[Effective Until 7/1/2024]

(a) Any person, partnership, association, corporation, any state, county or local governmental unit, or any division, department, board or agency of the governmental unit, in order to lawfully establish, conduct, operate or maintain a hospital, recuperation center, nursing home, home for the aged, residential HIV supportive living facility, assisted-care living facility, home care organization, residential hospice, birthing center, prescribed child care center, renal dialysis clinic, outpatient diagnostic center, ambulatory surgical treatment center, adult care home or traumatic brain injury residential homes in this state, shall obtain a license from the commission, upon the approval and recommendation of the board in the following manner:

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Terms Used In Tennessee Code 68-11-206

  • 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
  • Assisted-care living facility: means a facility, building, establishment, complex or distinct part thereof that accepts primarily aged persons for domiciliary care and services as described in this section. See Tennessee Code 68-11-201
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Birthing center: means any institution, facility, place or building devoted exclusively or primarily to the provision of routine delivery services and postpartum care for mothers and their newborn infants. See Tennessee Code 68-11-201
  • commission: means the health facilities commission created by §. See Tennessee Code 68-11-201
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Department: means the department of health. See Tennessee Code 68-11-201
  • Dependent: A person dependent for support upon another.
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • 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
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Home for the aged: means a home represented and held out to the general public as a home which accepts primarily aged persons for relatively permanent, domiciliary care. See Tennessee Code 68-11-201
  • Hospital: means any institution, place, building or agency represented and held out to the general public as ready, willing and able to furnish care, accommodations, facilities and equipment for the use, in connection with the services of a physician or dentist, of one (1) or more nonrelated persons who may be suffering from deformity, injury or disease or from any other condition for which nursing, medical or surgical services would be appropriate for care, diagnosis or treatment. See Tennessee Code 68-11-201
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • Month: means a calendar month. See Tennessee Code 1-3-105
  • Nursing home: means any institution, place, building or agency represented and held out to the general public for the express or implied purpose of providing care for one (1) or more nonrelated persons who are not acutely ill, but who do require skilled nursing care and related medical services. See Tennessee Code 68-11-201
  • Outpatient diagnostic center: except as otherwise limited in this subdivision (33), means any facility providing outpatient diagnostic services, unless the outpatient diagnostic services are provided as the services of another licensed healthcare institution that reports such outpatient diagnostic services on its joint annual report, or the facility is otherwise excluded from this subdivision (33). See Tennessee Code 68-11-201
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • 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
  • Prescribed child care center: means a nonresidential child care, health care/child care center providing physician prescribed services and appropriate developmental services for six (6) or more children who are medically or technology dependent and require continuous nursing intervention. See Tennessee Code 68-11-201
  • Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
  • Recuperation center: means an establishment with permanent facilities that include inpatient beds, with an organized medical staff, and with medical services, including physician services and continuous nursing services, to provide treatment for patients who are not in an acute phase of illness, but who currently require primarily convalescent or restorative services, usually post-acute hospital care of relatively short duration. See Tennessee Code 68-11-201
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Renal dialysis clinic: means any institution, facility, place or building devoted to the provision of renal dialysis on an outpatient basis to persons diagnosed with end stage renal disease. See Tennessee Code 68-11-201
  • 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
  • Residential hospice: means a licensed homelike residential facility designed, staffed and organized to provide hospice or HIV care services, or both, except the services shall be provided at the residential facility rather than the patient's regular or temporary place of residence. 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
  • 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
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105
(1) The applicant shall submit an application on a form to be prepared by the commission with the approval of the board, showing that the applicant is of reputable and responsible character and able to comply with the minimum standards for a facility and with rules and regulations lawfully promulgated under this part. The application shall contain the following additional information:

(A) The name or names of the applicant or applicants;
(B) The type of institution to be operated;
(C) The location of the institution;
(D) The name of the person or persons to be in charge of the institution or, for adult care home applicants, the name of the resident manager, if applicable;
(E) A certification that the applicant has implemented a policy of informing its employees of their obligations under § 71-6-103 to report incidents of abuse or neglect;
(F) If an application for a nursing home license, a list of all nursing homes that the applicant, or any person or entity holding a majority legal or equitable interest in the applicant, owns or operates and, if the applicant has not operated a nursing home in this state for a continuous period of twenty-four (24) months preceding the application, the information specified in § 68-11-804(c)(1) for each such nursing home located outside this state; and
(G) Such other information as the commission, with the approval of the board, may require;
(2)

(A) In addition to the requirements in subdivision (a)(1), an application for an adult care home or traumatic brain injury residential home license shall include the following additional information:

