Tenn. Comp. R. & Regs. 0940 — Mental Health & Substance Abuse Services

Chapter 0940-01-01 Repealed

Tenn. Comp. R. & Regs. 0940-01-01-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Repeal filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-01-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-3-104, and 33-1-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Repeal filed December 22, 2025; effective March 22, 2026.

Chapter 0940-01-02 Procedures for Prescription and Administration of Psychotropic Medications at Mental Health Institutes

Tenn. Comp. R. & Regs. 0940-01-02-.01 PURPOSE

The purpose of these rules is to delineate requirements and processes for obtaining informed consent for treatment, including psychotropic medication and physical treatment as defined in these rules, release of information, and authorizing treatment contrary to a Declaration for Mental Health Treatment at a Regional Mental Health Institute (RMHI). These rules may be utilized as guidelines by private psychiatric hospitals and psychiatric units of private general hospitals.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.02 SCOPE

(1) These rules address informed consent for services provided at an RMHI, not services that may be provided for RMHI patients at another agency, either during hospitalization or after discharge.

(2) An RMHI Treatment Review Committee (TRC) shall not authorize use of convulsive therapy, including but not limited to electroconvulsive therapy (ECT), either at the RMHI or by an outside provider. Use of convulsive therapy requires informed consent from the patient, the patient’s conservator or other legal representative, or a court order authorizing the treatment.

(3) A Treatment Review Committee shall not authorize use of seclusion or restraint, including physical holding restraint. Use of seclusion or restraint shall be authorized only by a licensed practitioner in accordance with Chapter 0940-03-06 (Hospital Isolation and Restraint).

(4) Nothing in these rules shall prevent the provision of treatment, including medication, or release of information in the event of an emergency situation.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: (For Administrative History prior to February, 1985 see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.03 DEFINITIONS

(1) “Advanced Practice Nurse” (APN) means a licensed registered nurse certified as an advanced practice nurse by the Tennessee Board of Nursing under Title 63, Chapter 7, T.C.A. who has been issued a certificate of fitness to write and sign prescriptions.

(2) “Clinical Professional” means a staff member who is a qualified mental health professional, a registered nurse, a pharmacist, or a member of the RMHI Medical Staff.

(3) “Conservator” means a person or an entity appointed by a court under Title 34, Chapter 3 or

Chapter 5, T.C.A. with authority to make health care decisions for an adult who lacks capacity to make informed decisions.

(4) “Declaration for Mental Health Treatment” means a document authorized by Title 33, Chapter 6, Part 10, T.C.A. that allows a person to say how they want to be treated or not be treated when they are unable to make informed decisions about their mental health treatment.

(5) “The Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(6) “Emergency” means circumstances in which there exists:

(a) An immediate threat of serious physical harm to the patient or to others caused by the violent behavior of the patient;

(b) Actual violent behavior by the patient causing substantial property damage; and/or (c) An immediate threat to the patient of deteriorating physical well-being with risk to life or long-term health caused by the effects of mental illness and/or a physical illness or condition.

(7) “Informed Consent” means voluntary consent or authorization, when applicable, given in writing after sufficient explanation and disclosure of the subject matter involved to enable the person whose consent is sought to make a knowing and willful decision without any element of force, fraud, deceit, duress, or other form of constraint or coercion.

(8) “Involuntary Patient” means a patient who has been admitted pursuant to Title 33, Chapter 6,

Part 4 or 5, T.C.A. §§ 33-3-401, 33-3-402, 33-3-403, 33-3-412, 33-3-607, 33-7-301, 33-7- 303, or 37-1-128.

(9) “Lacks Capacity” means that the patient is unable to understand the following:

(a) A proposed psychotropic medication, physical treatment, and/or release of information;

(b) The risks and benefits of such psychotropic medication, physical treatment, and/or release of information;

(c) The risks and benefits of any available alternative(s) to the psychotropic medication, physical treatment, and/or release of information; and/or (d) The risks and benefits of not receiving the psychotropic medication, physical treatment, and/or release of information, then (e) That patient cannot give informed consent for psychotropic medication, physical treatment, and/or release of information unless a conservator or other legal representative has been granted that authority.

(10) “Legally Incompetent Patient” means a patient from whom a court, pursuant to T.C.A. Title 34, has removed the power to make decisions as to treatment and for whom it has appointed a conservator to make such decisions.

(11) “Legal Representative” means an individual who has been granted legal authority to act on behalf of another individual.

(12) “Licensed Physician” means a graduate of an accredited medical school authorized to confer the degree of Doctor of Medicine (M.D.) who is duly licensed in the state, or an osteopathic physician who is a graduate of a recognized osteopathic college authorized to confer the degree of Doctor of Osteopathy (D.O.) and who is licensed to practice osteopathic medicine in the state.

(13) “Medical Record” means written documents, computerized electronic information, radiology film and scans, laboratory reports and pathology slides, videos, audio recordings, and other forms of information regarding the condition of a patient. The medical record includes both electronic and paper medical record systems.

(14) “Medication” means prescriptive medication, including psychotropic medication, that is administered to patients to treat or prevent disease or other abnormal conditions.

(a) “Prescriptive Medication” means a drug which requires authorization by a physician, advanced practice nurse, physician assistant, pharmacist, or other professional authorized by law to prescribe medication and which cannot be obtained on an overthe-counter basis in the community. This includes drugs prescribed to treat physical illnesses or conditions and psychotropic medication prescribed to treat mental illness.

(b) “Psychotropic Medication” means a drug which exercises a direct effect upon the central nervous system and which is capable of influencing and modifying behavior.

Psychotropic medications include but are not limited to anti-psychotics, antidepressants, agents for control of mania and depression, anti-anxiety agents, psychomotor stimulants, and hypnotics.

(15) “Patient Rights Advocate” (PRA) means a person designated by the RMHI Chief Executive Officer or designee to have the responsibilities imposed by these rules.

(16) “Physical Treatment” means a medical procedure or medication prescribed to treat a physical condition or illness, with the exception of routine first aid, performing examinations, giving injections, or obtaining laboratory samples.

(17) “Physician Assistant” (PA) means a person licensed as a physician assistant under Title 63,

Chapter 13, T.C.A.

(18) “Privileged” means authorization has been granted by the RMHI Governing Body to a physician, advanced practice nurse, physician assistant, or other licensed practitioner to render specific services, based upon the individual’s professional license and certification, as well as experience, competence, ability, and judgment.

(19) “Qualified Mental Health Professional” means a person who is licensed in the state, if required for the profession, and who is a psychiatrist; physician with expertise in psychiatry as determined by training, education, or experience; psychologist with health service provider designation; psychological examiner or senior psychological examiner; licensed master’s social worker with two (2) years of mental health experience or licensed clinical social worker; marital and family therapist; nurse with a master’s degree in nursing who functions as a psychiatric nurse; professional counselor; or, if the person is providing service to patients who are children, any of the above educational credentials plus mental health experience with children.

(20) “Regional Mental Health Institute” (RMHI) means a mental health hospital or psychiatric inpatient unit operated by the Department.

(21) “Regular Working Day” means 8:00 a.m. until 4:30 p.m., Monday through Friday, excluding legal state holidays.

(22) “Release of Information” means authorization, in accordance with applicable state and federal statutes and regulations, for a healthcare provider or organization to request or provide information that identifies an individual as a patient or former patient and information regarding their diagnosis and treatment to a specified person or organization.

(23) “Release of Information Form” means the Authorization to Release Confidential Information Form approved by the Department to be utilized to authorize release of information.

(24) “Revocation of Authorization to Release Confidential Information Form” means the form approved by the Department to be utilized to document revocation of a release of information.

(25) “RMHI Medical Staff” means a self-governing entity accountable to the RMHI Governing Body that is comprised of licensed physicians, advanced practice nurses, physician assistants, and, in accordance with the RMHI Medical Staff Bylaws, other licensed practitioners.

Members of the RMHI Medical Staff are privileged by the RMHI Governing Body to provide specific patient care functions, such as ordering medications and providing medical treatment. For purposes of these rules, physicians in an approved residency program at an RMHI shall be considered to be members of the RMHI Medical Staff.

(26) “Staff Member” means an individual employed by or performing duties at the RMHI, including contract employees, students, residents, and volunteers.

(27) “Treatment Review Committee” (TRC) means a committee constituted under T.C.A. § 33-6- 107 and these rules to make decisions for patients.

(28) “Treatment Team” means RMHI staff members directly involved in developing, implementing, and monitoring a patient’s treatment plan, including but not limited to the attending physician or assigned advanced practice nurse or physician assistant, a registered nurse, and a social services staff member.

(29) “Voluntary Patient” means a patient who has been admitted pursuant to Title 33, Chapter 6,

Part 2 or Part 3, T.C.A.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: (For Administrative History prior to February, 1985 see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.04 INFORMED CONSENT REQUIRED

(1) Except as otherwise authorized or in applicable state and federal statutes or regulations, psychotropic medications shall not be administered to a patient unless the patient has given informed consent in writing. A change of dosage or medication within a class does not require obtaining a new consent, but the patient shall be informed of such change and shall be provided an explanation for the change, and this shall be documented in the record.

Informed consent for psychotropic medication includes consent for procedures associated with the safety and efficacy of psychotropic medication management, such as periodic lab work.

(2) Except as otherwise authorized or in applicable state and federal statutes or regulations, physical treatment, including medication, shall not be administered to a patient unless the patient or patient’s legal representative has given informed consent in writing. Informed consent for physical treatment includes consent for procedures associated with the safety and efficacy of the physical treatment, such as periodic lab work.

(3) Except as otherwise authorized or in applicable state and federal statutes or regulations, healthcare information relating to a patient shall not be released to a person or organization unless the patient or patient’s legal representative has given informed consent in writing.

(4) Each RMHI shall have an informed consent policy that delineates which treatments/services require informed consent and which treatments/services do not require informed consent.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: (For Administrative History prior to February, 1985 see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.05 DURATION OF INFORMED CONSENT AND EFFECT OF REVOCATION

(1) Informed consent for psychotropic medication, physical treatment, and release of information shall be limited to the current RMHI admission. If a patient is discharged and subsequently readmitted, informed consent as required by these rules must be obtained for any psychotropic medication, physical treatment, and/or release of information related to the new admission.

(2) A consent for psychotropic medication or physical treatment remains effective until:

(a) The patient who has consented or the patient’s conservator who has the authority to give consent expressly revokes the consent in writing or orally, or (b) The patient who has consented continuously refuses, either orally or behaviorally, to take the psychotropic medication or physical treatment for a 72-hour period, thereby revoking the consent.

(3) A release of information remains effective until:

(a) The date, event or condition of expiration specified on the release of information form occurs, or (b) The patient who has consented or the patient’s conservator who has the authority to give consent expressly revokes the release of information in writing or orally.

(4) If, after revoking a consent, the patient or conservator subsequently indicates a willingness to have the psychotropic medication administered, to accept the physical treatment, and/or to allow release of information, the psychotropic medication, physical treatment, and/or release of information shall be resumed only after the patient gives a voluntary, informed consent in writing in accordance with Rules 0940-01-02-.04 and 0940-01-02-.06. If the patient continues to refuse psychotropic medication, and the treatment team deems that the medication is essential to the patient’s recovery, a TRC may be pursued in accordance with Rule 0940-01- 02-.10.

(5) Revocation of informed consent shall be documented as follows:

(a) If a patient or the patient’s conservator revokes a consent for psychotropic medication, the revocation shall be documented immediately in the patient’s medical record, and an order discontinuing the revoked psychotropic medication shall be written by a member of the RMHI Medical Staff. Refer to 0940-01-02-.07 related to the administration of emergency medications in the event of an emergency situation.

(b) If a patient or the patient’s conservator revokes a consent for physical treatment, the revocation shall be documented immediately in the patient’s medical record, and an order discontinuing the revoked physical treatment shall be written by a member of the RMHI Medical Staff.

(c) If a patient or the patient’s conservator revokes a release of information, the revocation shall be documented immediately on the Revocation of Authorization to Release Confidential Information Form and maintained in the patient’s medical record.

(6) A patient or the patient’s conservator may decide to partially revoke consent, retaining consent for part of the psychotropic medications, physical treatment, and/or release of information included on the consent. The written documentation of the partial revocation must clearly reflect which parts of the consent are revoked and which are retained.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: (For Administrative History prior to February, 1985 see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.06 PROCEDURES FOR OBTAINING INFORMED CONSENT

(1) Any staff member may encourage a patient to give informed consent for psychotropic medication, physical treatment, and/or release of information. A consent is not voluntary if it is given in response to force or to the threat of force, discharge, involuntary commitment, transfer to a more restrictive environment, or loss of privileges. Providing information about the benefits of psychotropic medication, physical treatment, and/or release of information and the potential adverse consequences of consenting or not consenting is permitted.

(2) Informed consent shall be obtained only after determining that there are no indicators (e.g., actions, statements, behavior) that the patient lacks capacity to give informed consent or, if indicators are present, after a physician, licensed practitioner, or qualified mental health professional has determined that the patient does not lack capacity. If the patient has provided a current Declaration for Mental Health Treatment that addresses the issue for which informed consent is needed, then the patient’s capacity must be assessed by:

(a) Two (2) physicians; or (b) One (1) physician with expertise in psychiatry by training, education, or experience and one (1) psychologist with health service provider designation.

(3) A staff member who has been trained in obtaining informed consent must discuss the proposed psychotropic medication, physical treatment, and/or release of information with the patient as follows:

(a) For psychotropic medication: A member of the RMHI Medical Staff, a registered nurse, or a pharmacist must discuss the psychotropic medication(s) to be prescribed and its type and purpose; the dosage and route of administration; the potential risks and side effects of the psychotropic medication(s); the advantages and risks of alternative treatments, if available; and the prognosis if the psychotropic medication(s) is not given. This discussion shall be tailored to the patient’s level of understanding.

(b) For physical treatment: A member of the RMHI Medical Staff or a registered nurse must discuss the physical treatment(s) to be prescribed and its purpose; the potential risks of the physical treatment(s); the advantages and risks of alternative treatments, if available; and the prognosis if the physical treatment is not provided. This discussion shall be tailored to the patient’s level of understanding.

(c) For release of information: A clinical professional or a staff member supervised by a clinical professional must discuss the proposed release, including the name of the person or organization the information is to be released to/from; the information to be released; the purpose of the release; and the potential risks if the information is not released. This discussion shall be tailored to the patient’s level of understanding.

(4) A staff member who has been trained in obtaining informed consent must discuss the content of the consent form(s) and/or the release of information form with the patient, patient’s conservator or other legal representative, offered to answer questions, and advised the patient that they may revoke informed consent at any time.

(5) Informed consent for psychotropic medication and/or physical treatment shall be documented on a state-approved form and maintained in the patient’s medical record.

Consent forms shall include notice of:

(a) The rights of a voluntary patient who does not lack capacity to refuse psychotropic medication and/or physical treatment, except in emergency situations;

(b) The rights of an involuntary patient who does not lack capacity to refuse psychotropic medication and/or physical treatment, except in emergency situations, unless the Treatment Review Committee authorizes psychotropic medication and/or physical treatment over the patient’s objection in accordance with Rule 0940-01-02-.10;

(c) The definition of emergency and the duration of psychotropic medication and/or physical treatment allowed in emergency situations;

(d) The right of revocation and procedures for revocation;

(e) The consent form shall state the class of psychotropic medication and/or physical treatment prescribed and shall contain an acknowledgment that the person who obtained the consent has fully discussed the psychotropic medication and/or physical treatment with the patient, including the information specified in subparagraphs 0940- 01-02-.06(3)(a) and (b); and (f) The consent form shall contain an acknowledgment that the person who obtained the consent has fully discussed the contents of the consent form with the patient, offered to answer questions, and advised the patient of their right to refuse psychotropic medication and/or physical treatment.

(6) Informed consent for release of information shall be documented on the release of information form.

(7) The consent form and/or the release of information form shall be signed, dated, and timestamped by the person giving informed consent and by the staff member who obtained the consent. The completed form must be maintained in the patient’s medical record.

(a) If a patient, conservator or other legal representative gives oral consent to psychotropic medication, physical treatment, and/or release of information, but is unable or unwilling to sign the consent form and/or the release of information form, oral consent shall be noted on the consent form and/or the release of information form and witnessed by two (2) staff members.

