Adult Day Care in Tennessee

All states: adult day services map

Tennessee adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Tennessee?

Tennessee has one license for adult day care, the adult day services center license, issued by the Tennessee Department of Human Services (DHS). There is no separate adult day health care license. TennCare, the state Medicaid program, pays for the same licensed service under the name Adult Day Care and relies on the DHS license instead of setting its own center standards.

Three layers of rules can apply to a Tennessee center, and each comes from a different agency:

• Licensing (DHS). The Adult Day Services Standards, Tenn. Comp. R. & Regs. Chapter 1240-07-10, adopted under T.C.A. 71-2-401 and following. These rules cover the license, staffing, space, services, records and incident reporting for every center, whatever the payer.
• Medicaid (TennCare). The TennCare CHOICES rules (Tenn. Comp. R. & Regs. 1200-13-01-.05) decide who can get Adult Day Care paid by Medicaid, how many hours, and how it is authorized. CHOICES is run through TennCare's managed care health plans. TennCare also runs PACE in the Chattanooga area.
• Other funding. The U.S. Department of Veterans Affairs pays for adult day health care for some veterans. The DHS adult day program itself is funded through the federal Social Services Block Grant.

The licensing rules define adult day services as care for 5 or more adults, for more than 3 hours but less than 24 hours a day, by someone not related to them, under an individualized plan that uses medical or social services (1240-07-10-.03). Because that definition covers both medical and social services, both kinds of program fall under the same license. Programs that serve people with Alzheimer's disease are also subject to T.C.A. 68-11-1401 and following, but the adult day rules do not create a separate dementia license.

Where the layers overlap, the DHS licensing rules are the stricter layer for how a center operates. TennCare adds its own eligibility rules, prior authorization by the health plan, and a cap on yearly hours.

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

Yes, if your program will serve 5 or more adults for more than 3 hours a day. DHS licenses these centers whether participants pay privately, through TennCare or some other way. A new center starts with a 6-month temporary license and then moves to an annual license.

How to apply. DHS lays out the steps on its How to Become a Licensed Adult Day Services Center page:

• Email the DHS Pre-Licensure Unit (ChildCarePrelicensure.DHS@tn.gov) to attend an informational orientation.
• Open an account in the DHS eLicensing system and complete pre-application training and an orientation or intake session.
• Apply once you have a location. The application includes proof of the director's or owner's education and experience, three references who are not relatives, business documents, written fire and environmental approvals, and criminal background check clearance letters for all employees.
• A DHS program specialist measures your space to set capacity and requests state or local fire, environmental health and Choose Safe Places reviews. You get a codes and zoning clearance letter and any special use or occupancy permits your city or county requires.
• DHS asks for the license fee after all inspections clear, then makes two walk-through visits before granting the temporary license.

Under the 2023 rule text (1240-07-10-.05), fire and environmental approvals must be dated within the 60 days before you apply, and the new director must complete a DHS orientation within the 6 months before licensure. Before the temporary license is issued, the center must carry general liability insurance of at least $500,000 per occurrence and $500,000 aggregate and pass an on-site inspection.

Fees. We did not find published license fee amounts. They are not in the rule or on the DHS licensing pages, so ask DHS. Centers run by a public, nonprofit or municipal body under a DHS grant, which pay an administrative fee under grant monitoring, are exempt from licensing fees. DHS will reimburse fingerprinting costs for people fingerprinted during a licensing year, up to the amount of the license fee paid, if you ask within 90 days of the end of that year.

Certificate of need. We did not find a certificate of need requirement or a moratorium in the adult day rules. Tennessee's separate health planning laws were not checked, so confirm with DHS before you sign a lease.

One license per site. The license states your licensed capacity and must be posted. Each center that shares a property must pass its own fire and environmental inspections (1240-07-10-.04). Under the 2023 rule text a license cannot be moved to another location or another operator.

Buying a center. Under the 2023 rule text, a sale, lease or transfer of control voids the license immediately unless the new operator already holds a temporary license. The rule states no advance notice period. Because the rules were revised in September 2026, check the current process with DHS early in any purchase.

Renewal and inspections. Under the 2023 rule text the annual license must be renewed, with the fee, at least 30 days before it expires, or the center must stop operating. A fire safety inspection is required before the temporary license and before each annual license. DHS says it inspects centers throughout the year and investigates complaints, and the rule allows visits with or without notice.

Exemptions. Programs with fewer than 5 participants, or that run 3 hours a day or less, fall outside the definition. A limited respite program run by a religious organization is exempt if it stays within the limits in T.C.A. 71-2-402 and files an exemption request through the DHS provider portal (see the private-pay section below). The DHS Commissioner may also decide a license is not needed for a center already licensed by another state agency that adequately regulates it.

