules adopted by the commission, the commission’s rules control.
(c)

(1) If construction is planned by a facility required to be licensed by the commission, except home care organizations as defined in § 68-11-201, for a building, additions to an existing building, or substantial alterations to an existing building, then two (2) sets of plans and specifications must be submitted to the commission to be approved. However, only one (1) set of schematics must be submitted to the commission for approval of plans and specifications converting an existing single-family dwelling into a:

(A) Licensed residential healthcare facility with six (6) or fewer beds;
(B) Licensed adult care home with five (5) or fewer residents; or
(C) Traumatic brain injury residential home with eight (8) or fewer residents.
(2) Before construction begins, approval of the plans and specifications must be obtained from the commission with respect to compliance with the minimum standards or rules, or both, of the commission.
(3) The commission may determine by rule specific types of site activity that may be initiated prior to approval.
(4) The plans must be accurate and detailed, containing the information, and drafted and submitted in a manner, that the commission may require by rule.
(5) The commission shall expeditiously process its review of plans that have been submitted in the full and final form required by rule.
(6) At the request of the owner of the proposed project or the design professional, the commission shall make plan review staff available for advice and consultation regarding programmatic concepts and preliminary plans early in the planning process.
(7) The commission shall assign adequate numbers of qualified staff to the plan review section to ensure that a thirty-day review cycle is provided on a submittal.
(8) If, upon final inspection or reinspection of the completed project, the commission’s representative finds that only minor items remain to be completed or corrected that do not significantly affect the health or safety of the occupants, then the commission’s representative shall permit occupancy pending completion or correction of those items.
(d) Standards adopted by the commission regarding accessibility by the handicapped must be no less strict than those in chapter 120 of this title.
(e)

(1) This subsection (e):

(A) Establishes the criteria for the creation of branch offices by a home care organization operating pursuant to its certificate of need authority or pursuant to its license as of May 11, 1998; and
(B) Does not permit a home care organization to expand its authority beyond the limitations of its certificate of need or its license as of May 11, 1998.
(2) Notwithstanding this section to the contrary, the offices of a home care organization providing home health services must be classified as either a parent office of the home care organization or as a branch office of the home care organization. In determining whether the office of a home care organization providing home health services is either a parent home care organization or a branch office, the commission shall apply the following criteria:

(A) A parent office shall develop and maintain administrative controls of the branch office and house the administrative functions of the home care organization. The parent office is ultimately responsible for human resource activities and all financial and contractual agreements for the home care organization, including both parent and branch offices;
(B) The administrator and director of nursing for the home care organization shall be primarily located in the parent office. The home care organization administrator and director of nursing shall make on-site supervisory visits to each branch office at least quarterly;
(C) A branch office is an office that provides services within the geographical area for which the home care organization is licensed. A branch office must be sufficiently close to share administrative services with the parent office. A branch office is deemed to be sufficiently close if it is within one hundred (100) miles of the parent office; provided, that the remaining criteria set forth in this subsection (e) also apply. A branch office that is greater than one hundred (100) miles from a parent office may be considered a branch office by the commission, if it otherwise meets the criteria set forth in this subsection (e);
(D) The parent office of a home care organization shall have a clearly defined process to ensure that effective interchange occurs between the parent and branch regarding various functions, including branch staffing requirements, branch office patient census, total visits provided by the branch, complaints, incident reports, and referrals;
(E) The branch office of a home care organization shall maintain the same name and standards of practice as the parent office of the home care organization, including forms, policies, procedures, and service delivery standards. The parent office of a home care organization shall maintain documentation of integration between the parent office and its branch offices;
(F) The parent office of a home care organization shall maintain regular administrative contact with its branch offices at least weekly. The parent office shall maintain documentation of this contact. The parent office must receive weekly written staffing reports from its branch offices, including information regarding staffing needs, staffing patterns, and staff productivity; and
(G) A branch office of a home care organization existing as of May 11, 1998, that is more than one hundred (100) miles from the parent office of the home care organization and that has been previously approved as a branch office by the commission may continue to be classified as a branch office if it otherwise meets the criteria set forth in this subsection (e).
(f)

(1) In a gastrointestinal endoscopy clinic that is regulated as an ambulatory surgical treatment center that performs endoscopic procedures, the use of an endoscopy technician, without other technicians, to assist a physician performing an endoscopic procedure in the clinic is deemed to be sufficient staffing for the procedure.
(2) For the purposes of this subsection (f), an endoscopy technician is a person who is trained to function in an assistive role in a gastroenterology setting. An endoscopy technician’s scope of practice includes:

(A) Assisting in data collection to identify the patient’s needs, problems, concerns, or human responses;
(B) Assisting, under the direction of the gastroenterology registered nurse and physician, in the implementation of the established plan of care;
(C) Assisting the gastroenterology registered nurse and physician before, during, and after diagnostic and therapeutic procedures;
(D) Providing and maintaining a safe environment for the patient and staff by complying with regulatory agency requirements and standards set forth by professional organizations and employers;
(E) Taking responsibility for personal continuing education;
(F) Having knowledge of practice issues related to the field of gastroenterology;
(G) Compliance with ethical, professional, and legal standards inherent to in-patient care and professional conduct;
(H) Participating in quality management activities as directed; and
(I) Collaborating within the gastroenterology team and with other healthcare professionals to ensure quality and continuity of care.
(g)

(1) An ambulatory surgical treatment center shall provide radiological staff services commensurate with the needs of the center within the facility or by means of other appropriate arrangement.
(2) If radiologic services are utilized by an ambulatory surgical treatment center, then the governing body of the center shall appoint an individual who is responsible for assuring that all radiologic services are provided in accordance with applicable laws and rules. The individual must be qualified in accordance with state law and the policies of the center.
(h) Notwithstanding a law to the contrary, the commission has the authority to amend the commission’s rules for licensure of a commission-regulated facility or entity as needed to be consistent with the federal home-based and community-based settings final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014), including the authority to differentiate licensure requirements for a commission-regulated facility or entity contracted to provide medicaid-reimbursed home- and community-based services pursuant to title 71, chapter 5, part 14, in order to allow the facility or entity to comply with the federal rule and continue to receive medicaid reimbursement for home- and community-based services. Rules adopted by the commission under this subsection (h) must be developed with input from stakeholders and promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5; except that the commission shall not promulgate emergency rules under this subsection (h) as defined in § 4-5-208. Licensure survey and enforcement must be conducted in a manner consistent with a rule issued under this subsection (h).
(i)

(1) The commission may license, for purposes of providing acute care services, a facility that is additionally licensed by the department of mental health and substance abuse services.
(2) The commission may promulgate rules to govern the process of licensing, for purposes of providing acute care services, a facility that is or may become additionally licensed by the department of mental health and substance abuse services and that is not otherwise exempt from licensing under the laws of this state or federal law. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(3) The commission shall consult with the department of mental health and substance abuse services when promulgating rules described in subdivision (i)(2).
(4) This subsection (i) does not alter or preclude the requirement of title 33, chapter 2, part 4, that a facility, not otherwise exempt, obtain licensure from the department of mental health and substance abuse services.
(j) The commission is authorized to promulgate rules governing the designation of rural emergency hospitals in a manner consistent with the federal regulations of the federal centers for medicare and medicaid services. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
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