(b) Informed consent may be obtained from a conservator or other legal representative by phone, video-conference, or other electronic means that allow the required information to be provided to the conservator or other legal representative. The consent form and/or the release of information form is to be explained to the conservator or other legal representative, and the conservator or other legal representative is to be given the opportunity to discuss the psychotropic medication, physical treatment, and/or release of information with a staff member in accordance with Rules 0940-01-02-.04 and 0940-01-02-.06.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001). New rule filed January 9, 1985; effective February 8, 1985. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.07 EMERGENCY SITUATIONS

(1) Psychotropic Medication (a) Without regard to whether the patient has or lacks capacity to give informed consent for psychotropic medication, in an emergency situation as defined in Rule 0940-01-02-.03, emergency psychotropic medication may be ordered and administered to the patient without informed consent or TRC authorization for up to twenty-four (24) hours and may be renewed for up to an additional twenty-four (24) hours, if the emergency situation continues.

The initial order for emergency psychotropic medication shall be valid for no longer than twenty-four (24) hours. If the initial order for emergency psychotropic medication was authorized without personal observation of the patient by the member of the RMHI Medical Staff who ordered the emergency psychotropic medication, a member of the RMHI Medical Staff shall personally evaluate the patient’s condition within one (1) hour of the order.
If the emergency continues beyond twenty-four (24) hours, the emergency order for psychotropic medication may be renewed once for up to an additional twentyfour (24) hours, but only after a face-to-face assessment of the patient by a member of the RMHI Medical Staff.

(b) After forty-eight (48) hours from the initial order for emergency psychotropic medication, the patient shall not receive psychotropic medication without informed consent or authorization by the TRC under Rules 0940-01-02-.08, 0940-01-02-.09,

Tenn. Comp. R. & Regs. 0940-01-02-.08 , 0940-01-02-.09, 0940-01-02-.10, or 0940-01-02-.11.

(6) The PRA shall compile a summary of actions taken at least annually and shall submit a report to the RMHI Governing Body Quality Committee for its review.

(7) The PRA’s duties in implementing these rules shall take priority over other duties as a general patient rights advocate and over other duties they may be assigned.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: New rules filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.09 LEGALLY INCOMPETENT PATIENTS

(1) Psychotropic medication and/or physical treatment shall be administered to and release of information shall be authorized for a legally incompetent patient only:

(a) With the voluntary, informed consent of the conservator, or (b) If the conservator is unavailable, under the same circumstances and procedures as a patient who lacks capacity under Rule 0940-01-02-.08, but not for more than ninety (90) days, or (c) In emergencies under Rule 0940-01-02-.07.

(2) A conservator to whom a court has granted the authority to make treatment decisions for a patient has all the rights, powers, and privileges granted to the patient.

(3) A TRC shall not override a decision by a parent, legal custodian, or legal guardian of a minor patient or a conservator of an adult patient.

(4) If informed consent is required for psychotropic medication, physical treatment, and/or release of information and the conservator is consistently unavailable, the Chief Executive Officer or designee shall be informed and shall seek appointment of an alternative conservator.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, 34-3-107 and 33-6-1006.
Administrative History: New rules filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.10 PATIENTS WHO DO NOT LACK CAPACITY AND WITHOLD INFORMED CONSENT

(1) Voluntary Patients (a) If a voluntary patient who does not lack capacity withholds informed consent for psychotropic medication, physical treatment, and/or release of information, the treatment team shall discuss the recommendations regarding the proposed psychotropic medication, physical treatment, and/or release of information and the patient’s response when informed consent is requested.

(b) The treatment team shall attempt to formulate a plan that is acceptable to the patient (e.g., reduced dosage, alternate medication, a possible trial period of medication or treatment, alternative treatment if any is available, and/or a limited release of information), and shall then meet with the patient to determine if they are willing to give informed consent or authorization when applicable for the psychotropic medication, physical treatment, and/or release of information.

The discussion of the recommendations with the patient and the patient’s response;
The attempt to formulate a plan that is acceptable to the patient, including the patient’s involvement in this attempt, and the patient’s response; and 3. Any attempt to meet with the patient that the patient declines.

(d) If, after the treatment team meets with the patient, the patient still withholds informed consent for the psychotropic medication or physical treatment, the psychotropic medication and/or physical treatment shall not be administered to the patient except in emergency situations as specified in Rule 0940-01-02-.07.

(e) If, after the treatment team meets with the patient, the patient still withholds informed consent or authorization when applicable for release of information, releases of information shall be managed in accordance with applicable state and federal statutes and regulations.

(f) Staff members may continue non-coercive efforts to persuade the patient to give informed consent for the psychotropic medication, physical treatment, and/or release of information.

(2) Involuntary Patients (a) If an involuntary patient who does not lack capacity withholds informed consent for psychotropic medication, physical treatment, and/or release of information, the treatment team shall discuss the physician’s or licensed practitioner’s recommendations regarding the proposed psychotropic medication, physical treatment, and/or release of information and the patient’s response when informed consent is requested.

(b) The treatment team shall attempt to formulate a plan that is acceptable to the patient (e.g., reduced dosage, alternate medication, a possible trial period of medication or treatment, alternative treatment if any is available, and/or a limited release of information), and shall then meet with the patient to determine if they are willing to give informed consent for the psychotropic medication, physical treatment, and/or release of information.

The discussion of the recommendations with the patient and the patient’s response;
The attempt to formulate a plan that is acceptable to the patient, including the patient’s involvement in this attempt, and the patient’s response; and 3. Any attempt to meet with the patient that the patient declines.

(d) If, after the treatment team meets with the patient, the patient still withholds informed consent for the psychotropic medication and/or physical treatment and the treatment team continues to believe that the psychotropic medication and/or physical treatment is a necessary part of the patient’s treatment plan, a TRC meeting shall be requested.

(e) If, after the treatment team meets with the patient, the patient still withholds informed consent for release of information, releases of information shall be managed in accordance with applicable state and federal statutes and regulations. The TRC shall not approve releases of information for a patient who does not lack capacity.

(f) Staff members may continue non-coercive efforts to persuade the patient to give informed consent for the psychotropic medication, physical treatment, and/or release of information.

(3) TRC Process (a) The TRC shall meet within three (3) regular working days of the request and:

Review the patient’s medical record, including documentation regarding the patient’s objections to the use of psychotropic medications and/or physical treatment, attempts by the treatment team to formulate a plan acceptable to the patient, and the recommendation of the treatment team;
Interview the patient (unless the patient declines to participate in the TRC meeting);
Make the final decision regarding psychotropic medication and/or physical treatment; and 4. Document its review and final decision on a state-approved form in the patient’s medical record.

(b) Psychotropic medication and/or physical treatment may be administered to an involuntary patient who does not lack capacity and who withholds informed consent for psychotropic medication and/or physical treatment for up to ninety (90) days upon the approval of the TRC.

(c) The TRC may continue to approve use of psychotropic medication and/or physical treatment at ninety (90) day intervals until informed consent for the psychotropic medication and/or physical treatment is obtained, the psychotropic medication and/or physical treatment is discontinued, or the patient is determined to lack capacity to give informed consent and the processes under Rules 0940-01-02-.08, 0940-01-02-.09, or

Tenn. Comp. R. & Regs. 0940-01-02-.11 , with informed consent provided by the Declaration for Mental Health Treatment.

(5) TRC Process If the patient’s Treatment Team determines that treatment, including psychotropic medication, physical treatment, and/or release of information, in a manner contrary to an involuntary patient’s wishes as expressed in the Declaration for Mental Health Treatment is the only viable treatment for the patient, a TRC meeting shall be requested to consider approval to provide the treatment. The TRC shall meet within three (3) regular working days of the request and:

(a) Review the patient’s medical record, including the documentation relating to the patient lacking capacity, the patient’s Declaration for Mental Health Treatment, the request for authorization for treatment in a manner contrary to the Declaration for Mental Health Treatment, the rationale for the request, and the treatment recommendations;

(b) Interview the patient (unless the patient declines to participate in the TRC meeting);

(c) Make a decision regarding whether to authorize treatment in a manner contrary to the patient’s Declaration for Mental Health Treatment; and (d) Document its decision and the justification on a state-approved form in the patient’s medical record.

(6) The TRC may authorize treatment, including but not limited to psychotropic medications, physical treatment, and/or release of information, in a manner contrary to the patient’s wishes as expressed in a Declaration for Mental Health Treatment for no longer than ninety (90) days.

(7) The PRA shall monitor the patient and document comments and/or recommendations in the patient’s medical record. The PRA may, if indicated, request that two (2) physicians or a physician with expertise in psychiatry by training, education, or experience and a psychologist with health service provider designation reassess the patient to determine whether the patient still lacks capacity no more frequently than every two (2) weeks during the same admission.

(8) The authority of the Declaration for Mental Health Treatment and/or the authority of the TRC expires if the patient gains capacity to provide informed consent. Informed consent shall be obtained from the patient as required by Rules 0940-01-02-.04 and 0940-01-02-.06 before further administration of psychotropic medication, provision of physical treatment, and/or release of information.

(9) If the patient continues to lack capacity for thirty (30) days, the PRA shall advise the Chief Executive Officer or designee of the need for a conservator to give informed consent for the patient. The Chief Executive Officer or designee shall proceed under authority of T.C.A. Title 33 to obtain a limited conservator for the patient.

(a) If conservatorship proceedings are initiated within ninety (90) days after psychotropic medication, physical treatment, and/or release of information was authorized by the TRC, the psychotropic medication, physical treatment, and/or release of information may continue until a conservator is appointed or the patient no longer lacks capacity.

(b) If conservatorship proceedings are not initiated within ninety (90) days after psychotropic medication, physical treatment, and/or release of information was authorized by the TRC, such psychotropic medication, physical treatment, and/or release of information shall terminate no later than ninety (90) days after it was authorized by the TRC. The patient may not be medicated and/or treated and information may not be released, except in emergency situations under Rule 0940-01- 02-.07 or in accordance with the provisions of the patient’s Declaration for Mental Health Treatment, until a conservator is appointed or the patient no longer lacks capacity.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: New rules filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-02-.12 PATIENT RIGHTS ADVOCATES

(1) Each RMHI shall have a staff member designated by the Chief Executive Officer or designee to be the Patient Rights Advocate (PRA).

(2) The PRA’s job plan shall include the duties imposed by these rules.

(3) The PRA shall work cooperatively with other RMHI staff members, shall be an objective advocate for patient rights, and shall effectively present the patient’s views and wishes in the procedures.

(4) The PRA shall work with RMHI staff members in conducting both initial and continuing education on the requirements of these rules.

(5) The PRA shall maintain a compliance monitoring file on each patient receiving psychotropic medication, physical treatment, and/or release of information under Rules 0940-01-02-.07,

Tenn. Comp. R. & Regs. 0940-01-02-.13 TREATMENT REVIEW COMMITTEES

(1) Each RMHI shall have a Treatment Review Committee (TRC) to make decisions for patients.

A RMHI may have multiple TRCs making decisions in various areas of the facility. If multiple TRCs are established, all must meet the composition requirements of this rule.

(2) The Chief Executive Officer or designee shall appoint the Treatment Review Committee members. A TRC shall be composed of four or more members. The members shall be:

(a) A chair, designated by the Chief Executive Officer or designee, who shall be responsible for conducting the TRC meeting in accordance with these rules and for assuring that all required TRC documentation is completed as required by these rules.

One of the following shall be designated as the chair of the TRC:

For TRCs considering psychotropic medication, the chair shall be a member of the RMHI Clinical Staff.
For TRCs considering physical treatment, the chair shall be a member of the RMHI Medical Staff.
For TRCs considering release of information, the chair shall be a member of the RMHI Medical Staff or a qualified mental health professional.

(b) The Patient Rights Advocate, and (c) Two (2) or more of the following: a physician, an advanced practice nurse, a physician assistant, a pharmacist, a registered nurse, a psychologist with health service provider designation, a psychological examiner or senior psychological examiner with health service provider designation, a master’s level social worker, a professional counselor, a marital and family therapist, or a clinical chaplain.

(3) No person who is a member of a patient’s Treatment Team shall serve on a TRC for that patient.

(4) A TRC that considers psychotropic medication shall include a psychiatrist, a psychiatric advanced practice nurse, or a psychiatric physician assistant.

(5) A TRC that considers physical treatment, including medication, for a physical condition or illness shall include a physician, an advanced practice nurse, or a physician assistant.

(6) The TRC shall encourage the patient to participate in the TRC meeting to the extent possible.

(7) The patient’s family members, support persons, conservator, or other legal representative may attend the TRC meeting.

(8) At the discretion of the TRC, members of the patient’s treatment team may be requested to attend the TRC meeting to provide input.

(9) Unless clinically contraindicated, a TRC meeting may be held by phone, video-conference, or other electronic means that allows full participation by the patient, all members of the TRC, and the patient’s conservator or other legal representative, if applicable. If the TRC meeting is conducted in this manner, at least one (1) member of the TRC shall be physically present with the patient.

(10) If the patient requests a review by the TRC, the PRA shall immediately request a review by the TRC, unless the TRC has met on the same issue for the patient during the two (2) weeks prior to the request during the same admission.

(11) The patient may request the PRA or another staff member, including a member of the patient’s treatment team, to assist or to speak on the patient’s behalf in all TRC meetings.

History

Authority: T.C.A. §§ 33-1-302 through 33-1-305, 33-3-104, 33-6-107, and 33-6-1006.
Administrative History: New rules filed December 22, 2025; effective March 22, 2026.

Chapter 0940-01-03 Repealed

Tenn. Comp. R. & Regs. 0940-01-03-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-105, 33-1-203 through 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-3-104.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001.) New rule filed January 9, 1985; effective February 8, 1985. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-01-03-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-1-302, 33-1-303, 33-1-305, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001.) New rule filed January 9, 1985; effective February 8, 1985. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-01-03-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-1-302, 33-1-303, 33-1-305, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001.) New rule filed January 9, 1985; effective February 8, 1985. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-01-03-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-1-302, 33-1-303, 33-1-305, 33-3-104, and 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001.) New rule filed January 9, 1985; effective February 8, 1985. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-01-03-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1-305, and 33-3-104 through 33-3-105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001.) New rule filed January 9, 1985; effective February 8, 1985. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-01-03-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-203 through 33-1-205, 33-1-302, 33-1-303, 33-1-305, 33-3-104, and 33-3- 105.
Administrative History: (For Administrative History prior to February, 1985, see page 1.001.) New rule filed January 9, 1985; effective February 8, 1985. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-01-04 Repealed

Tenn. Comp. R. & Regs. 0940-01-04 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH

AND SUBSTANCE ABUSE SERVICES

Authority: T.C.A. §§ 33-104, 33-105, and 33-403. Administrative History: Original rule filed August 23, 1974; effective September 22, 1974. Amendment filed October 10, 1974; effective November 9, 1974.

Amendment filed March 15, 1977; effective April 14, 1977. Amendment filed September 1, 1977; effective October 1, 1977. Amendment filed January 27, 1978; effective March 1, 1978. Repeal filed May 31, 1978; effective July 1, 1978. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Chapter 0940-01-05 Repealed

Tenn. Comp. R. & Regs. 0940-01-05 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH

AND SUBSTANCE ABUSE SERVICES

Authority: T.C.A. § 33-104(3). Administrative History: Original rule filed August 8, 1974, effective September 7, 1974. Repeal filed October 17, 1978, effective December 1, 1978. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Chapter 0940-01-06 Capacity to Make Decisions

Tenn. Comp. R. & Regs. 0940-01-06-.01 PURPOSE

The purpose of this chapter is to prescribe a uniform assessment process as required by T.C.A. § 33-3- 217, to determine whether a patient with mental illness or serious emotional disturbance lacks capacity to make informed decisions on issues within the meaning of T.C.A. § 33-3-218 and Rule Chapter 0940-01- 02.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-3-217, and 33-3-218.
Administrative History: Original rule filed December 29, 2005; effective March 14, 2006. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-06-.02 SCOPE

This chapter covers informed decisions that are needed to be made in an inpatient psychiatric treatment setting, including state-operated Regional Mental Health Institutes (RMHIs), private psychiatric hospitals, and psychiatric units of private general hospitals. This chapter does not cover outpatient services and does not cover services in an emergency room in a medical or surgical facility except for psychiatric admission to the facility. This chapter does not apply to any emergency that endangers a patient’s health or life.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-3-217, and 33-3-218.
Administrative History: Original rule filed December 29, 2005; effective March 14, 2006. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-06-.03 APPLICABILITY

(1) For patients aged 16 or older, who have a mental illness or serious emotional disturbance, this chapter applies to:

(a) Application for voluntary admission to or discharge from a hospital or inpatient treatment resource;

(b) After voluntary or involuntary admission to a hospital or inpatient treatment resource, determination of the patient’s capacity to make an informed decision regarding:

Inpatient mental health treatment, including use of psychotropic medication, 2. Release of information, 3. Request for information, or 4. Treatment of a physical condition or illness in an inpatient psychiatric treatment setting.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-3-217, 33-3-218, and 33-8-202.
Administrative History: Original rule filed December 29, 2005; effective March 14, 2006. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-06-.04 DEFINITIONS

(1) “Examiner” means a physician, licensed practitioner, registered nurse, or qualified mental health professional.