What are the staffing rules for adult day centers in Tennessee?

Tennessee licensing rules require at least 1 direct care staff member on site for every 8 participants, and at least one more staff member for off-site activities. TennCare does not set its own adult day ratio, so the 1:8 licensing ratio is the one to staff to. We did not find a separate ratio for participants with dementia.

The ratio is in Tenn. Comp. R. & Regs. 1240-07-10-.12. DHS proposed an amendment to this staffing rule in 2026, but it was withdrawn on August 19, 2026, before the other amendments took effect, so the existing text still applies.

• Licensing (DHS): 1:8 direct care staff on site, plus at least 1 more staff member for outings.
• Medicaid (TennCare CHOICES): no ratio specified. The CHOICES definition says the provider must supply all needed help and supervision as part of the service.
• Other funding: we did not find staffing standards for adult day from any other funding source.

Minimum staff on site. At all times the center needs at least one staff member who can read, write and speak English, and at least one direct care staff member certified in CPR and trained in first aid, the Heimlich maneuver and the center's emergency plans.

Who counts toward the ratio. Volunteers count only if they meet the direct care staff qualifications and background check rules. Other volunteers must be supervised by paid direct care staff. High school students aged 14 and older may help but do not count. At least 75 percent of the staff counted in the ratio must have a high school diploma or GED, and staff must be 18 or older, with an exception for students. The rule does not say whether the director counts toward the ratio.

Director. The director must meet one of five education and experience options, ranging from a college degree plus experience to a high school diploma plus 5 years of full-time management experience. An acting director must be named whenever the director is away.

Nurses. We did not find a nurse or RN requirement in the adult day rules (2023 text).

Training. Before starting work, all staff, paid or unpaid, complete DHS-recognized training on universal precautions, fire safety, emergency plans, infection control and abuse reporting. Training on abuse, neglect and exploitation must be done within 30 days. All staff complete 8 hours of DHS-recognized training each year.

Background checks. Under the 2023 rule text (1240-07-10-.09), owners who have contact with participants, employees, directors and volunteers who serve more than 36 hours a year need a fingerprint-based TBI and FBI check, a juvenile records check, and searches of the Health Department vulnerable persons registry, the sex offender registry and the Department of Children's Services child abuse registry, all cleared before they start.

Health screening. We did not find a staff TB test or vaccination requirement in the adult day rules. Ask DHS whether one applies.

What does an adult day center in Tennessee have to provide?

Every licensed Tennessee center provides supervision, personal care as needed, and individualized activities with measurable goals. Centers must also serve a snack or meal to participants who stay 4 hours or more and meet space and restroom minimums. Transportation is optional, but it comes with detailed rules if you offer it.

Services and activities. Activities must include daily exercise, rest, social interaction and mental stimulation. Passive activities such as watching TV can be no more than 20 percent of the planned schedule, and the activity schedule must be posted (1240-07-10-.07). The licensing rules do not require nursing or therapy services.

Meals. Participants in care for at least 4 hours get a snack, or a meal if their time covers a normal meal hour. Food must follow the Dietary Guidelines for Americans and Health Department food service permitting, and a menu must be posted.

Medications. Staff trained in medications may assist with or supervise self-administration, such as reading labels, opening containers and giving reminders, only with physician direction or written authorization from the responsible party. Medication errors are reported the same day to the director, the family and DHS.

Transportation. A center that transports participants is fully responsible for them and needs a written transportation plan, licensed and trained drivers, vehicle liability insurance, a trip log, a walk-through of the vehicle at the end of each trip, and a rest stop at least every 90 minutes on the vehicle.

Space and capacity. Under 1240-07-10-.10:

• At least 40 square feet of indoor activity space per participant, not counting bathrooms, storage or staff-only rooms. Programs inside nursing homes, hospitals, assisted care living facilities or other multi-use buildings need their own dedicated space at the same 40 square feet per participant.
• At least two toilets for the first 15 participants (one wheelchair accessible), plus one more for each additional 10 participants, with at least half wheelchair accessible.
• Space on the ground floor or reachable by ramp or elevator, a rest area with furniture for reclining, an area to separate a participant who becomes ill, office and storage space, and a working landline telephone.

Hours. Centers must have a written hours of operation policy. We did not find a minimum number of days or hours a center must be open.