(i) The maximum number of residents;
(ii) Type of license;
(iii) If any residents are family members of the applicant;
(iv) Names and locations of all other facilities in and outside this state for which the applicant has any license and the compliance history of each facility, including penalties, suspensions or other disciplinary actions;
(v) The extent to which a resident manager, substitute caregivers and other staff will be used in the facility;
(vi) A list of any unsatisfied judgments;
(vii) Past or pending litigation against the applicant;
(viii) Unpaid local, state and federal taxes;
(ix) Notification regarding any bankruptcy filings made by the applicant;
(x) Demonstration of the applicant’s financial ability to maintain sufficient financial resources to support the operating costs of the adult care home or traumatic brain injury residential home; and
(xi) A comprehensive business plan for the first two (2) years of operation;
(B) The board shall promulgate regulations specifying additional financial requirements, such as bonds or liability insurance;
(C) An adult care home provider shall obtain a separate license for each adult care home. An adult care home provider may, upon operation of a licensed adult care home for a minimum period of one (1) year and completion of an annual licensure survey without any findings of noncompliance resulting in penalties, suspensions or other disciplinary actions, submit application to separately license a second adult care home. Only upon operation of two (2) licensed adult care homes for a consecutive period of at least one (1) year, licensure survey in each facility without any findings of noncompliance resulting in penalties, suspensions or other disciplinary actions, may an adult care home provider submit application to separately license additional adult care homes. The board may grant an exception to the one-at-a-time license requirement for Level 2 adult care homes for nursing facilities, assisted-care living facilities and other providers when such nursing facility, assisted-care living facility or provider has demonstrated expertise in delivering the specialized services necessary to the specified population that would be served by the licensed adult care homes. The board may establish in regulations a limit on the total number of adult care homes that can be operated by a single adult care home provider;
(D) A Level 2 license allows an adult care home provider to serve adults requiring specialized services. As used in this section, “specialized services” means services provided to ventilator dependent residents and residents with a traumatic brain injury as defined in § 68-55-101. The applicant shall specify the type of license sought as a part of its application. The board shall promulgate regulations specifying additional requirements for a Level 2 license;
(E) A license authorized by this part allows a traumatic brain injury residential home provider to serve disabled adults suffering from the effects of a traumatic brain injury as defined in § 68-55-101. A traumatic brain injury residential home provider shall not be required to obtain a Level 2 or any other licensure, other than a license to operate its day services through a separate facility licensed by this state. The board shall promulgate regulations specifying additional requirements for traumatic brain injury residential home licensure consistent with this part;
(3) At a minimum, Level 2 adult care home providers serving ventilator-dependent residents shall meet all of the following requirements:

(A) Have an audible, redundant alarm system located outside of resident’s room to alert the adult care home provider or resident manager of a resident disconnection or ventilator failure;
(B) Have a functioning emergency back-up generator adequate to maintain electrical service for residentsT needs until regular service is restored;
(C) All ventilators shall be equipped with internal battery backup systems;
(D) A backup ventilator shall be available at all times;
(4) The board shall promulgate in regulation additional licensure requirements that define appropriate health and safety standards necessary to protect the health and welfare of residents. Specific elements to be addressed include, but are not limited to:

(A) Facility and building standards;
(B) Minimum size and number of bedrooms and bathrooms;
(C) Number of residents to a bedroom and a bathroom;
(D) Sanitation;
(E) Hazardous waste disposal;
(F) Disaster preparedness;
(G) Medication administration and storage; and
(H) Resident record requirements;
(5)

(A) The board shall maintain current information on all licensed adult care home providers. The information shall include:

(i) Name, location and mailing address of the facility;
(ii) Description of the facility;
(iii) Date of last inspection;
(iv) Penalties;
(v) Suspensions; and
(vi) Other disciplinary actions;
(B) The information shall be made available upon request to a prospective resident, resident, or family member;
(6) If the board determines that a license for any facility will not be granted, it shall so notify the applicant. The decision of the board shall be final;
(7) If the board finds that the applicant complies with this part and the rules and regulations promulgated under this part, then the board shall recommend and approve the issuance of a license, and thereupon a license shall be issued by the commission licensing the applicant to operate the facility for the remainder of the fiscal year; and
(8) Each license to operate a facility shall expire annually on the anniversary date of its original issuance and shall become invalid on that date unless renewed. A licensee may renew its license within sixty (60) days following the license expiration date upon payment of the renewal fee in addition to a late penalty established by the board for each month or fraction of a month that payment for renewal is late; provided, that the late penalty shall not exceed twice the renewal fee. If a licensee fails to renew its license within sixty (60) days following the license expiration date, then the licensee shall reapply for licensure in accordance with the rules established by the board. However, during the transition period, renewed licenses may be issued at prorated monthly renewal fee rates for terms of no less than five (5) months nor more than eighteen (18) months. A license shall not be assignable or transferable, shall be issued only for the premises named in the application, shall be posted in a conspicuous place in the facility, and may be renewed from year to year.
(b)

(1) Upon request by a licensee, the board shall have authority to place a license in an inactive status for a period determined by the board upon a finding that:

(A) The licensee has a need to temporarily suspend operations; and
(B) The licensee intends to continue operations after a period of suspension.
(2) Placing a license in an inactive status shall not relieve the licensee from the annual license fees imposed by § 68-11-216.
(c) Any condition placed on the issuance of a certificate of need pursuant to § 68-11-1605 shall be deemed a condition on any subsequently issued license under this section.
(d)

(1) This subsection (d) controls the recovery and collection of civil monetary penalties for which a facility or individual is liable under this part.
(2) An action to recover or collect a civil monetary penalty owed pursuant to this part shall not be taken until:

(A) The facility or individual has waived the right to a contested case hearing pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3;
(B) The time allowed for the facility or individual to demand a contested case hearing has expired without a demand being made or a denial filed; or
(C) A final administrative order has been entered pursuant to § 4-5314.
(3) If the full amount of the civil monetary penalty owed pursuant to this part has not been received in full within sixty (60) days from the occurrence of an event described in subdivision (d)(2), or received by the due date specified by order, then the executive director of the health facilities commission shall immediately proceed to recover such amount, plus interest computed at the applicable formula rate as defined in § 47-14-102, retroactive to the earliest date of occurrence of an event described in subdivision (d)(2), by one (1) or more of the following means:

(A) Directing the reduction of the amount owed from any balance otherwise due from the state to the facility and directing a remittance of the amount to the health facilities commission;
(B) Adding such amounts to the licensing fee, with renewal of the license pursuant to subdivision (a)(8) and § 68-11-216 contingent upon the prior payment of such costs; or
(C) Bringing, an action in circuit or chancery court to recover such amounts.
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