(2) “Lacks capacity” means that the person is:

(a) Unable to understand a proposed procedure or treatment; or (b) Unable to understand the risks and benefits of such procedure or treatment; or (c) Unable to understand the risks and benefits of any available alternative to the procedure or treatment; or (d) Unable to understand the risks and benefits of not receiving the procedure or treatment.

(3) “Licensed physician” means a graduate of an accredited medical school authorized to confer the degree of Doctor of Medicine (M.D.) who is duly licensed in the state, or an osteopathic physician who is a graduate of a recognized osteopathic college authorized to confer the degree of Doctor of Osteopathy (D.O.) and who is licensed to practice osteopathic medicine in the state.

(4) “Licensed practitioner” means an individual who is licensed and qualified to direct or provide care, treatment, and services in accordance with state law and regulation, applicable federal law and regulation, and organizational policy.

(5) “Mental illness”, as defined in T.C.A. § 33-1-101(19), means a psychiatric disorder, alcohol dependence, or drug dependence, but does not include intellectual disability or other developmental disabilities.

(6) “Qualified mental health professional” means a person who is licensed in the state, if required for the profession, and who is a psychiatrist; physician with expertise in psychiatry as determined by training, education, or experience; psychologist with health service provider designation; psychological examiner, or senior psychological examiner; licensed master’s social worker with two (2) years of mental health experience or licensed clinical social worker; marital and family therapist; nurse who has a master’s degree in nursing who functions as a psychiatric nurse; professional counselor; or if the person is providing service to patients who are children, any of the above educational credentials plus mental health experience with children.

(7) “Serious emotional disturbance” means a condition in a child who currently or at any time during the past year has had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet psychiatric diagnostic criteria that results in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities and includes any mental disorder, regardless of whether it is of biological etiology.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-3-217, and 33-3-218.
Administrative History: Original rule filed December 29, 2005; effective March 14, 2006. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-06-.05 ASSESSMENT

(1) Validity of the assessment. If an examiner concludes that a patient is unable to make an informed decision about a subject to which these rules apply, then the patient lacks capacity for a decision about the subject matter at that time.

(2) Stringency of the assessment. The stringency of the capacity assessment should correspond directly with the seriousness of the likely consequences of the informed decision that needs to be made. The examiner should consider the risks and benefits of the decision in reaching a conclusion on the patient’s capacity to make an informed decision, with decisions associated with a higher risk of negative consequences requiring a higher standard of decision-making capacity than lower risk decisions.

(3) Performing the assessment.

(a) The examiner must approach the evaluation of a patient’s capacity to make an informed decision on the presumption that the patient has capacity.

(b) The examiner must consider the patient’s understanding of the information, the patient’s ability to express a choice, the patient’s appreciation of how the information applies to them, and the patient’s ability to compare information and anticipate consequences of choice.

(c) The examiner must take reasonable steps to conduct the assessment in a way that enables the patient to show capacity to make informed decisions about the procedure or treatment.

(d) The examiner must provide relevant information to the patient, including:

The issue to be decided and the reason a decision is needed;
The proposed procedure or treatment and the risks and benefits of the proposed procedure or treatment;
Any consequences of accepting or refusing the procedure or treatment;
The risks and benefits of any available alternatives; and 5. The patient’s right to refuse or later withdraw from participation in the procedure or treatment and the risks and benefits of refusal or withdrawal.

(e) The examiner must consider the following in determining whether the person lacks capacity:

The person’s understanding of the proposed procedure or treatment;
The person’s understanding of the anticipated side effects of the proposed procedure or treatment;
The person’s understanding of what could happen if the procedure or treatment is carried out;
The person’s understanding of what could happen if the procedure or treatment is not carried out;
The person’s understanding of available alternative procedures or treatments, including their risks and benefits;
The person’s understanding that the procedure or treatment can be refused and what could happen if the procedure or treatment is refused;
The person’s understanding of whether the procedure or treatment can be stopped after it begins and the potential consequences; and 8. The person’s ability to maintain a choice by continuing to express the same decision about the issue at various times during the assessment process.

(4) Documenting the assessment. The examiner must document the assessment, including:

(a) The issue which required an informed decision;

(b) Specific actions, statements, or behaviors of the patient that initially gave reason to question the patient’s capacity;

(c) Specific actions, statements and/or behaviors of the patient that support the examiner’s conclusion about the patient’s capacity to make an informed decision;

(d) The examiner’s conclusion on the patient’s capacity to make an informed decision; and (e) The examiner’s signature, credentials, and the date and time of the assessment.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-3-217, and 33-3-218.
Administrative History: Original rule filed December 29, 2005; effective March 14, 2006. Amendments filed December 22, 2025; effective March 22, 2026.

Tenn. Comp. R. & Regs. 0940-01-06-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1- 305, 33-1-309, 33-2-301, 33-2-302, 33-3-217, and 33-3-218.
Administrative History: Original rule filed December 29, 2005; effective March 14, 2006. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-01-07 Conflict Resolution

Tenn. Comp. R. & Regs. 0940-01-07-.01 PURPOSE

(1) The purpose of this chapter is to provide a process for clear, orderly and expeditious conflict resolution between service recipients and licensees.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-2-601, et seq.
Administrative History: Original rule filed January 31, 2006; effective April 16, 2006.

Tenn. Comp. R. & Regs. 0940-01-07-.02 SCOPE

(1) This chapter applies to all licensees of the Department for resolution of conflict(s) between a service recipient and a service provider.

(a) Conflicts include, but are not limited to:

Health and safety concerns;
Accessibility of service location;
Provision or termination of services and supports except when a service or support is terminated because a third party payer refuses to continue to fund the service or support; and 4. When the parent, legal guardian, legal custodian, legal caregiver of a child, 16 years of age or older with serious emotional disturbance or mental illness, believes that the child’s decision to terminate treatment will have severe, adverse effects on the child.

(b) This conflict resolution process does not apply to:

Grievances related to the family support program under T.C.A. § 33-5-209;
Location of service or support unless the location is inaccessible to the service recipient and/or service recipient’s family, as appropriate;
Request for discharge from a voluntary admission under T.C.A. §§ 33-6-201 et seq.;
Decisions of an inpatient mental health facility’s treatment review committee under T.C.A. § 33-6-107;
Decisions of a developmental disability service provider’s behavior support committee and/or human rights committee;
Commitment for involuntary treatment and/or mandatory outpatient treatment;
Administration of electroconvulsive therapy or other convulsive therapy to a child;
Rights under federal or other state laws, rules or court decisions; and 9. Termination of service or support because a third party payer refuses to continue to fund the service or support.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-601, et seq., 33-6- 206, and 33-8-202.
Administrative History: Original rule filed January 31, 2006; effective April 16, 2006.

Tenn. Comp. R. & Regs. 0940-01-07-.03 DEFINITION

(1) Legal representative means:

(a) The parent;

(b) The legal custodian;

(d) The legal guardian of a service recipient who is an unemancipated child;

(e) The conservator or attorney-in-fact under a durable power of attorney for health care of an adult service recipient; or (f) A surrogate decision maker under T.C.A. §§ 33-3-219 and 33-3-220, if the conflict is related to routine medical, dental or mental health treatment.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-601, et seq., 33-6- 206, 33-8-202, and 34-6-301, et seq.
Administrative History: Original rule filed January 31, 2006; effective April 16, 2006.

Tenn. Comp. R. & Regs. 0940-01-07-.04 DUTIES OF LICENSEES

(1) Every licensee of the department must develop and implement clear conflict resolution procedures that comply with this chapter. Such procedures must include informal meetings and an appeal process and must ensure that each conflict is resolved within the time frame in

Tenn. Comp. R. & Regs. 0940-01-07-.06 PROCEDURES

(1) Conflict resolution must not exceed two (2) steps to finality: an informal meeting under 0940- 01-07-.06(10) and an appeal under 0940-01-07-.06(11).

(2) A request for conflict resolution must be submitted to the licensee not more than thirty (30) calendar days after the occurrence of the matter which is the basis for the request.

(3) Requests for conflict resolution must contain:

(a) The basis for the request;

(b) The corrective action desired by the service recipient or his/her legal representative; and (c) Sufficient facts or other information to begin the process.

(4) A request may be submitted orally or in writing to the chief officer of the licensee or designee of the chief officer. If the request is given orally, it must be documented in the service recipient’s record. A written request must be filed in the service recipient’s record. No request may be denied because a specific form adopted by a licensee has not been used.

(5) Conflict resolution proceedings may occur during business hours or at other mutually agreeable times.

(6) Conflict resolution proceedings may be held at the licensee’s location or at a mutually agreed upon place convenient to all parties.

(7) Any proceeding under this chapter may be conducted by telephone conference call, computer-aided meeting processes or other electronic means in which all parties can participate.

(8) A service recipient or his/her legal representative may represent himself/herself in the procedure or may designate another person to speak on his/her behalf.

(9) If a service recipient or his/her legal representative intends to retain legal counsel, the service recipient or his/her legal representative must notify the licensee of the intent. If the service recipient or his/her legal representative retains legal counsel, the licensee may also have legal counsel present during the proceeding.

(10) The first step in the conflict resolution procedure must be an informal meeting of involved persons:

(a) The informal meeting must be held no more than fiv e (5) business days after the request.

(b) The meeting must include an informal discussion of issues raised.

(c) The outcome of the informal meeting must be documented in the service recipient’s record with a copy of the outcome sent to all parties within two (2) business days after the meeting.

(11) If the issue is not resolved during the informal meeting, the service recipient or his/her legal representative may request an appeal within five (5) business days of receipt of the documented outcome of the informal meeting.

(12) The chief officer or his/her designee must hear the appeal within ten (10) business days of the request.

(a) If the issue that is the basis for the request for conflict resolution directly involves the chief officer, a designee must be appointed.

(b) The appeal must include an informal discussion of the request for conflict resolution, the facts, and the recommendations of the involved parties and other individuals as determined by the chief officer or designee. The rules of civil procedure, evidence and administrative procedures do not apply to the appeal.

(c) The chief officer or designee must provide the parties a written statement of the resolution of the appeal within two (2) business days after the conclusion of the hearing. A copy of the written statement must be placed in the service recipient’s record.

(d) The decision of the chief officer or designee is final and may not be appealed.

(13) By mutual consent of the service recipient or his/her legal representative and the chief officer or his/her designee, the time limits in this rule may be extended.

(14) The chief officer of the licensee must retain, in a separate file, a copy of any request for use of conflict resolution, the outcome, and any supporting documentation.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-6-201, et seq., and 34- 6-301, et seq.
Administrative History: Original rule filed January 31, 2006; effective April 16, 2006.

Tenn. Comp. R. & Regs. 0940-01-07-.05 RIGHTS OF SERVICE RECIPIENTS

(1) A service recipient who has capacity or the legal representative if the service recipient lacks capacity, may request conflict resolution procedures if he/she has been unable to resolve a conflict.

(2) While conflict resolution is pending, provision of services or supports must not cease over the objection of a service recipient with a developmental disability or his/her legal representative.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-2-601, et seq.
Administrative History: Original rule filed January 31, 2006; effective April 16, 2006.

Chapter 0940-01-08 Repealed

Tenn. Comp. R. & Regs. 0940-01-08 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH

AND SUBSTANCE ABUSE SERVICES

Chapter 0940-01-09 Rules of Procedure for Hearing Contested Cases

Tenn. Comp. R. & Regs. 0940-01-09 Rules of Procedure for Hearing Contested Cases

RULES

OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH

AND SUBSTANCE ABUSE SERVICES

For Rules of Procedure for Hearing Contested Cases see Rules of the Secretary of State, Chapter 1360- 04-01.

Authority: T.C.A. § 4-509. Administrative History: Original chapter filed November 22, 1978, effective January 8, 1979. Administrative correction made to chapter reference in December 2022. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Chapter 0940-01-10 Public Records Requests

Tenn. Comp. R. & Regs. 0940-01-10-.01 PURPOSE

The purpose of these rules is to establish procedures regarding public records requests received by the Tennessee Department of Mental Health and Substance Abuse Services, and to provide economical and efficient access to public records as provided under the Tennessee Public Records Act.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019.

Tenn. Comp. R. & Regs. 0940-01-10-.02 DEFINITIONS

(1) “Governmental Entity” means the State of Tennessee, or any county, municipality, city or other political subdivision of the State of Tennessee.

(2) “Office of Open Records Counsel” or “OORC” means the office established pursuant to Tenn.

Code Ann. §§ 8-4-601 et seq, or any successor office or entity.

(3) “Privacy Counsel” means the General Counsel of TDMHSAS unless otherwise delegated.

(4) “Public Records” means all documents, papers, letters, maps, books, photographs, microfilms, electronic data processing files and output, films, sound recordings, or other material, regardless of physical form or characteristics, made or received pursuant to law or ordinance or in connection with the transaction of official business by any governmental agency, not otherwise protected by law or exempt from disclosure under the TPRA.

(5) “Public Records Request Coordinator” or “PRRC” means the individual, or individuals, designated in Rule 0940-01-10-.05 who has, or have, the responsibility to ensure public record requests are routed to the appropriate records custodian and are fulfilled in accordance with the TPRA. The PRRC may also be a records custodian.

(6) “Records Custodian” means the office, official, or employee lawfully responsible for the direct custody and care of a public record. The records custodian is not necessarily the original preparer or receiver of the record.

(7) “Requestor” means the citizen seeking access to a public record, whether it is for inspection or duplication.

(8) “TDMHSAS” or the “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(9) “TPRA” means the Tennessee Public Records Act found in Title 10, Chapter 7 of the Tennessee Code Annotated.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019.

Tenn. Comp. R. & Regs. 0940-01-10-.03 GENERAL INFORMATION

(1) The TPRA provides that all state, county, and municipal records shall, at all times during business hours, which for public hospitals shall be during the business hours of their administrative offices, be open for personal inspection by any citizen of this state, and those in charge of the records shall not refuse such right of inspection to any citizen, unless otherwise provided by state or federal rule or law. Accordingly, the public records of TDMHSAS are presumed to be open for inspection unless otherwise provided by law.

(2) Personnel of TDMHSAS shall timely and efficiently provide access and assistance to persons requesting to view or receive copies of public records. No provision of this Rule shall be used to hinder access to open public records. However, the integrity and organization of public records, as well as the efficient and safe operation of TDMHSAS, shall be protected as provided by current law. Concerns about this Rule should be addressed to the PRRC for TDMHSAS.

(3) This Rule shall be applied consistently throughout the various offices and divisions of TDMHSAS.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019.

Tenn. Comp. R. & Regs. 0940-01-10-.04 REQUESTING ACCESS TO PUBLIC RECORDS

(1) Public records requests shall be made to the PRRC in order to ensure public records requests are routed to the appropriate records custodian and fulfilled in a timely manner. Any employee of TDMHSAS who receives what they believe may be a public records request, formal or informal, shall immediately notify the PRRC.

(2) Requests for inspection are not required to be made in writing. The PRRC shall request a mailing or email address from the requestor for providing any written communication required under the TPRA.

(3) Requests for inspection may be made orally or in writing using the Public Records Request Form at Andrew Jackson Building, 6th Floor, 500 Deaderick Street, Nashville, TN 37243, by phone at 615-532-6500, or by email at oc.tdmhsas@tn.gov.

(4) Requests for copies, or requests for inspection and copies, of public records shall be made in writing. Requestors may use the Public Records Request Form found in Rule 0940-01-10-.01 or any other written form of communication such as mail or electronic mail.

(5) Proof of Tennessee citizenship by presentation of a valid Tennessee driver’s license, or alternative acceptable form of identification, may be required as a condition to inspect or receive copies of public records.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019. Amendments filed October 16, 2024; effective January 14, 2025.

Tenn. Comp. R. & Regs. 0940-01-10-.05 RESPONDING TO PUBLIC RECORDS REQUESTS

(1) The PRRC, or an employee under the direction of the PRRC, shall review public records requests and make an initial determination of the following:

(a) If the requestor provided evidence of Tennessee citizenship, if required, pursuant to

Rule 0940-01-10-.04;

(b) If the records requested are described with sufficient specificity to identify them;

(c) If TDMHSAS has custody of the requested records and, if so, the name of the respective records custodian; and (d) If the records requested, or any of their contents, are protected by privacy laws or are in any way confidential or privileged under federal and/or state law and whether the Privacy Counsel needs to be consulted.