Written policies. Each center needs written policies on admissions, discharges, fees, hours of operation, transportation (if offered), personnel, and emergency and disaster plans, and must give personnel policies to all employees (1240-07-10-.06). Other required documents include a medication policy, a written transportation plan if you transport, and a written plan for a participant who does not leave during a fire drill. Municipal, county or nonprofit centers with 10 or more participants must have a governing board of at least 4 members that meets at least once a year, keeps minutes and reviews finances.

Safety. Fire drills must be held and documented at least every quarter, with records kept for one year and an evacuation plan posted. Emergency numbers, including the Adult Protective Services intake line and the Child and Adult Care Complaint Hotline, must be posted, along with No Smoking signs and the license.

Medicaid limits. TennCare CHOICES caps Adult Day Care at 2,080 hours per member per calendar year, and it cannot be consumer directed. CHOICES does not pay for Attendant Care, Personal Care Visits or Companion Care while a member is receiving Adult Day Care.

What rules protect participants in Tennessee adult day centers?

Tennessee rules require an assessment before enrollment, a signed acknowledgment of the participant bill of rights, an individualized plan reviewed at least every 3 months, and daily attendance records. Serious incidents must be reported to DHS the same day. The rules require a written discharge policy but, in the text we read, set no discharge reasons or notice period.

Who can enroll. People who pose a significant threat to themselves or others, or who cannot benefit from the program, may not be enrolled and must be referred elsewhere (1240-07-10-.07). For TennCare members, Adult Day Care must be in an approved plan of care and authorized by the member's health plan before it starts.

Participant record. Under 1240-07-10-.08, each record includes:

• A pre-enrollment assessment covering psychosocial, health and behavioral history, and the last physician visit if available.
• A signed acknowledgment of the participant bill of rights, which covers dignity, confidentiality, freedom from harm and grievances.
• Any legal documents, and a transportation plan.

Care plan. The individualized plan is developed with the participant and family and reviewed at each change in status and at least every 3 months, with written progress reports each quarter. Plans for people with dementia must include memory-stimulating activities.

Restraints. Restraints require a signed, time-limited physician order, and standing orders are not allowed. An emergency restraint requires a written order within 7 days and notice to DHS. Locked and chemical restraints are banned.

Attendance and records. Centers keep daily attendance records. Each participant's record is kept at least one year after the person leaves the program.

Incidents. Incidents, accidents, injuries, illnesses and emergencies are written up and reported to the responsible party by the end of the same day. Serious incidents, such as injuries needing more than first aid, Adult Protective Services reports, 911 or police calls, transportation accidents, any participant death and major medication errors, are reported to DHS the same day through the Child and Adult Care Complaint Hotline at 1-800-462-8261 (1240-07-10-.15). Suspected abuse is reported to Adult Protective Services right away. A new criminal charge, conviction or registry listing for a staff member or other covered person must be reported to DHS by phone within 24 hours.

What we did not find. We did not find a required physician exam or TB screening at enrollment, required contents for an enrollment agreement, or set discharge reasons and notice periods. Families should ask the center for its written admission, discharge and fee policies, and operators should ask DHS what it expects.

How does Medicaid pay for adult day in Tennessee?

TennCare pays for Adult Day Care through CHOICES Groups 2 and 3, its managed long-term services program. Centers bill the member's TennCare health plan under code S5100 in 15-minute units, listed at $3.75 per unit (about $15 an hour) since July 1, 2025. PACE also covers adult day center care for eligible people in the Chattanooga area.

TennCare CHOICES. TennCare runs CHOICES through contracted managed care health plans, and a center must hold its DHS license and be credentialed with and authorized by the plan. Adult Day Care is a benefit for Group 2 members (who meet nursing facility level of care) and Group 3 members (who are at risk of needing it), aged 65 and older, or 21 and older with physical disabilities (1200-13-01-.05).

• Billing code and unit: S5100, per 15 minutes.
• Rate: $3.75 per unit, effective July 1, 2025, from the CHOICES rate chart attached to TennCare's June 9, 2025 provider memo. We did not find a later rate memo. Ask each health plan you contract with what it pays.
• Limit: 2,080 hours per member per calendar year. Adult Day Care cannot be consumer directed.
• Authorization: the service must be in the member's approved plan of care and authorized by the health plan before it is delivered.

Transportation. CHOICES does not provide transportation to home and community services, except when a member needs Adult Day Care that is not available within 30 miles of home. We did not find a separate transportation billing code for adult day.

PACE. TennCare's PACE program serves people 55 and older who meet nursing facility level of care, live in the service area (all of Hamilton County and listed zip codes in Rhea, Bradley and Meigs counties) and can live safely in the community. The PACE organization, Alexian PACE in Chattanooga, provides an adult day center and transportation, and its center is on the DHS list of licensed adult day providers. PACE is paid a set amount per enrollee, so adult day is not billed by the unit.

