Certificate of Need Exemptions
Per Public Chapter 985, the following two exemptions are effective on July 1, 2025:
1. Freestanding emergency departments (FSEDs) will be exempt from Certificate of Need requirements when the proposed FSED will be located within 10 miles of the host hospital’s main campus and at least 10 miles or more from another actively licensed acute care hospital or satellite emergency department facility.
2. In addition, counties without an actively licensed acute care hospital will be exempt from most Certificate of Need requirements except for the following project types: A rehabilitation facility, a home care organization, hospice, non-residential substitution-based treatment center for opiate addiction, nursing homes, and organ transplantation.
Providers are required to complete Health Facilities Commission initial exemption notification forms to determine if they qualify under the new exemption provisions.
Click on the appropriate tab for further information and appropriate forms.
Pediatric Exemption
Effective October 1, 2021, under TCA 68-11-1607 (s) (1), a certificate of need is not required to establish a home health agency limited to providing home health services to patients less than eighteen (18) years of age. A license issued by the commission pursuant to this subsection (s) for the provision of home health services to patients under eighteen (18) years of age must be limited to the provision of only those services.
A home health agency that provides pediatric home health services without a certificate of need within two (2) years of the initiation of service, be accredited by and submit proof to the commission of the accreditation from:
(i) An accrediting organization with deeming authority from the federal Centers for Medicare and Medicaid Services;
(ii) The Joint Commission;
(iii) The Community Health Accreditation Partner; or
(iv) The Accreditation Commission for Health Care.
TCA 68-11-1607 (r) (2) indicates a home health agency that provides home health services without a certificate that fails to comply with the accreditation requirement of subdivision TCA 68-11-1607 (r)(1) is subject to licensure sanction under § 68-11-207.
Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA) Exemption
Effective October 1, 2021, under TCA 68-11-1607 (r) (1), a certificate of need is not required to establish a home health agency limited to providing home health services under the federal Energy Employees Occupational Illness Compensation Program Act of 2000 (EEOICPA) (42 U.S.C. § 7384, et seq.), or a subsequent amendment, revision, or modification. A license issued by the commission pursuant to this subsection (r) for services under the EEOICPA must be limited to the provision of only those services. Furthermore, a home health agency providing home health services without a certificate of need pursuant to this subsection (r) must be accredited by The Joint Commission, the Community Health Accreditation Partner, or the Accreditation Commission for Health Care and submit proof of such accreditation to the commission within two (2) years of the initiation of service.
FORMS
Initial Notification of Home Health Accreditation for CON Exemption
Form notifies HFCs Certificate of Need Division of the intent to pursue home health accreditation under CON Exemption for Pediatric and/or EEOICPA.
Annual Progress Report for Home Health Accreditation for CON Exemption
Form reports accreditation progress under the CON exemption.
Final Report Home Health Agencies Exempted Due to Serving PEDIATRIC Patients
Final Report Home Health Agencies Exempted Due to Serving EEOICPA Patients
These reports report required information to fulfill the requirement of being accredited withint 2 years of licensure per statute.
OTHER INFORMATION
For information regarding TennCare and Private Duty, please Click Here for the memo from TennCare
List of Licensed Home Health Agencies by Licensed County
List of Licensed Home Health Agencies Limited to EEOICPA by Licensed County
List of Licensed Home Health Agencies Limited to Pediatric by Licensed County
PROCESS FOR FREESTANDING EMERGENCY DEPARTMENT (FSED) PROJECTS FILED UNDER PUBLIC CHAPTER 985 EFFECTIVE JULY 1, 2025
1. Public Chapter 985 is available for review at the following link: https://publications.tnsosfiles.com/acts/113/pub/pc0985.pdf
2. The process of establishing a freestanding emergency department under Public Chapter 985 is initiated by filing an Initial Notification of the Establishment of a Freestanding Emergency Department (FSED) form. The initial notification form will only be accepted beginning on July 1, 2025, beginning at 8:00 am CST.