(2) The PRRC, or an employee under the direction of the PRRC, shall acknowledge receipt of the request and take any of the following appropriate actions:

(a) Advise the requestor of this Rule and the elections made regarding:

Proof of Tennessee citizenship pursuant to Rule 0940-01-10-.04;
Any forms required for copies;
Fees, labor threshold, and waivers, if applicable; and 4. Aggregation of multiple or frequent requests.

(b) If appropriate, deny the request in writing and provide the reason for the denial, which may include but is not limited to any of the following:

The requestor is not, or has not presented evidence of being, a Tennessee citizen pursuant to Rule 0940-01-10-.04.
The request lacks specificity.
An exemption makes the record not subject to disclosure under the TPRA.
TDMHSAS is not the custodian of the requested records.
The records do not exist.
Any other legal grounds for denial.

(d) Forward the request to the appropriate records custodian in TDMHSAS.

(e) If requested records are in the custody of a different governmental entity, and the PRRC knows the correct governmental entity to which the public records request should be made, the PRRC will advise the requestor of the correct governmental entity and the PRRC for that entity, if known.

(3) The designated PRRC is the Director of Communications of TDMHSAS; provided, however, that responsibilities of the PRRC under this Rule may be delegated to one or more employees under the direction of the PRRC. The PRRC may be contacted at:

TDMHSAS Director of Communications Andrew Jackson Building, 6th Floor 500 Deaderick Street Nashville, TN 37243 Telephone: (615) 532-6500 Email: oc.tdmhsas@tn.gov (4) Upon receiving a public records request, the PRRC, or an employee under the direction of the PRRC, shall promptly make requested public records available in accordance with T.C.A. § 10-7-503. If the PRRC is uncertain as to whether an applicable exemption applies or whether the records requested, or any of their contents, are protected by privacy laws or are in any way confidential or privileged under federal and/or state law, the PRRC will consult with the Privacy Counsel in the Division of General Counsel. The PRRC may also consult with the OORC after first consulting with the Privacy Counsel.

(5) If it is not practicable to promptly provide requested records because additional time is necessary to determine whether the requested records exist; to search for, retrieve, or otherwise gain access to records; to determine whether the records are open; to redact records; or for other similar reasons, then the PRRC, or an employee under the direction of the PRRC, shall, within seven (7) business days from the PRRC’s receipt of the request, send the requestor a completed Public Records Request Response Form.

(6) If the PRRC, or an employee under the direction of the PRRC, denies a public records request, he or she shall deny the request in writing as provided in Rule 0940-01-10-.05(2)(b) using the Public Records Request Response Form.

(7) If the PRRC, or an employee under the direction of the PRRC, reasonably determines production of records should be segmented because the records request is for a large volume of records, or additional time is necessary to prepare the records for access, the PRRC, or an employee under the direction of the PRRC, shall use the Public Records Request Response Form to notify the requestor that production of the records will be in segments and that a records production schedule will be provided as expeditiously as practicable. If appropriate, the PRRC, or an employee under the direction of the PRRC, should contact the requestor to see if the request can be narrowed.

(8) If the PRRC, or an employee under the direction of the PRRC, discovers records responsive to a records request were omitted from a response, then the PRRC, or an employee under the direction of the PRRC, should contact the requestor to inform him/her of the omission.

The PRRC, or an employee under the direction of the PRRC, shall ascertain whether the requestor wants to inspect and/or copy the previously omitted records. Any such request shall be subject to the provisions of this Rule regarding inspection and copies of public records, and fees and charges.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019. Amendments filed October 16, 2024; effective January 14, 2025.

Tenn. Comp. R. & Regs. 0940-01-10-.06 REDACTION OF PUBLIC RECORDS

(1) If a record contains confidential information or information that is not open for public inspection, the PRRC will consult with the Privacy Counsel or other appropriate parties regarding potential redaction of records. The PRRC may also consult with the OORC or with the Office of Attorney General and Reporter after first consulting with the Privacy Counsel.

(2) TDMHSAS will make best efforts to remove any and all information it deems confidential or otherwise protected from disclosure pursuant to any state and/or federal law, rule, or

regulation before disclosing the information in response to a public records request.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019.

Tenn. Comp. R. & Regs. 0940-01-10-.07 INSPECTION OF PUBLIC RECORDS

(1) There shall be no charge for inspection of open public records.

(2) The location for inspection of records within the offices of TDMHSAS shall be determined by the PRRC.

(3) Under reasonable circumstances, the PRRC or a records custodian may require an appointment for inspection or may require inspection of records at an alternate location.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019.

Tenn. Comp. R. & Regs. 0940-01-10-.08 COPIES OF PUBLIC RECORDS

(1) The PRRC shall promptly respond to a public records request for copies in the most economic and efficient manner practicable, to include providing digital copies.

(2) Copies will be available for pickup at a location specified by the PRRC.

(3) Upon payment for postage or delivery charges, copies will be delivered to the address provided by the requestor.

(4) If the requestor requests digital copies, digital copies will be delivered via email to an email address designated by the requestor.

(5) A requestor may use a personal camera or cell phone to take a photograph of a public record, so long as the integrity of the record is maintained. If a record contains confidential information or information that is not open for public inspection, the record may not be photographed until all appropriate redactions are completed.

(6) TDMHSAS, or its contractors or agents, shall maintain custody of its records at all times. A requestor shall not be allowed to take custody of any TDMHSAS record.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019.

Tenn. Comp. R. & Regs. 0940-01-10-.09 FEES AND CHARGES; PROCEDURES FOR BILLING AND PAYMENT;

AGGREGATION OF FREQUENT AND MULTIPLE REQUESTS.

(1) The PRRC shall provide requestors with an itemized estimate of the charges prior to producing copies of records and may require pre-payment of such charges before producing requested records.

(2) When fees for copies and labor do not exceed $50, the fees may be waived by the PRRC.

Requests for waivers for fees above $50 must be presented to the PRRC, who is authorized to determine if such waiver is in the best interest of TDMHSAS and for the public good. Fees associated with aggregated records requests will not be waived.

(3) Fees and charges for copies are as follows:

(a) $0.15 per page for letter and legal-sized black and white copies.

(b) $0.50 per page for letter and legal-sized color copies.

(d) If an outside vendor is used, the actual costs assessed by the vendor.

(4) Fees for labor and actual costs will be assessed in accordance with the OORC’s Schedule of Reasonable Charges.

(5) Payment of fees and charges for copies is to be made by personal check payable to “TDMHSAS Fiscal Services” presented to TDMHSAS Fiscal Services, Andrew Jackson Building, 6th Floor, 500 Deaderick Street, Nashville, TN 37243.

(6) Payment in advance will be required when costs are estimated to exceed $50.

(7) Aggregation of Frequent and Multiple Requests:

(a) TDMHSAS will aggregate records requests in accordance with the Frequent and Multiple Request Policy promulgated by the OORC when more than four (4) requests are received within a calendar month either from a single individual or a group of individuals deemed to be working in concert.

(b) The level at which records requests will be aggregated is departmental.

(c) The PRRC is responsible for making the determination that a group of individuals are working in concert. As soon as practicable after such a determination is made, the PRRC shall inform the individuals in writing that they have been deemed to be working in concert and that they have the right to appeal the decision to the OORC.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019. (This space intentionally left blank.)

Tenn. Comp. R. & Regs. 0940-01-10-.10 PUBLIC RECORDS REQUEST FORM

PUBLIC RECORDS REQUEST FORM

The Tennesse e Public Reco rds Act (TPRA) g rants Tennesse e citizens the right to access open public records t hat exist at the time of the request. The TPRA does no t require records cu stodi ans to compile information or create or recreate records that do not exis t.

To: [I nsert Governmental Entity Name and Name and Contact Information for the Public Records Request Coordinator]

From: [I nsert Requestor’s Name and Contact I nformation (include an address for any TPRA required written response)]

Is the requestor a Tennessee citizen?  Yes  No Req uest:  I nspection (The TPRA does not permit fees or require a writt en request for inspection only i .)  Copy/Duplicate If costs fo r copies are assessed, the requestor has a right to receive an estimate.

Do you wish to waive yo ur rig ht t o an estimate and agree to pay copying and duplication costs i n an amount not to exceed $ ?

If so, ini tial here_________________.

Delivery preference:  On-Site Pick-Up  USPS First-Class Mail  Electronic  O ther:

RECORDS REQUESTED:

Provide a detailed description of the record(s) requested, including: (1) type of r ecord; (2) timeframe or dates for the records sought; and (3) subject matter or key w ords related to the re cords. Under the TPRA, record requests must be sufficiently detailed to enable a governmental entity to identify the specific record s sought. As such, y our record request must provide enough detail to enable t he records custodian r esponding to the request to identi fy the specific record s you are seeking. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________ _________________________________________ Signature of Requestor and Date Submitted Signature of Public Records Coordinator and Date Received i Note, Tenn. Code Ann. § 10-7-504(a)(20)(C) permits c harging for redaction of private records of a utility.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019. (This space intentionally left blank.)

Tenn. Comp. R. & Regs. 0940-01-10-.11 PUBLIC RECORDS REQUEST RESPONSE FORM

PUBLIC RECORDS REQUEST RESPONSE FORM

TN Department of Mental Health and Substance Abuse Services [Date] [R equestor’s Name and Contact Information]:

In response to your records request received on [Date Request Received], our offic e is taking the actio n(s) indicated below:  The public record(s) responsive to your request will be made available for inspec tion:

Location:

Date & Time:  Copies of public record(s) r esponsive to your request are:  Attached;  Available fo r pickup at the following lo catio n: ; or  Being delivered via:  USPS First-Class Mail  Electronically  O ther:_________________________  Your request is denied on t he follo wing g rounds:  Your request was not suff iciently detailed to enable identifi cation of the specific requested record(s). You need to provide additi onal information to identify the requested record(s).  No such record(s) exist s or this offi ce does not maintain record(s) responsive to your re quest.  No proof of Tennessee ci tizenship was presented with y our request. Your r equest w ill be reconsidered upon presentation of an adequate form of identificatio n.  You are not a Tennessee citizen.  You have not paid the estimated copying/production f ees.  The follo wing state, federal, or other appli cable law prohibits disclosure of the requested records: ________________________________________________________________________.  It is not p racti cable for the r ecords you requested to be made promptly available fo r inspection and/or copying because:  It has not y et been determined th at records responsive to your request exist; or  This office is sti ll in the process of retrieving, reviewing, and/or redacting the requested records.

The time reasonably necessary to produce th e re cord(s) or information and/or to make a determination of a proper response to your request is: _.

If you have any addit ional questions regarding your record request, please contact [Records Custodian or Public Records Request Coordinator].

Sincerely, [R ecords Custodian or Public Record Request Coordinator] [Name, Title, and C ontact I nformation] 1 If all request ed records do not have the same resp onse, so indicate.

History

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed October 5, 2018; effective January 3, 2019.

Chapter 0940-02-01 Determination of Average Daily Cost

Tenn. Comp. R. & Regs. 0940-02-01-.01 DEFINITIONS

As used in this Chapter, unless the context requires otherwise:

(1) “Commissioner” means the Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services.

(2) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(3) “Institution” means Lakeshore Mental Health Institute, Memphis Mental Health Institute, Middle Tennessee Mental Health Institute, Moccasin Bend Mental Health Institute, or Western Mental Health Institute, regardless of name known as and any combination of mental health institutes providing the same type of service.

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Amendment by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984. Amendments filed February 26, 2009, effective June 26, 2009. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-02-01-.02 COMPUTATION OF AVERAGE DAILY COST

The department, using cost report forms prescribed by the department, shall calculate the average daily cost. The cost report shall include the costs of operations of the institutions, statistical and other data, adjustments and reclassifications to trial balance expenditures, allocation of costs, statistical basis of allocation of costs, calculation of average daily cost for each type of service, and certification by a responsible institution official. The department shall complete the cost report in accordance with the Medicare and Medicaid principles of reimbursement as found in the current edition of the Medicare Principles of Reimbursement Manual, except as otherwise provided for in the instructions for the preparation of the cost report.

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Amendments filed February 26, 2009; effective June 26, 2009.

Tenn. Comp. R. & Regs. 0940-02-01-.03 COMPUTATION OF COST INCREASE FACTOR

The department shall compute a cost increase factor in the following manner. For an institution that has completed three (3) full years of rendering a certain type of service, this factor shall be the average of the institution’s increase or decrease in average daily cost for that type of service over the prior two (2) years. Negative averages shall be considered as zero. For an institution that has not completed three (3) full years of rendering a certain type of service, the factor shall not exceed the 100th percentile value for the factor for mental health institutes. The cost-increase amounts used in determining the 100th percentile shall be the latest values calculated for at least 50 percent of the mental health institutes that have rendered like type services three (3) full years.

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Amended and New rule filed October 14, 1980; effective December 1, 1980. Amendments filed February 26, 2009; effective June 26, 2009.

Tenn. Comp. R. & Regs. 0940-02-01-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed February 26, 2009; effective June 26, 2009.

Tenn. Comp. R. & Regs. 0940-02-01-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed February 26, 2009; effective June 26, 2009.

Tenn. Comp. R. & Regs. 0940-02-01-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed February 26, 2009; effective June 26, 2009.

Tenn. Comp. R. & Regs. 0940-02-01-.07 DETERMINATION OF TENTATIVE AVERAGE DAILY COST

The commissioner shall determine a tentative average daily cost using a cost analysis procedure by:

(1) Computing the average daily cost under Rule 0940-02-01-.02 Computation of Average Daily Cost and (2) Adding to the computed average daily cost an amount utilizing the cost increase factor prescribed in Rule 0940-02-01-.03 Computation of Cost Increase Factor.

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Amendments filed February 26, 2009; effective June 26, 2009.

Tenn. Comp. R. & Regs. 0940-02-01-.08 NOTICE AND COMMENT

After the commissioner has determined the tentative average daily cost for each type of service, he shall give notice that the tentative average daily cost is effective on a specific date, not less than fifteen (15) days after giving notice. The commissioner will receive comments on the tentative rates during the fifteen (15) day notice period.

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Amendment filed February 26, 2009; effective June 26, 2009.

Tenn. Comp. R. & Regs. 0940-02-01-.09 AVERAGE DAILY COST EFFECTIVE DATE, FILING

Unless the commissioner withdraws or modifies a tentative average daily cost, it becomes effective as the average daily cost on the date specified in the notice. If the commissioner withdraws or modifies a tentative average daily cost within the 15 day notice period, he shall give notice in writing of such withdrawal or modification and the modification or withdrawal will be effective on the effective date of the original tentative filing. The department shall maintain in its central office all computations, notices, tentative average daily cost schedules, notices of withdrawal or modification and average daily cost. These documents are available for public inspection and copying during normal business hours.

History

Authority: T.C.A. §§ 4-4-103, 33-1-305, and 33-2-1101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Amendment filed February 26, 2009; effective June 26, 2009.

Chapter 0940-02-02 Patient/Resident Work Programs

Tenn. Comp. R. & Regs. 0940-02-02-.01 ASSIGNMENT TO WORK PROGRAM

No patient/resident shall be assigned to work program unless the work to be done is part of a closely supervised work therapy program.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984. New rule filed July 11, 1984; effective August 10, 1984.

Tenn. Comp. R. & Regs. 0940-02-02-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984.

Tenn. Comp. R. & Regs. 0940-02-02-.03 REFERRAL

No patient/resident may be accepted for a work assignment without the completion of a referral form by a member of the treatment or training team responsible for the individual’s care. In mental health institutes this referral form shall be signed by a licensed physician who is responsible for the total treatment plan; in developmental centers, this referral form shall be signed by qualified mental retardation professional and co-signed by a licensed physician who is responsible for the total habilitation plan. The referral form should indicate the physician’s approval, along with any limitations as to the type of work in which the patient/resident may participate.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment filed July 11, 1984; effective August 10, 1984.

Tenn. Comp. R. & Regs. 0940-02-02-.04 PATIENT/RESIDENT PARTICIPATION IN TREATMENT OR HABILITATION PLANS

Those patients/residents capable of involvement in the development of their own treatment or habilitation plans should participate and be counseled as to the work program. Coercion into working or punishment for refusing to participate in the work program is patient abuse.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978.

Tenn. Comp. R. & Regs. 0940-02-02-.05 REASSESSMENT

A reassessment of the work assignment of each patient/resident shall be made not less than every ninety (90) days. A review of the work performance of each patient/resident shall be made every ninety (90) days. A copy of the reassessment shall be placed in the individual’s record.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978.