Attendance documentation. The licensing rules require daily attendance records, and centers that transport must log each participant's pick-up and drop-off times. We did not find a TennCare or health plan rule that spells out the sign-in or attendance records needed for adult day claims. Wellpoint's CHOICES provider manual describes an electronic check-in and check-out system for applicable CHOICES services but does not say whether adult day is included, so ask each plan you bill how it wants attendance documented.

Can a private-pay adult day center operate in Tennessee without Medicaid?

Yes, a center can be fully private pay, but it still needs a DHS license if it serves 5 or more adults for more than 3 hours a day. Tennessee's licensing rules apply whatever the payer. The main way to run a group program without a license is the narrow exemption for limited respite programs run by religious organizations.

The religious respite exemption. Under T.C.A. 71-2-402, as amended by Public Chapter 788 of 2026, an exempt program must:

• Be run by a religious institution or organization.
• Serve adults who can function in a group and can eat and use the toilet without a personal aide.
• Have each adult attend no more than 3 days and 16 hours a week, with no more than 20 adults at a time.
• Not administer medications.
• Register with DHS through its exemption request process.
• Keep at least the same direct care staff ratio required of licensed centers.

Protections for private-pay participants. Every licensed center needs a written fee policy, must give participants the bill of rights, must comply with Section 504 and the Americans with Disabilities Act, and may not discriminate based on age or disability. We did not find required contract or fee disclosure contents beyond the written fee policy.

Reporting an unlicensed program. DHS takes reports of suspected unlicensed adult day programs through the Child and Adult Care Complaint Hotline (1-800-462-8261) or AdultDayServices.DHS@tn.gov.

Other funding. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans who meet clinical and community care rules, through VA medical centers, State Veterans Homes or community providers. The DHS Adult Day Services page says the state program is funded through the federal Social Services Block Grant, but it does not say whether that money pays centers for participant care. We did not confirm whether Older Americans Act or state aging funds pay for adult day anywhere in Tennessee. Your local Area Agency on Aging and Disability can tell you what is available in your region.

The market. The DHS list of licensed adult day providers dated August 3, 2026 names 40 centers, mostly in Shelby, Davidson, Hamilton, Knox and Rutherford counties. We did not find a Tennessee adult day association with a website or other published presence.

What is changing next for adult day in Tennessee?

As of our last check on October 21, 2026, we did not find an upcoming change to Tennessee's adult day rules or TennCare adult day payment. Three recent changes matter for operators, and all are already in effect.

• Revised licensing rules, September 22, 2026. DHS amended Chapter 1240-07-10 after a February 12, 2026 hearing, and the changes took effect September 22, 2026 (Secretary of State rule filings). The proposed change to the staffing rule was withdrawn on August 19, 2026, so the 1:8 ratio is unchanged. We could not read the text of the other changes, so ask DHS what is different before you rely on the 2023 details on this page.
• Wider religious respite exemption, April 2026. Public Chapter 788 raised the limits for exempt religious respite programs from 12 to 16 hours a week and from fewer than 15 to up to 20 adults at a time, and requires those programs to keep the licensed center staff ratio. The Governor signed it April 23, 2026.
• CHOICES rate increase, July 1, 2025. As part of a direct support worker wage increase, TennCare raised CHOICES rates for services with a direct care component, including Adult Day Care at $3.75 per 15 minutes.

Tennessee adult day sources

• Tennessee Department of Human Services: Adult Day Services
• DHS: How to Become a Licensed Adult Day Services Center
• Tennessee Secretary of State: rule filings for Chapter 1240-07-10 (Adult Day Services Standards)
• Tenn. Comp. R. & Regs. 1240-07-10-.05: licensing procedures
• Tenn. Comp. R. & Regs. 1240-07-10-.12: staffing
• Tenn. Comp. R. & Regs. 1200-13-01-.05: TennCare CHOICES benefits
• TennCare provider memo, June 9, 2025: CHOICES rate chart
• TennCare: Program of All-Inclusive Care for the Elderly (PACE)
• DHS: Licensed Adult Day Service Providers list, August 3, 2026
• Tennessee General Assembly: HB 1495 / SB 1581 (Public Chapter 788 of 2026)

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Effective Transportation Tracking for Elder Day Centers
• Podcast: Adding Adult Day Services to Home Care Brings Synergy and Margins
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states that license or certify every adult day center

California, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Texas, Utah, Wyoming. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.