3. The initial notification forms will be available on the HFC website.
4. Completed FSED Initial notification of intent forms will be submitted through the HSDA staff inbox at HSDA.staff@tn.gov .
5. The initial notification of intent form will be processed by HFC staff to ensure completeness of the form. If incomplete, additional information will be required from the applicant. The applicant will be requested to provide any additional information within two business days.
6. All filed FSED projects filed under Public Chapter 985 will be posted to the HFC website.
7. The notification form will be reviewed for accuracy of information and distances. Within five business days, HFC staff will validate if that there are no actively licensed hospitals, operational FSEDs, unimplemented hospital or FSED projects, FSEDs currently under construction within 10 miles of the proposed project. Google Maps will be used as the official determination of distances. Distances will be measured by the shortest distances between two points (“as the crow flies”). The licensed address on file with the Health Facilities Commission of the applicant will be used to determine distances. In cases of any undeveloped property without an official address, the location of the facility on the plot plan as well as any applicable parcel data will serve as the point of reference.
8. Within 5 business days, applicants will be informed by email if the proposed project meets all statutory requirements.
*Please note that if an FSED project initiates services (through the CON process or PC 985 Exemption), or a hospital obtains its license, that any other FSED projects within 10 miles will no longer be eligible for the carveout under PC 985, regardless of their project status. Those other FSED projects would be required to file a Certificate of Need.
Initial Application - PDF Version Initial Application - Word Version
PROCESS FOR INITIAL NOTIFICATION OF EXEMPTION OF CERTIFICATE OF NEED ACTIVITY IN A COUNTY WITHOUT A LICENSED HOSPITAL FILED UNDER PUBLIC CHAPTER 985 EFFECTIVE JULY 1, 2025
1. Public Chapter 985 is available for review at the following link: https://publications.tnsosfiles.com/acts/113/pub/pc0985.pdf
2. The process of establishing a qualified Certificate of Need Exempt Institution and/or service under Public Chapter 985 is initiated by filing an “Initial Notification of Exemption of Certification of Need Activity in A County Without a Licensed Hospital” Form. The initial notification form will only be accepted beginning on July 1, 2025, beginning at 8:00 am CST.
3. The exemption does not apply to the following:
1) rehabilitation facility;
2) a home health organization such as a home health or hospice agency;
3) hospice;
4) opiate addiction provided through a nonresidential substitution-based treatment center for opiate addiction;
5) a nursing home; or 6) organ transplantation.
4. The initial notification form as well as a map of eligible counties without an actively licensed hospital is available below.
5. Completed Initial notification of intent forms must be submitted through the HSDA staff inbox at HSDA.staff@tn.gov .
6. The initial notification of intent form will be processed by HFC staff to ensure completeness of the form. If incomplete, additional information will be required from the applicant. The applicant will be requested to provide any additional information within two business days.
7. The notification form will be reviewed for accuracy of information and distances.
Within five business days, HFC staff will validate if that there are no actively licensed hospitals, operational FSEDs, unimplemented hospital or FSED projects, FSEDs currently under construction within 10 miles of the proposed project. Google Maps will be used as the official determination of distances. Distances will be measured by the shortest distances between two points (“as the crow flies”). The licensed address on file with the Health Facilities Commission of the applicant will be used to determine distances. In cases of any undeveloped property without an official address, the location of the facility on the plot plan as well as any applicable parcel data will serve as the point of reference.
8. Within 5 business days, applicants will be informed by email if the proposed project meets all statutory requirements.
9. All filed exemption projects filed under Public Chapter 985 will be posted to the HFC website.
*Please note that if an FSED project initiates services (through the CON process or PC 985 Exemption), or a hospital obtains its license, that any other FSED projects within 10 miles will no longer be eligible for the carveout under PC 985, regardless of their project status. Those other FSED projects would be required to file a Certificate of Need.
Initial Application - PDF Version Initial Application - Word Version