Tenn. Comp. R. & Regs. 0940-02-02-.06 LIMITATIONS

No patient/resident shall be permitted to engage in work that is unsupervised or is supervisory in nature. No patient/resident may participate in the care of training of other patients or residents unless he or she has undergone prior formalized training. Based on the degree of handicap, no patient/resident under the legal working age, as defined by applicable Federal and State Child labor Laws, may engage in work.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978.

Tenn. Comp. R. & Regs. 0940-02-02-.07 GUIDELINES-CERTIFICATION PROCEDURES

(1) If an assignment constitutes work and the patient/resident has an unimpaired productive capacity, the patient/resident is entitled to not less than the statutory minimum wage.

(2) Handicapped individuals with impaired productive capacity shall be reimbursed under the following guidelines:

(a) During the first year of the employment relationship, a patient/resident will be considered to be in evaluating and training, to the extent that competent instruction and supervision are provided to determine one’s potential and teach adjustment to a work environment or the skills needed to perform one or more types of work, and will receive at least commensurate pay based on his actual productivity as compared with similar work performed by non-handicapped persons.

(b) After the first year of the employment relationship, the patient/resident will be subjected to a group minimum wage of not less than 50% of the minimum statutory wage or commensurate pay, whichever is higher.

(c) A minimum wage or commensurate pay less than the group minimum wage, but not less than 25% of the minimum statutory wage, may be authorized for a severely handicapped individual.

(d) For those patient/resident workers with a productive capacity less than 25% of the minimum statutory wage, commensurate pay need only be paid and no minimum wage shall be required if a work activity center is designed to provide therapeutic activities and if so certified by a non-profit, non-governmental advocacy agency.

(e) Under no circumstances may a patient/resident worker, other than those in a work activity center, be paid less than 25% of the minimum statutory wage after the first year of the employment relationship.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment by public chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984.

Tenn. Comp. R. & Regs. 0940-02-02-.08 DEDUCTIONS FROM WAGES

No deductions will be made from the wages paid to working patients/residents for the cost of maintenance, hospitalization, burial funds or other nonstandard provisions. However, on the basis of ability-to-pay criteria, the institution may negotiate with the patient/resident or his responsible relative or guardian concerning an increase in payment for care and treatment rendered as a result of an individual’s increased income.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978.

Tenn. Comp. R. & Regs. 0940-02-02-.09 SELF-CARE AND DOMICILIARY TASKS

All self-care and domiciliary activities which are routine tasks that an individual would be expected to perform at his or her own home are not to be considered as work. Those tasks that a patient/resident may do at the conclusion of an instructional activity session where the individual assists with the cleanup of the immediate work or play area shall not be considered as work.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978.

Tenn. Comp. R. & Regs. 0940-02-02-.10 RECORDS AND REPORTS

Each developmental center and mental health institute will establish appropriate time and attendance reports upon which to base remuneration. In addition, records showing which patient/resident workers are in each certified program under Rule 0940-02-02-.07, the disability and productivity of each worker, and the prevailing wage for similar work performed by nonhandicapped workers must be preserved for two years. Records that are required for non-patient/resident employees under 29 CFR, Part 516, are required for all patient/resident workers.

History

Authority: T.C.A. §§ 33-1-203 and 33-1-205.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984. New rule filed July 11, 1984; effective August 10, 1984.

Chapter 0940-02-03 Repealed

Tenn. Comp. R. & Regs. 0940-02-03-.01 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-202, 33-1-203, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed February 3, 1983; effective March 16, 1983. Repeal filed September 23, 2011; effective December 22, 2011.

Tenn. Comp. R. & Regs. 0940-02-03-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-202, 33-1-203, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed February 3, 1983; effective March 16, 1983. Repeal filed September 23, 2011; effective December 22, 2011.

Tenn. Comp. R. & Regs. 0940-02-03-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-202, 33-1-203, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed February 3, 1983; effective March 16, 1983. Repeal filed September 23, 2011; effective December 22, 2011.

Tenn. Comp. R. & Regs. 0940-02-03-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-202, 33-1-203, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed February 3, 1983; effective March 16, 1983. Repeal filed September 23, 2011; effective December 22, 2011.

Tenn. Comp. R. & Regs. 0940-02-03-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-202, 33-1-203, 33-1-302, 33-1-303, 33-1-305, and 33-1-309.
Administrative History: Original rule filed February 3, 1983; effective March 16, 1983. Repeal filed September 23, 2011; effective December 22, 2011.

Chapter 0940-02-04 Administration Inspections and Searches

Tenn. Comp. R. & Regs. 0940-02-04-.01 PURPOSE

The Tennessee Department of Mental Health and Substance Abuse Services has a duty to protect the safety of persons at its facilities and to preserve and protect the property of those persons and of the State of Tennessee. In order to fulfill this responsibility the use of administrative inspections and searches is necessary. This rule is intended to standardize practices and provide guidelines for proper conduct of administrative inspections and searches of persons and property at department facilities.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-02-04-.02 SCOPE

This chapter is applicable to administrative inspections and searches conducted by department employees at any facility operated by the department. This chapter does not apply to any facility that elects not to conduct any searches or administrative inspections.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986.

Tenn. Comp. R. & Regs. 0940-02-04-.03 DEFINITIONS

As used in this chapter, unless the context requires otherwise, terms shall have the following meanings:

(1) Administrative inspection – a principally visual inspection of a cursory and limited nature to permit the viewing of the contents of packages, containers, and the passenger and trunk area of motor vehicles.

(2) Consent – clear, unequivocal and entirely voluntary permission to conduct an administrative inspection or search given by the subject thereof or the controller of property subject thereto.

(3) Contraband – any item expressly prohibited or limited in its use, possession or presence on facility grounds by law or by departmental or facility rules, policy or procedures.

(4) Department – the Tennessee Department of Mental Health and Substance Abuse Services.

(5) Employees – all workers on the staff of any division, facility or office of the department.

(6) Exigent circumstances – situations in which facts indicate that immediate action is necessary to prevent danger or to prevent loss or destruction of evidence during the delay required to obtain a warrant.

(7) Patients – persons under evaluation, care or treatment in a facility operated by the department for the mentally ill.

(8) Probable cause – a factual ground for belief sufficient to cause a reasonably prudent person to conclude that a crime has been or is being committed, or that contraband or evidence of a crime will likely be found in a particular place or area.

(9) Residents – persons under evaluation, care, training or treatment in a facility operated by the department for the mentally retarded.

(10) Search – Any physical examination of a person or a person’s clothing, or a thorough examination of a package, container, or vehicle.

(a) Frisk search – a search in which a person being searched is not required to remove his or her clothing.

(b) Strip search – a search in which a person being searched is required to remove or rearrange some or all of his or her clothing.

(c) Visual body cavity search – the visual inspection of a person’s body cavities made without touching the person being searched physically or with instruments.

(d) Manual body cavity search – an inspection of mouth, ear, nose, anal or vaginal body cavities performed only by authorized medical or nursing staff utilizing the fingers or appropriate instruments.

(11) Visitors – persons other than department employees who enter facility grounds.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-02-04-.04 POLICY

(1) Administrative inspections and searches shall be conducted only by properly authorized department staff and only in accordance with the procedures specified herein.

(2) Administrative inspections and searches shall be conducted only as necessary to achieve the following purposes:

(a) To prevent introduction of prohibited or dangerous instrumentalities into the facility, and especially into the patient or resident population therein, (b) To prevent theft of property, belonging to patients, residents, employees or visitors at the facility.

(c) To prevent theft and unauthorized use of state property, or (d) To discover hazards to health and safety that might otherwise go unnoticed.

(3) Administrative inspections and searches shall be conducted in a manner which will avoid embarrassment or indignity to those whose persons or property are being inspected or searched.

(4) Notice of this policy and these procedures shall be given to all those potentially affected thereby.

(5) Employees and visitors subject to administrative inspection shall be provided with the opportunity to leave personal belongings and vehicles at designated areas: personal belongings and vehicles left at said designated areas will not be subject to administrative inspection.

(6) Employees may be permitted to keep some personal belongings in property (examples: desks, file cabinets) owned by the state that is assigned or issued to employees for use in their jobs. However, the contents of such state property may be inspected at any time by supervisory personnel, without notice to or the permission of the employee to whom the property is assigned.

(7) The head of each facility shall issue instructions consistent with this policy and these procedures assigning Authority and responsibility for the implementation of this policy and these procedures at the respective facilities. Use of administrative inspection procedures is not required at any facility so long as the head of a facility determines that theft and safety problems can be resolved in a less obtrusive manner.

(8) The department shall provide an on-going program of training for personnel responsible for the implementation of this policy.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986.

Tenn. Comp. R. & Regs. 0940-02-04-.05 NOTICE PROCEDURES

(1) Signs shall be posted in highly conspicuous areas on facility grounds, and particularly at facility entrances, to give notice to visitors and employees when persons and property on facility grounds are subject to administrative inspection. Signs should include information that bringing alcohol, drugs or weapons onto facility grounds is not permitted, and that such items are subject to confiscation.

(2) Present employees, patients and residents shall be appropriately informed of this policy and these procedures prior to its implementation.

(3) Upon admission, patients and residents shall be given information about this policy and these procedures by means of including such information in the statement and explanation of patients’ or residents’ rights provided at admission.

(4) Whenever practicable, prospective patients or residents, and their families and friends should be given information about this policy and these procedures prior to the time of admission.

(5) Applicants for employment should be given information about this policy and these procedures.

(6) Generally, notice should be given in a manner and at a time reasonably calculated to allow a person to make decisions and arrangements to protect legitimate privacy interests.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986.

Tenn. Comp. R. & Regs. 0940-02-04-.06 ADMINISTRATIVE INSPECTION PROCEDURES

(1) Personnel designated by the commissioner of the department to exercise the Authority of security guards may request any employee or other person on facility grounds to submit to an administrative inspection or to present appropriate identification. This Authority is to be exercised only by employees specifically authorized by the head of a facility to conduct administrative inspections.

(2) Any employee not complying with a request to submit to administrative inspection or to present identification shall be subject to disciplinary procedures and other appropriate legal action.

(3) Any visitor not complying with a request to submit to administrative inspection or to present identification shall be subject to being escorted from facility grounds and other appropriate legal action.

(4) Any patient or resident not complying with a request to submit to administrative inspection shall be subject to being escorted to his or her housing unit, and the refusal shall be reported to designated professional staff for a determination of any necessary further action.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986.

Tenn. Comp. R. & Regs. 0940-02-04-.07 SEARCH PROCEDURES: ALL SEARCHES

(1) All searches shall be conducted for a specific purpose consistent with the policy stated herein.

(2) All personnel whose duties include any role in conducting or authorizing searches shall receive special training in the procedures outlined herein, and in the principles of the law of search and seizure and of privacy rights.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986.

Tenn. Comp. R. & Regs. 0940-02-04-.08 PROCEDURES FOR SEARCHES OF EMPLOYEES AND VISITORS

(1) Searches of visitors and employees, or their vehicles and other property, shall be conducted only by facility security guards or by such other persons as designated by the Commissioner to exercise the Authority of security guards. This Authority is to be exercised only by employees specifically authorized by the head of a facility to conduct searches.

(2) Employees entering a security facility or unit, or visitors to patients or residents in a security facility or unit may be requested to consent to a frisk search prior to the visit. Any visitor refusing consent to this procedure may be denied permission to visit.

(3) Searches of visitors and employees are limited to searches not requiring the removal of clothing.

(4) Searches, other than as authorized in Part 2 above, of visitors and employees, or of their vehicles or other property, shall be conducted only in the following circumstances:

(a) Pursuant to a lawful search warrant and limited to the Authority given in the warrant, or (b) With the voluntary consent of the person subject to search, or (c) With the voluntary consent of the person exercising control of property subject to search, or (d) With probable cause in exigent circumstances.

(5) Whenever practicable, prior to the search of visitors or employees or of their vehicles or property, a search warrant shall be obtained pursuant to Rule 41 of the Tennessee Rules of Criminal Procedures. Searches without a warrant or voluntary consent are expressly discouraged, and should not be conducted unless a compelling need for an immediate search can be demonstrated.

(6) No physical force shall be used by department employees in searches of employees or visitors. When a proposed search is resisted, search efforts shall cease. In appropriate cases, a report should then be made to a local law enforcement agency.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986.

Tenn. Comp. R. & Regs. 0940-02-04-.09 PROCEDURES FOR SEARCHES OF PATIENTS AND RESIDENTS

(1) The person and property of patients and residents shall be subject to search, including strip search, including strip search, upon admission, upon return from leave and at such other times as is determined by designated professional staff to be necessary for the protection of the patient or resident, other patients or residents, or staff of the facility. Any strip or body cavity search of a patient or resident should be conducted by clinical personnel.

(2) Except in exigent circumstances, all searches other than those upon admission must be authorized in writing by professional staff designated by the head of the facility to authorize searches of patients or residents. The authorization shall include the justification for the search.

(3) If an intrusion on the privacy of the person or property of a patient or resident is incidental to a care-giving activity and not for the primary purpose of discovering contraband or evidence of a crime, such intrusion is not characterized as a search. The need of the patient or resident for services that necessitate such intrusions must be specifically documented in the individual treatment or habilitation plan of the patient or resident, and the continuing need for these services periodically reviewed. Without said documentation, such services must only be performed at the request of or with the competent consent of the patient or resident. In all cases, such services must be performed with consideration, respect and full recognition of the dignity of the patient or resident.

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, and 33-1-205.
Administrative History: Original rule filed October 2, 1986; effective November 16, 1986.

Chapter 0940-02-05 Regional Mental Health (RMHI) Care at the Expense of the State and Periodic Payments

Tenn. Comp. R. & Regs. 0940-02-05-.01 PURPOSE

(1) The purpose of these rules is to describe the Department’s policy for determining:

(a) Indigence such that a service recipient may receive care from a Regional Mental Health Institute (RMHI) at the expense of the state; and (b) The periodic payments to be made by non-indigent service recipients or responsible relatives for care by a RMHI.

(2) These rules do not apply to a person subject to evaluation, diagnosis or treatment under Title 33, Chapter 5; or Chapter 7, Part 3.

(3) These rules only apply to Tennessee residents who are legally in the United States of America. Services recipients who are not Tennessee residents or are not legally in the United States of America shall be liable for the total charge for services provided and shall not be eligible for a periodic payment plan under this chapter.

(4) Pursuant to T.C.A. § 33-1-204, these rules shall not create an entitlement to services from the state.

History

Authority: T.C.A. §§ 4-4-103, 33-1-204, 33-1-302, 33-1-305, 33-1-309, 33-2-1102, and 33-2-1108.
Administrative History: Original rule filed March 30, 2012; effective June 28, 2012.

Tenn. Comp. R. & Regs. 0940-02-05-.02 DEFINITIONS

(1) “Assets” means, excluding income, the total value of an individual’s equity in real and personal property of whatever kind or nature. Assets include, but are not limited to, the individual’s stocks, bonds, cash, accounts receivable, moneys due, or any other interests whether they are self-managed or held by the service recipient’s authorized representative or by any other individual or entity on behalf of the service recipient.

(2) “Charges” means the cost per patient day calculated under Rule 0940-02-01 Determination of Average Daily Cost, unless the actual cost exceeds 200% of the Average Daily Cost, in which case the Chief Officer of the RMHI may charge all or some portion of the actual bill to the service recipient, responsible relative, or third party payor.

(3) “Department” or “TDMHSAS” means the Tennessee Department of Mental Health and Substance Abuse Services.

(4) “Federal Poverty Guidelines” means the latest federal poverty measurement guidelines, for all contiguous states and the District of Columbia, issued by the United States Department of Health and Human Services and published annually in the Federal Register under 42 U.S.C. 9902(2).

(5) “Income” means gross income and is the total of earned and unearned income used by the Internal Revenue Service of the United States of America to determine whether an income tax return shall be filed.

(6) “Liabilities” are debts and obligations. Liabilities consist of current liabilities, which are bills that are due to creditors to settle debts within a relatively short period of time (usually within one year) and include such obligations as utilities, rent insurance premiums, taxes, medical bills, repair bills, credit card balances. Liabilities also include long-term liabilities, which are debts that are not expected to be liquidated within one year and include mortgages and longterm leases, student and automobile loans and other structured and amortized loans.

(7) “Net Worth” means the value of a person’s assets compared to their liabilities.

(8) “Period of indigence” means the period of time during which a service recipient has received or is receiving RMHI services and was determined to be indigent under this chapter.

(9) “Period of non-indigence” means the period of time when a service recipient has received or is receiving RMHI services and was determined to be non-indigent under this chapter.

(10) “Regional Mental Health Institute or RMHI” means a mental health hospital operated by TDMHSAS for service recipients with mental illness or serious emotional disturbance.

(11) “Responsible relative” means the parent of an unemancipated child with mental illness, serious emotional disturbance, alcohol dependence, drug dependence, or developmental disabilities who is receiving service in programs of the Department.

(12) “Service recipient” means a person who is receiving care or has received care from a RMHI.

(13) “Tennessee resident” means a person living in Tennessee with the intention of living there permanently or for an indefinite period of time.

History

Authority: T. C.A. §§ 4-4-103, 33-1-101, 33-1-302, 33-1-305, 33-1-309, and 33-2-1102.
Administrative History: Original rule filed March 30, 2012; effective June 28, 2012. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-02-05-.03 RMHI CARE AT THE EXPENSE OF THE STATE FOR INDIGENT SERVICE

RECIPIENTS.

(1) Any service recipient who receives care at a RMHI while indigent under this chapter shall receive that care at the expense of the state.

(2) Nothing in this rule exempts any public or private third-party payor from financial liability for any allowable charges for care from an RMHI.

(3) For the purposes of this rule, a service recipient is indigent during any period of time within which both of the following are true:

(a) The service recipient’s income is less than 100% of the Federal Poverty Guidelines.

(b) The service recipient’s net worth falls below the sum of $50,000 plus 500% of the Federal Poverty Guidelines.

(4) If an indigent service recipient has any responsible relatives, then an indigency determination will be made for the responsible relatives in addition to the service recipient. Only when the service recipient and all responsible relatives are found to be indigent, may a service recipient receive care at the expense of the state.

(5) The determination of indigence shall be made by person(s) designated by the RMHI Chief Officer.

(6) If the service recipient or responsible relative does not agree with the initial or subsequent determination, either person may request that the RMHI’s Chief Officer review the decision. If the service recipient or responsible relative does not agree with the determination of the RMHI’s Chief Officer, then either person may request that the Commissioner or designee make a final determination.

(7) The Department may review and alter an indigency determination at any time, but shall review at least annually the indigency status of any service recipient continuously receiving care by an RMHI for one year or longer.

(8) The service recipient or responsible relative may request a review and alteration of an indigency determination any time a change in income or net worth can be demonstrated.

(9) The Department may access information to determine indigence from any relevant source of data, including but not limited to, state and federal agencies administering benefits to a service recipient or responsible relative.

(10) The Department shall document the method by which indigence was determined in addition to all backup information used to substantiate the determination.

(11) A service recipient or responsible relative shall be found to be non-indigent if:

(a) A service recipient or responsible relative does not meet the criteria set forth in 0940- 02-05-.03(3); or (b) Insufficient information is available to determine indigence.

(12) A person shall be liable for the total charges for care by an RMHI and for the amount of the state’s expense incurred in recovering the amounts, including attorney salaries or fees, unless declared indigent under this rule. In order to be declared indigent, the person or responsible relative shall:

(a) Provide TDMHSAS with information TDMHSAS deems necessary for the determination of indigency; or (b) Provide TDMHSAS with a written release allowing TDMHSAS to access any information TDMHSAS deems necessary to determine indigency.

(13) A person or responsible relative shall notify TDMHSAS of any change in status that may affect an indigency determination.

(14) A person or responsible relative who knowingly provides false information that results in an inaccurate determination of indigence shall be liable for the total charges for care by an RMHI and for the amount of the state’s expense incurred in recovering the amounts, including attorney salaries or fees.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-1102, 33-2-1103, 33-2-1105, and 33- 2-1109.
Administrative History: Original rule filed March 30, 2012; effective June 28, 2012. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-02-05-.04 PERIODIC PAYMENTS BY NON-INDIGENT SERVICE RECIPIENTS OR

RESPONSIBLE RELATIVES.

(1) Service recipients and their responsible relatives, if any, shall be liable for charges incurred for care received at a RMHI during any period of non-indigence as determined under this

chapter.

(2) The state has a continuing claim against a service recipient or responsible relative or his or her estate for any unpaid difference between the amount owed and the amount paid for care from a RMHI for any period of non-indigence.

(3) At any time, a service recipient or responsible relatives may request a periodic payment plan under which a monthly payment amount will be established.

(4) In cases where the service recipient or responsible relatives have a public or private third party payor, the periodic payment plan may apply to the agreed deductible, co-payments or any portion of the charges not reimbursed by the third party provided that the RMHI has not agreed to accept the third party payment as payment in full.

(5) A payment plan may be established only when the service recipient’s and all responsible relatives’ net worth is less than the sum of $50,000 plus 500% of the Federal Poverty Guidelines.

(6) Person(s) designated by the RMHI Chief Officer shall determine whether a service recipient or responsible relative meets net worth requirements specified in Rule 0940-02-05-.04(5) to be eligible for a payment plan, and, if so, establish the amount of the monthly payment according to the schedule in Rule 0940-02-05-.04(11).

(7) The Department may review and alter a periodic payment plan at any time.

(8) If the service recipient or responsible relative does not agree with the initial or subsequent determination, either person may request that the RMHI’s Chief Officer review the decision. If the service recipient or responsible relative does not agree with the determination of the RMHI’s Chief Officer, then either person may request that the Commissioner or designee make a final determination.

(9) The service recipient or responsible relative may request review and alteration of a payment plan determination any time a change in income or net worth can be demonstrated.

(10) A person shall be liable for the total charges for care by an RMHI and for the amount of the state’s expense incurred in recovering the amounts, including attorney salaries or fees, unless declared eligible to receive a payment plan under this rule. In order to be declared eligible to receive a payment plan, the person or responsible relative shall:

(a) Provide TDMHSAS with information TDMHSAS deems necessary to establish a payment plan; or (b) Provide TDMHSAS with a written release allowing TDMHSAS to access any information TDMHSAS deems necessary to establish a payment plan.

(11) A person or responsible relative who knowingly provides false information that results in an inaccurate establishment of a payment plan shall be liable for the total charges for care by an RMHI and for the amount of the state’s expense incurred in recovering the amounts, including attorney salaries or fees.

(12) The following monthly payment plan shall be established for service recipients or responsible relatives who request a payment plan and meet the net worth requirement stated in Rule 0940-02-05-.04(5).

Service recipient’s income as a percentage of Federal Poverty Guidelines (FPG)

Formula for monthly payment amount 100% but less than 150% FPG 5% of the monthly equivalent of 100% FPG for a family size of one 150% but less than 200% FPG 5% of the monthly equivalent of 150% FPG for a family size of one 200% but less than 250% FPG 5% of the monthly equivalent of 200% FPG for a family size of one 250% but less than 500% FPG 5% of the monthly equivalent of 250% of FPG for a family size of one Over 500% FPG 5% of average monthly income

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-1102, 33-2-1103, 33-2-1104, 33-2- 1105, and 33-2-1107.
Administrative History: Original rule filed March 30, 2012; effective June 28, 2012. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Chapter 0940-03-01 Release from Involuntary Hospitalization

Tenn. Comp. R. & Regs. 0940-03-01-.01 SCOPE OF RULES

This chapter governs the release from involuntary hospitalization of persons committed under T.C.A. §§ 33-6-104, 33-7-301(b) and 33-7-303(c). It does not govern release from hospitalization under T.C.A. §§ 33-6-101, 33-6-103, 33-7-301(a) and 33-7-303(a).

History

Authority: T.C.A. §§ 33-1-204 and 33-1-205.
Administrative History: Original rule filed November 9, 1978; effective December 25, 1978. Repealed by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984.

Tenn. Comp. R. & Regs. 0940-03-01-.02 PERIODIC EXAMINATION

The superintendent of a mental health institute shall have each patient examined as often as possible, but at least after ninety days of admission, one hundred eighty days of admission, and thereafter at six-month intervals from the date of the last examination, to assess the patient’s progress and treatment needs.

History

Authority: T.C.A. §§ 33-1-204 and 33-1-205.
Administrative History: Original rule filed November 9, 1978; effective December 25, 1978. Amendment filed July 11, 1984; effective August 10, 1984.

Tenn. Comp. R. & Regs. 0940-03-01-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-205, 33-1-302, 33-1-303, and 33-1-305.
Administrative History: Original rule filed November 9, 1978; effective December 25, 1978. Repealed by Public Chapter 969; effective July 1, 1984. New rule filed July 11, 1984; effective August 10, 1984. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-03-01-.04 PRELIMINARY ASSESSMENT

(1) When a number of the patient’s treatment team (as set out in patient’s chart) finds that any involuntarily committed patient is about to become ready for release, the treatment team and attending licensed physician shall confer. The treatment team shall review the patient’s record to assess the patient’s readiness for release and any needed follow-up services; if the patient needs further evaluation, they shall perform such evaluation. They shall then present the patient’s records, including records of further evaluation of and interviews with the patient to the attending licensed physician for review and recommendation under Rule 0940-03-01- .05.

(2) If the patient is a pre-trial defendant, the treatment team shall consider the court-ordered evaluation issues and whether the defendant will return to jail or the community to await trial.

(3) If the patient has been committed following an acquittal by reason of insanity, the treatment team and attending licensed physician shall consider the circumstances of the crime for which the person was acquitted. They shall then present the patient’s record, including records of further evaluations of and interviews with the patient, to another licensed physician for additional review and recommendation under Rule 0940-03-01-.05.

History

Authority: T.C.A. §§ 33-1-204 and 33-1-205.
Administrative History: Original rule filed November 9, 1978; effective December 25, 1978. Repealed by Public Chapter 969; effective July 1, 1984. New rule filed July 11, 1984; effective August 10, 1984.

Tenn. Comp. R. & Regs. 0940-03-01-.05 PHYSICIAN’S RECOMMENDATION

The attending licensed physician shall review the patient’s record and supplementary information provided under Rule 0940-03-01-.04 to assess the patient’s readiness for release. A written recommendation with reasons shall then be made to the superintendent for review and decision under Rule 0940-03-01-.06.

When the patient was hospitalized under T.C.A. § 33-7-303, both the attending licensed physician and another licensed physician must assess the patient’s readiness for release and make recommendations appropriate for review and decision under Rule 0940-03-01-.06.

History

Authority: T.C.A. §§ 33-1-204 and 33-1-205.
Administrative History: Original rule filed November 9, 1978; effective December 25, 1978. Repealed by Public Chapter 969; effective July 1, 1984. New rule filed July 11, 1984; effective August 10, 1984.

Tenn. Comp. R. & Regs. 0940-03-01-.06 SUPERINTENDENT’S DECISION

(1) The superintendent shall review the recommendation of the licensed physician(s) to release or not release the patient and other relevant information. The recommendation of the licensed physician(s) does not bind the superintendent.

(2) (a) If the superintendent finds that the patient is ready to be released and is not subject to judicial review under T.C.A. § 33-6-110, he shall order the patient’s release under T.C.A. §§ 33-6-109 or 33-6-201.

(b) If the superintendent finds that the patient is ready to be released and the patient is subject to release under T.C.A. § 33-6-110, the superintendent shall implement the procedures specified in T.C.A. § 33-6-110.

(c) If the superintendent finds that the patient is not ready to be released, he shall so order and direct the patient’s continued hospitalization under the authority of his hospitalization.

(3) Notices:

(a) The superintendent shall give notice of release of any involuntarily committed patient to the committing court. In addition, if the patient was hospitalized following an insanity acquittal, before release, the superintendent shall give written notice of his order of release to the patient, the licensed physicians, the district attorney for the committing court, and the director of special services.

(b) If the superintendent finds that the patient is not ready to be released, he shall give written notice of his order of continued hospitalization to the patient and the licensed physicians.

(4) The superintendent’s decision is final.

History

Authority: T.C.A. §§ 33-1-204 and 33-1-205.
Administrative History: Original rule filed November 9, 1978; effective December 25, 1978. Amendment filed July 11, 1984; effective August 10, 1984.

Chapter 0940-03-02 Mandatory Pre-Screening for Admission to State Supported Mental Health Institutes

Tenn. Comp. R. & Regs. 0940-03-02-.01 PURPOSE

The following rules establish mandatory pre-screening to state supported mental health institutes. Specifically, they provide for the establishment of designated sites and identified procedures for evaluation of individuals being considered for admission to state supported mental health institutes. The mandatory pre-screening system will assure the most appropriate and effective care for individuals being considered for referral and admissions to state-supported mental health institutes. The goal of the system is to minimize length of confinement, promote speedy return to the community, and maximize the individual’s ability to remain in a community setting. The system includes a screening process designed to reduce inappropriate utilization of inpatient resources and promote coordinated service delivery in the most appropriate, least restrictive environment available and by use of resources currently available.

History

Authority: T.C.A. §§ 32-2-602, 33-1-203, and 33-1-204.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985.

Tenn. Comp. R. & Regs. 0940-03-02-.02 DEFINITIONS

(1) Mandatory Pre-Screening Authority – Agency or group designated by the Commissioner as the community-based entity which pre-screens for admission to a state supported mental health institute.

(2) Commissioner – The Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services or his authorized representative.

(3) Community Mental Health Center (CMHC) – Private non-profit mental health agency designated and contracted with by the department to provide specific mental health services in assigned geographical area.

(4) Catchment Area – Geographical area of the state of Tennessee assigned by the Commissioner to be served by a specific community mental health center.

(5) State Supported (Regional) Mental Health Institute – Regional mental health residential facility operated by the department or any agency with which the department contracts specifically for replacement services of a regional mental health institute.

(6) Referral Agency – Entity which provides mental health services, not owned or operated by the department and not a mandatory pre-screening authority.

(7) Private Practitioner – A licensed physician or licensed psychologist with health service provider designation who is not acting as an agent of either the department or an agency with which the department contracts when dealing with a specific referral for admission to a regional mental health institute.

(8) Pre-Screen – An assessment of need for admission to a state-supported mental health institute.

(9) Mandatory Pre-Screening Plan – Plan submitted by the mandatory pre-screening authority in conjunction with community mental health center and approved by the department which provides for the development and implementation of a single mandatory pre-screening system for that community mental health center’s catchment area.

(10) Affiliate Agreement – Contract or agreement between mandatory pre-screening authority and another agency or individual which establishes roles and responsibilities in carrying out the mandatory pre-screening plan.

(11) Legal Status – The section of T.C.A. under which an individual may be admitted to residential mental health care in a state-supported mental health institute.

(12) Private Residential Treatment Resource – A private alcohol and drug or psychiatric program designated to provide residential/inpatient services.

History

Authority: T.C.A. §§ 32-2-602, 33-1-203, and 33-1-204.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985. Amendment filed September 25, 1995; effective December 9, 1995. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-02-.03 PROCEDURES FOR BECOMING A MANDATORY PRE-SCREENING AUTHORITY

(1) Letter of Intent: A community mental health center must establish a mandatory pre-screening

authority for its catchment area. The community mental health center must submit a letter of intent which sets out the following:

(a) Specific agency which will be mandatory pre-screening authority.

(b) Applicable catchment area(s).

(d) Description of mandatory pre-screening system to be implemented, including how other agencies such as local hospital emergency rooms, law enforcement, crisis stabilization units, other mental health service providers, etc. are involved in implementation and what their function is in the mandatory pre-screening process.

(e) Date of implementation. If the plan is to be implemented before January, 1987, plan must be submitted to the department at least ninety (90) days before start-up. See also

rule 0940-03-02-.11 of this chapter.

(2) Department, after review and approval of letter of intent, in a timely manner will authorize development of a mandatory pre-screening plan and will provide appropriate public notice of that authorization.

(3) Agency(ies) will develop and submit a mandatory pre-screening plan under guidelines specified in rule 0940-03-02-.10 and 0940-03-02-.11 of this chapter.

History

Authority: T.C.A. §§ 4-4-103, 33-1-203 through 33-1-205, and 33-2-602.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985.

Tenn. Comp. R. & Regs. 0940-03-02-.04 of this chapter.

(2) When the community mental health center is not the mandatory pre-screening agency:

(a) The community mental health center must participate in the development of a mandatory pre-screening plan for its catchment area.

(b) Provide available mental health services to individuals who are not admitted to a regional mental health institute or who are awaiting admission under T.C.A. § 33-6-104 to a regional mental health institute.

(d) Provide to regional mental health institute a written assessment of less restrictive alternatives prior to probable cause hearing when individual is already hospitalized.

(e) Review and endorse a plan to convert an emergency regional mental health institute admission to voluntary status prior to occurrence of such conversion.

(f) Provide to regional mental health institute an evaluation of patient’s current mental condition under circumstances specified in T.C.A. § 33-6-108.

(g) Negotiate, sign, and implement an agreement with the regional mental health institute and mandatory pre-screening authority that addresses responsibilities of all parties in treatment and discharge planning. Agreements should also specify procedures should a patient not be admitted to a regional mental health institute.

History

Authority: T.C.A. §§ 32-2-602, 33-1-203, and 33-1-204.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985.

Tenn. Comp. R. & Regs. 0940-03-02-.05 RESPONSIBILITIES OF THE COMMUNITY MENTAL HEALTH CENTER

(1) When the community mental health center is the mandatory pre-screening agency, see rule

Tenn. Comp. R. & Regs. 0940-03-02-.06 RESPONSIBILITIES OF THE DEPARTMENT

(1) Review and approve proposed mandatory pre-screening plans.

(2) Designate a mandatory pre-screening authority for each catchment area and provide public notice of that designation. Such an authority may serve one or more catchment areas but there will be a maximum of one mandatory pre-screening authority per catchment area.

(3) Allocate and contract available funds as necessary for mandatory pre-screening services. An appeal process, as defined in the department’s manual, Program Report and Data Requirements for Mental Health and Alcohol and Drug Grantees, is to be utilized to resolve any dispute between the mandatory pre-screening agency and the department which might impact funding.

(4) Develop procedures (with appropriate time lines) for plan review with recommendations for approval, renewal, and/or change in the mandatory pre-screening plan.

(5) Provide consultation, oversight, and local and system monitoring of implementation of mandatory pre-screening plan.

(6) Assist in transition to and implementation of the mandatory pre-screening process across the state in accordance with recommendation by the mandatory pre-screening authority.

(7) Monitor and enforce compliance by mandatory pre-screening authority, community mental health center and regional mental health institute of their obligations under terms of mandatory pre-screening plan.

(8) Establish a committee made up of departmental staff and representatives of nondepartmental agencies to make recommendations to the Commissioner when a mandatory pre-screening authority is unable to develop a plan or reach an agreement on a plan.

(9) Develop a referral form for all patients referred for admission to regional mental health institutes. This form must include, at least the following information on each patient:

(a) Reason/justification for referral.

(b) Evidence that less restrictive alternatives have been assessed and ruled out.

(c) Indication of contact with regional mental health institute to assess availability of space and tentative agreement to admit.

(d) Current medication, if any.

(e) Community mental health center, private practitioner, or agency who will follow patient during hospitalization and be responsible for aftercare.

(f) Tentative plan for discharge.

History

Authority: T.C.A. §§ 32-2-602, 33-1-203, and 33-1-204.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985.

Tenn. Comp. R. & Regs. 0940-03-02-.07 RESPONSIBILITIES OF THE REGIONAL MENTAL HEALTH INSTITUTE

(1) Negotiate, sign and implement an agreement with the mandatory pre-screening authority and catchment area community mental health center, when appropriate, that addresses responsibilities of all parties in treatment and discharge planning. Agreements should also specify procedures should a patient not be admitted to a regional mental health institute.

(2) Verify to court community mental health center prior to probable cause hearing.

(3) Provide both certificates of need for hospitalization when a petition for emergency is filed when patient already voluntarily hospitalized.

(4) Ensure screening by the appropriate mandatory pre-screening authority of individuals applying for transfer from a private residential treatment resource to a regional mental health institute.

(5) Obtain catchment area community mental health center’s endorsement of a plan to convert an emergency admission to voluntary status prior to conversion.

History

Authority: T.C.A. §§ 32-2-602, 33-1-203, and 33-1-204.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985.

Tenn. Comp. R. & Regs. 0940-03-02-.08 of this chapter.

(2) When the mandatory pre-screening authority is not a community mental health center, the department may either directly contract for mandatory pre-screening services with the designated mandatory pre-screening authority, or may contract with a community mental health center or community mental health centers served by the designated mandatory prescreening authority subject to department’s approval of any sub-contract.

History

Authority: T.C.A. §§ 32-2-602, 33-1-203, and 33-1-204.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985.

Tenn. Comp. R. & Regs. 0940-03-02-.09 RELATIONSHIP BETWEEN MANDATORY PRE-SCREENING AUTHORITY AND

DEPARTMENT.

(1) When a community mental health center is the mandatory pre-screening authority, see rule

Tenn. Comp. R. & Regs. 0940-03-02-.10 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 32-2-602, 33-1-203, 33-1-204, 33-1-302, 33-1-303, and 33-1-305.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-03-02-.11 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-203 through 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-602.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal by Public Chapter 969; effective July 1, 1984. New rule filed November 27, 1985; effective December 31, 1985. Amendment filed September 25, 1995; effective December 9, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-03-03 Forensics

Tenn. Comp. R. & Regs. 0940-03-03-.01 SCOPE

(1) These rules specify certification criteria for forensic evaluators who are employees of the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS); or, who are under contract with TDMHSAS through an agency or as a private practitioner.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment filed November 22, 1991; effective January 6, 1992. Amendment filed September 25, 1995; effective December 9, 1995. Repeal and new rule filed March 11, 2010; effective June 9, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-03-.02 FORENSIC CERTIFICATION

(1) Forensic evaluator certification is awarded at the discretion of TDMHSAS to a professional who meets education and licensure requirements and who satisfactorily completes forensic training offered by TDMHSAS.

(2) Forensic evaluator certification is valid for two full fiscal years and shall be renewed by attending a TDMHSAS forensic recertification training session. A forensic training session approved by TDMHSAS may be substituted for the recertification training.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal and new rule filed March 11, 2010; effective June 9, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-03-.03 EVALUATION OF AND EXPERT TESTIMONY ON COMPETENCE TO STAND TRIAL

UNDER T.C.A. TITLE 33, CHAPTER 7, PART 3.

(1) Persons performing mental health evaluations and/or providing expert witness testimony to determine competence to stand trial under T.C.A. Title 33, Chapter 7, Part 3 shall:

(a) Meet the qualification requirements specified in Rule 0940-03-03-.03(2)(a)-(h);

(b) Be certified as a forensic evaluator as described in Rule 0940-03-03-.02; and (c) Participate in the assessment of the defendant.

(2) A person with any of the following qualifications may seek certification to determine competence to stand trial:

(a) A physician licensed in the State of Tennessee with expertise in psychiatry as determined by training, education, or experience;

(b) A psychologist licensed in Tennessee with health service provider designation;

(d) A master’s social worker licensed in Tennessee under the supervision of a clinical social worker licensed in Tennessee;

(e) A clinical social worker licensed in Tennessee;

(f) A nurse clinical specialist licensed to practice nursing in Tennessee who has earned a master’s degree in psychiatric nursing;

(g) A professional counselor licensed in Tennessee;

(h) A person who has received a master’s degree or its equivalent, in a human service or behavioral science related field, and who has completed at least one year of practical forensic experience under the supervision of a certified forensic evaluator subject to review and approval by the Director of the Office of Forensic Services of TDMHSAS.

(3) All notices of recommendations to the court for an inpatient evaluation under T.C.A. § 33-7- 301(a) shall be signed by either a physician licensed in the State of Tennessee with expertise in psychiatry as determined by training, education, or experience or a psychologist licensed in Tennessee with health service provider designation. The physician or psychologist signing the notice of recommendations to the court shall have participated in the assessment of the defendant.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effectiv e July 1, 1984. Repeal and new rule filed March 11, 2010; effective June 9, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed January 30, 2023; effective April 30, 2023.

Tenn. Comp. R. & Regs. 0940-03-03-.04 EVALUATION OF AND EXPERT TESTIMONY ON MENTAL CONDITION AT THE

TIME OF THE OFFENSE UNDER TITLE 33, CHAPTER 7, PART 3.

(1) Persons performing mental health evaluations and/or providing expert witness testimony regarding mental condition at the time of the offense under Title 33, Chapter 7, Part 3 shall:

(a) Meet the qualification requirements specified in Rule 0940-03-03-.04(2);

(b) Be certified as a forensic evaluator as described in Rule 0940-03-03-.02; and (c) Participate in the assessment of the defendant.

(2) Mental health evaluations and expert testimony regarding mental condition at the time of the offense may be provided only by persons who meet the following minimum qualifications:

(a) A physician licensed in Tennessee with expertise in psychiatry as determined by training, education or experience; or (b) A psychologist licensed in Tennessee with health service provider designation.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984. Repeal and new rule filed March 11, 2010; effective June 9, 2010. Amendments filed January 30, 2023; effective April 30, 2023.

Tenn. Comp. R. & Regs. 0940-03-03-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984. Repeal filed March 11, 2010; effective June 9, 2010.

Tenn. Comp. R. & Regs. 0940-03-03-.09 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984. New rule filed July 11, 1984; effective August 10, 1984. Amendment filed November 22, 1991; effective January 6, 1992. Amendment filed September 25, 1995; effective December 9, 1995. Repeal filed March 11, 2010; effective June 9, 2010.

Tenn. Comp. R. & Regs. 0940-03-03-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal filed March 11, 2010; effective June 9, 2010.

Tenn. Comp. R. & Regs. 0940-03-03-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984. Amendment filed November 22, 1991; effective January 6, 1992. Amendment filed September 25, 1995; effective December 9, 1995. Repeal filed March 11, 2010; effective June 9, 2010.

Tenn. Comp. R. & Regs. 0940-03-03-.08 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, and Title 33, Chapter 7.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984. Repeal filed March 11, 2010; effective June 9, 2010.

Chapter 0940-03-04 Outpatient Services

Tenn. Comp. R. & Regs. 0940-03-04-.01 REPEALED

History

Authority: T.C.A. § 33-6-2.
Administrative History: Original rule filed September 27, 1982; effective October 27, 1982. Amendment filed January 9, 1985; effective February 8, 1985. Amendment filed September 25, 1995; effective December 9, 1995. Repeal filed October 3, 2002; effective December 17, 2002.

Chapter 0940-03-05 Mental Health Supportive Living Facility Quality Enabling Program

Tenn. Comp. R. & Regs. 0940-03-05-.01 Mental Health Supportive Living Facility Quality Enabling Program

PURPOSE. It is the intent of these rules to improve the quality of care and service in Tennessee’s mental health supportive living facilities through distributing certain designated and limited state funds.

History

Authority: T.C.A. § 12-4-330.
Administrative History: Original rule filed February 3, 1989; effective March 23, 1989. Amendment filed December 13, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-05-.02 PARTICIPATION OF RESIDENTS

(1) To be eligible to participate in this program, a resident must meet all of the following requirements both at the time of application and at all times during continued participation in the program:

(a) Has an income that is limited to payments under Social Security Act;

(b) Total income does not exceed the monthly SSI benefit rate; and (c) Meets the criteria for admission into a mental health supportive living facility.

History

Authority: T.C.A. § 12-4-330.
Administrative History: Original rule filed February 3, 1989; effective March 23, 1989. Amendments filed December 13, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-05-.03 PARTICIPATION OF PROVIDERS

(1) To be eligible to participate in this program, a mental health supportive living facility, as defined by departmental rules, must meet all of the following requirements, both at the time of application and at all times during continued participation in the program:

(a) Holds a current valid license from the department to operate a mental health supportive living facility;

(b) Is located in Hardeman, Obion, Wilson, Madison, Knox, Dyer, Hamilton, Davidson, Lincoln, Warren or Shelby counties;

(c) Collects and furnishes at the request of the department such data and information as is necessary to evaluate the effectiveness of the program;

(d) Has the operator or responsible attendant participate in all department sponsored training programs which are made available without charge or department approved training programs; and (e) Must accept payment in full toward the cost for the supportive living facility services and not attempt to hold any other person as responsible or liable for the cost of these services. Payment made to the provider under this program is intended to improve the quality of care and service to a resident and is not to be considered as income to the resident. Residents are not, by this program, disqualified or adversely affected for benefits from other local, state, or federal programs that are based on income eligibility.

A facility is not prohibited from accepting gifts in any form from churches, civic organizations, etc.

History

Authority: T.C.A. § 12-4-330.
Administrative History: Original rule filed February 3, 1989; effective March 23, 1989. Amendments filed December 13, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-05-.04 APPLICATION TO PARTICIPATE

(1) The department will notify eligible providers and potentially-eligible persons of the availability of this program and the requirements to participate and the process to make an application.

(2) All applications must be made on forms provided by the department. Completed applications must be submitted to the department for review. A decision on the application will be made within thirty (30) days of its receipt.

(3) Potential providers must apply in the name of the licensee.

(4) Current residents of a mental health supportive living facility which has been approved to participate, or which has a pending application should apply through a representative of the mental health supportive living facility.

(5) Potential residents may apply by themselves or through a representative from a mental health supportive living facility, but should also identify an approved provider who is willing to admit them as residents.

(6) Reimbursement will not be made until both the mental health supportive living facility and the resident have been approved for participation.

History

Authority: T.C.A. § 12-4-330.
Administrative History: Original rule filed February 3, 1989; effective March 23, 1989.

Tenn. Comp. R. & Regs. 0940-03-05-.05 REIMBURSEMENT

(1) The department shall reimburse an approved and participating mental health supportive living facility for each day of care and services given to an approved and participating resident.

Reimbursement will be available for days that the resident is away from the facility for weekend trips, camping trips, or other absences that are temporary in nature, with the resident returning to the facility after the brief absence.

(2) The amount of reimbursement shall be two ($2.00) dollars per day of residence.

(3) No mental health supportive living facility shall receive the payment as provided for in these rules for more than thirty percent (30%) of its licensed residential capacity.

(4) Claims for reimbursement must be submitted each month to the department on forms approved by the department. At the end of the month the authorized representative of the mental health supportive living facility must certify the participant’s continued eligibility for services during the previous month, attesting that the representative has personally examined documents demonstrating that continued eligibility.

(5) Claims for reimbursement can be made for days of care and services to eligible current residents by the mental health supportive living facility that were provided beginning from the effective date of the rules.

(6) The department may recoup or recover funds paid to any provider for services provided to an ineligible recipient, or if the provider has accepted prohibited payments as described under

Rule 0940-03-05-.03(e), from any other individual on behalf of the resident.

(7) Reimbursement is limited to the amount appropriated through state funds for the program.

Reimbursement will be made on the first come first served basis with the date the claim is received at the department as the date of eligibility for reimbursement. The program will terminate if the total appropriated for this program has been expended.

History

Authority: T.C.A. § 12-4-330 and Chapter 12, Public Acts, 1989. Administrative History : Original rule filed February 3, 1989; effective March 23, 1989. Amendment filed May 10, 1989; effective June 24, 1989. Amendments filed December 13, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-05-.06 TERMINATION FROM PARTICIPATION

(1) A participating provider or a participating resident may be terminated from this program for any of the following reasons:

(a) The termination of the program after thirty (30) days’ notice to all persons and all mental health supportive living facilities who are then participating;

(b) A resident no longer meets the requirements for participation in the program, set forth above, or a provider no longer meets the requirements for participation in the program, set forth above;

(d) Failure to comply with any of the provisions of these rules; or (e) False or erroneous certification or claim of a resident’s period of residence or eligibility, including concealing income.

History

Authority: T.C.A. § 12-4-330.
Administrative History: Original rule filed February 3, 1989; effective March 23, 1989. Amendments filed December 13, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-05-.07 HEARINGS

(1) If a program applicant or participant is dissatisfied with any decision made by the department with regard to this program, he/she has the right to appeal that decision and request a hearing by writing the Director of Licensure.

(2) All such hearings shall be conducted before the Director of Licensure, who is designated by the department to hear such cases and to enter a final judgment in such matters. All such hearings shall be as provided in the Uniform Administrative Procedures Act, T.C.A. Title 4,

Chapter 5, Part 3.

(3) The decision of the Director of Licensure may be appealed to the Chancery Court, as provided in T.C.A. § 4-5-322.

History

Authority: T.C.A. § 12-4-330.
Administrative History: Original rule filed February 3, 1989; effective March 23, 1989. Amendments filed December 13, 2007; effective April 29, 2008.

Chapter 0940-03-06 Hospital Isolation and Restraint

Tenn. Comp. R. & Regs. 0940-03-06-.01 SCOPE

(1) This chapter applies to all facilities providing inpatient mental health services in a hospital without regard to source of licensure, certification or accreditation. Isolation and restraint may be used in such settings only in compliance with this chapter.

(2) Isolation or restraint in mental health treatment settings other than hospitals is governed by chapters applicable to those settings. Chemical restraint is permissible only in a hospital and in compliance with this chapter.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.02 DEFINITIONS

(1) Chemical Restraint: A medication that is prescribed to restrict the service recipient’s freedom of movement for the control of extreme violent physical behavior. Chemical restraints are medications used in addition to, or in replacement of, the service recipient’s regular drug regimen to control extreme violent physical behavior. The medications that comprise the service recipient’s regular medical regimen (including PRN medications) are not considered chemical restraints, even if their purpose is to treat ongoing behavioral symptoms.

(2) Conservator: A court appointed conservator or a Veterans Administration guardian.

(3) Hospital: A licensed public or private inpatient treatment resource or hospital or a part of a hospital that provides inpatient care and treatment for persons with mental illness or serious emotional disturbance.

(4) Isolation: The confinement of a service recipient alone in a room or an area where the service recipient is physically prevented from leaving. This definition is not limited to instances in which a service recipient is confined by a locked or closed door. This definition explicitly excludes the segregation of a service recipient for the purpose of managing biological contagion consistent with the Centers for Disease Control Guidelines.

Isolation does not include confinement to a locked unit or ward where other individuals are present. Isolation is not solely confinement of a service recipient to an area, but separation of the service recipient from other persons.

Isolation does not include time-out, which is a behavior management procedure in which, contingent upon the demonstration of undesired behavior, the opportunity for positive reinforcement is withheld, which may involve the voluntary separation of the individual service recipient from others.

(5) Licensed Independent Practitioner: An individual licensed by the Tennessee Health Related Boards as a:

(a) Medical doctor;

(b) Doctor of osteopathy;

(d) Certified nurse practitioner;

(e) Nurse with a masters degree in nursing who functions as a psychiatric nurse;

(f) Psychologist with health service provider designation;

(g) Licensed clinical social worker;

(h) Licensed professional counselor;

(i) Senior psychological examiner;

(j) Psychological examiner (k) Marriage and family therapist; or (l) Other licensed mental health professional who is permitted by law to practice independently.

In addition, to be considered a licensed independent practitioner for purposes of this chapter, the individual must be privileged by the hospital medical staff and governing body to authorize the use of isolation and restraint.

(6) Licensed Mental Health Professional: For purposes of this chapter, a licensed mental health professional is an individual who meets the requirements in the definition of Licensed Independent Practitioner or who is licensed by the Tennessee Health Related Boards as a registered nurse, licensed practical nurse, or substance abuse counselor.

(7) Medical Director: The physician designated to have overall responsibility for the provision of psychiatric care at the hospital. If the Medical Director is the treating physician, the chief officer must appoint an alternate for review purposes under this chapter.

(8) Physical Restraint: Any method, including physical holding or use of a mechanical device, material, or equipment attached or adjacent to an individual service recipient’s body, that he or she cannot easily remove, and that restricts freedom of movement or normal access to one’s body. There are two types of physical restraint:

(a) Physical Holding: The use of staff body contact with a service recipient in order to restrict freedom of movement or normal access to one’s body.

Physical holding does not include the use of physical touch associated with prompting, comforting or assisting that does not prevent the individual service recipient’s freedom of movement or normal access to his or her body. In addition, physical holding does not include “physical escort” which means the temporary touching or holding of the hand, wrist, arm, shoulder or back for the purpose of inducing the individual to walk to a safe location.

(b) Mechanical Restraint: For purposes of this chapter, the application of a mechanical device, material, or equipment attached or adjacent to the service recipient’s body that the service recipient cannot easily remove and that restricts freedom of movement or normal access to the service recipient’s body. This includes the use of ambulatory restraint devices except as noted under the other exceptions below.

For purposes of this chapter, physical restraint does not include the use of:

Any restrictive devices or manual methods employed by a law enforcement agent or other public safety officer to maintain custody, detention, or public safety during the transport of an individual under the jurisdiction of the criminal justice system or juveniles with charges in the juvenile justice system; or 2. Restraints for medical immobilization, adaptive support, or medical protection; or 3. Restrictive devices administratively authorized to ensure the safety of the service recipient or others when an involuntary committed service recipient must be transported; or 4. Restrictive mechanical ambulatory devices used for the service recipient who:

(i) Exhibits intractable behavior which is severely self-injurious or injurious to others, and (ii) Has not responded to usual and customary interventions, and (iii) Has restrictive mechanical ambulatory devices provided for and carried out in conformity with the service recipient’s behavioral plan in the individualized treatment plan.

This behavioral plan must be re-evaluated at least every seven (7) days by the service recipient’s treatment team. Any use of restrictive mechanical ambulatory devices must be reviewed by the Medical Director or designee every 24 hours.

(9) PRN: An order which is written to allow a medication or treatment to be given on an asneeded basis.

(10) Seclusion: See Isolation.

(11) Service Recipient: For purposes of this chapter, an individual receiving inpatient mental health services in a hospital.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Amendments filed December 26, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-06-.03 PURPOSE OF ISOLATION OR RESTRAINT

(1) Isolation or restraint may be used only in emergency situations when necessary to assure the physical safety of the service recipient or a person nearby or to prevent significant destruction of property, if the process of destroying the property puts the service recipient or persons nearby in danger. Isolation or restraint may be used only when other less intrusive or restrictive methods have been ineffective or determined to be inappropriate. Isolation or restraint must be terminated when the behavior justifying its use no longer exists.

(2) Isolation or restraint must not be imposed in any form as a means of coercion, discipline, convenience or retaliation by staff.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.04 APPLICATION OF THIS CHAPTER

(1) This chapter applies to any hospital providing inpatient mental health services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.05 POLICIES AND PROCEDURES

(1) Any hospital that provides inpatient mental health services and uses isolation or restraint must develop and employ policies and procedures that ensure compliance with this chapter.

Policies and procedures must identify approved techniques for the safe and appropriate application and removal of isolation and restraint, including physical holding. Policies and procedures must also identify approved devices, materials, and/or equipment that is approved by the hospital for use as mechanical restraints. No policy or procedure may authorize a removal of clothing from a service recipient in conjunction with the use of isolation or restraint, other than that which is determined to place the service recipient or others at risk.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.06 INITIATION OF ISOLATION OR PHYSICAL RESTRAINT IN THE ABSENCE OF A

LICENSED INDEPENDENT PRACTITIONER.

(1) In the absence of a licensed independent practitioner, isolation or restraint may be initiated by a licensed mental health professional or by non-licensed mental health personnel with a minimum of a bachelor’s degree or two (2) years of full time equivalent experience in a mental health inpatient or residential treatment setting. Any staff member who initiates isolation or physical restraint must have documented training in compliance with this chapter.

Staff who are authorized to take orders must immediately contact a licensed independent practitioner regarding authorization for the isolation or restraint. Chemical restraint can be initiated only by order of a physician.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.07 AUTHORIZATION

(1) The use of isolation or physical restraint shall be authorized only by a licensed independent practitioner. Only a physician may authorize chemical restraint. All authorizations must specify isolation or the type of restraint that is authorized. If mechanical restraint is authorized, the authorization must specify the type of restraint device(s) to be utilized and the number of points of restraint. A new authorization is required if there is a change in the intervention utilized, including increasing the number of points of restraint or the application of additional restraint devices. If the use of isolation or restraint has been discontinued, it may be used again only with a new authorization, even if a previous order’s time limits have not yet expired. Isolation or restraint, including chemical restraint, cannot be ordered on a PRN

basis. If the licensed independent practitioner who authorized the use of isolation, mechanical restraint, or physical holding restraint is not the service recipient’s treating physician, the treating physician shall be consulted as soon as possible.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.08 LENGTH OF AUTHORIZATION

(1) Each order for chemical restraint is limited to a single dose of medication to be administered at a single point in time. Each order for mechanical restraint or isolation is limited to a maximum of four (4) hours for adults, two (2) hours for youth ages 9 through 17, and one (1) hour for children under age 9. Each order for physical holding for any age service recipient is limited to a maximum of thirty (30) minutes.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Amendment filed December 26, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-06-.09 RENEWAL

(1) A licensed independent practitioner can renew the original order, including by verbal authorization, when a service recipient continues to need isolation or physical restraint beyond the time limits of the original order. Renewals must comply with the time limits specified in 0940-03-06-.08, for up to a total of 24 continuous hours. The hospital’s medical director or designee must then review the case and may authorize the licensed independent practitioner to renew the order for isolation or restraint in accordance with the time limits specified in 0940-03-06-.08 for up to a total of another 24 hours. If isolation or restraint is still indicated after the second 24 hour period, the hospital’s medical director must again review the case. This review process by the hospital’s medical director must occur at least every 24 hours as long as the service recipient is in isolation or physical restraint. A licensed independent practitioner must conduct a face-to-face assessment at least every 8 hours for service recipients ages 18 and older and every 4 hours for service recipients ages 17 and younger.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.10 ASSESSMENTS

(1) The hospital must conduct the following types of assessments:

(a) Risk Assessments:

Each service recipient must be assessed to identify individuals at risk of need for external controls such as isolation or restraint for his or her behavior. This assessment should include identification of any specific situations or issues, including cultural issues, that could potentially trigger behavior that might require the use of isolation or restraint.
Each service recipient must be assessed to identify potential risks to the service recipient that might be associated with the use of isolation or restraint. The assessment shall include risks of physical/medical and psychological/emotional harm associated with the use of isolation or restraint, including risks related to cultural issues.
Risk assessments must be performed at admission by a licensed independent practitioner and updated by a licensed independent practitioner or other licensed mental health professional when there is significant change in mental status, behavior, or physical/medical condition. Risk assessments must be documented in the service recipient’s record.

(b) Assessment of Need:

Prior to the use of isolation or restraint, the service recipient must have an assessment that supports that the use of isolation or restraint is necessary to assure the physical safety of the service recipient or a person nearby and that all less restrictive interventions have been ineffective or determined to be inappropriate.
If the licensed independent practitioner authorizing the use of isolation or restraint is present at the time of the initiation of isolation or restraint, the licensed independent practitioner shall document the assessment of need in the service recipient’s record.
If the use of isolation or restraint is initiated in the absence of a licensed independent practitioner, a licensed mental health professional shall document the assessment of need in the service recipient’s record at the time use of isolation or restraint is initiated. The licensed independent practitioner authorizing the use of isolation or restraint must document the rationale for the use of isolation or restraint in the service recipient’s record at the time the verbal/telephone order is authenticated.

Within one (1) hour of the initiation of the use of isolation or physical restraint, a licensed independent practitioner or a registered nurse trained in accordance with 0940-03-06-.19 must see and assess the service recipient’s condition. This assessment must be conducted regardless of the length of time the service recipient is in isolation or physical restraint. This assessment must be documented by the licensed independent practitioner or registered nurse in the service recipient’s record.
When chemical restraint is used, a physician must see and assess the service recipient’s condition within one (1) hour of the administration of the medication used for chemical restraint. This assessment must be documented by the physician in the service recipient’s record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Amendment filed December 26, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-06-.11 BEHAVIORAL CRITERIA FOR RELEASE

(1) Behavioral criteria for release from isolation or physical restraint must be specified by a licensed independent practitioner or a licensed mental health professional who can authorize initiation of isolation or physical restraint. The behavioral criteria must be documented in the service recipient’s record and must be communicated to the service recipient as soon as possible during the isolation or physical restraint procedure.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.12 MONITORING AND ASSESSMENT OF CONTINUED NEED

(1) All results of monitoring must be documented in the service recipient’s record.

(2) Assessment of continued need of isolation or physical restraint: To continue the use of isolation or physical restraint, there must be ongoing assessment of continued need for isolation or restraint, including behavior which justifies the continued use of isolation or restraint and that the established behavioral criteria for release have not been met. Use of restraint or isolation must be monitored as follows:

(3) Isolation. A service recipient in isolation must be monitored by staff trained in monitoring isolation. Monitoring activities must comply with the following:

(a) The service recipient must be continuously monitored. For the first hour, monitoring must be by direct visual observation. After the first hour, monitoring may be via video camera WITH audio; if video monitoring is utilized a staff member must continuously monitor the video.

(b) At intervals no greater than 15 minutes, staff must document visual observations of behavior regarding continued need for isolation, observation of respiration, untoward effects of isolation and signs of distress. Such checks must be made via direct visual observation of the service recipient. Electronic monitoring for 15-minute checks is not allowed.

(c) At intervals no greater than one (1) hour, the service recipient must be allowed the opportunity to toilet and offered fluids. Nourishment must be offered at routine meal and snack times. This must be documented in the service recipient’s record.

(d) At intervals no greater than one (1) hour, a licensed independent practitioner or other licensed mental health professional authorized to initiate isolation under this chapter must document an assessment of continued need for isolation.

(e) Release from Isolation: The service recipient must be released from isolation when the need for isolation no longer exists. Either a licensed independent practitioner or other licensed mental health professional who has been authorized to initiate isolation under this chapter must document in the service recipient’s record an assessment of the service recipient’s behavior and mental and physical status at the time the service recipient is released from isolation. Documentation shall include the duration of the use of isolation.

(4) Physical Restraint Monitoring. Monitoring activities must comply with the following:

(a) Mechanical Restraint: A service recipient in mechanical restraint must be monitored by staff trained in the monitoring of mechanical restraint. Staff must remain in the immediate physical presence of and in the same room as a service recipient who is in restraint.

At intervals no greater than 15 minutes, staff must document visual observations of behavior regarding the continued need for restraint; check and document the application of the restraint; respiration, untoward effects of restraint and signs of distress.
At intervals no greater than one (1) hour, the service recipient must be allowed the opportunity to toilet, offered fluids and be checked for range of motion.

Nourishment must be offered at routine meal and snack times. This must be documented in the service recipient’s record.

At intervals no greater than one (1) hour, a licensed independent practitioner or other licensed mental health professional authorized to initiate isolation under this chapter must document an assessment of continued need for mechanical restraint.
Release from Mechanical Restraint: Mechanical restraints must be removed when the need for mechanical restraint no longer exists. Either a licensed independent practitioner or other licensed mental health professional who has been authorized to initiate restraint under this chapter must document in the service recipient’s record an assessment of the service recipient’s behavior and mental and physical status at the time the service recipient is released from restraint. Documentation shall include the duration of the use of mechanical restraint.

(b) Physical Holding: A service recipient in a physical hold must be monitored by staff trained in the monitoring of physical restraint. Monitoring activities must comply with the following:

A trained staff member who is an observer must be present at all times while a service recipient is in a physical hold.
At intervals no greater than 15 minutes, the staff member observing the physical hold must document visual observations of behavior regarding continued need for restraint; check and document application of the restraint, respiration, negative effects of restraint, and signs of distress. In addition, there must be an evaluation of the fatigue of the staff employing the hold.
At intervals no greater than one (1) hour, the service recipient must be allowed the opportunity to toilet and offered fluids, and be checked for range of motion.

Nourishment must be offered at routine meal and snack times. This must be documented in the service recipient’s record.

At intervals no greater than thirty (30) minutes, a licensed independent practitioner or other licensed mental health professional authorized to initiate isolation under this chapter must document an assessment of continued need for physical holding.
Release from Physical Holding: A service recipient must be released from physical holding when the need for physical holding no longer exists. Either a licensed independent practitioner or other licensed mental health professional who has been authorized to initiate restraint under this chapter must document in the service recipient’s record an assessment of the service recipient’s behavior and mental and physical status at the time the service recipient is released from restraint. Documentation shall include the duration of the use of physical holding.

(5) Chemical Restraint Monitoring: A service recipient who has been chemically restrained must be continuously observed by a staff member who is in the immediate physical presence and in the same room as the service recipient and who is trained to monitor chemical restraint.

Particular attention must be given to safety issues such as preventing falls. Monitoring activities must comply with the following:

(a) If intravenous medication is administered, the service recipient must be examined by either a physician, licensed nurse or physician assistant within five (5) minutes of administration and at least every ten (10) minutes thereafter for the next thirty (30) minutes, if possible based on the service recipient’s behavior, for mental status, blood pressure, pulse, respiration, signs of distress, signs and symptoms of adverse drug reaction and other issues as indicated. These examinations must be documented in the service recipient’s record.

(b) If intramuscular medication is administered, the service recipient must be examined by either a physician, licensed nurse or physician assistant within fifteen (15) minutes of administration and at least every fifteen (15) minutes for the first hour, if possible based on the service recipient’s behavior, for mental status, blood pressure, pulse, respiration, signs of distress, signs and symptoms of adverse drug reaction and other issues as indicated. These examinations must be documented in the service recipient’s record.

(c) If oral medication is administered, the service recipient must be examined by either a physician, licensed nurse or physician assistant within thirty (30) minutes of the medication administration and every thirty (30) minutes for the first hour, if possible based on the service recipient’s behavior, for mental status, blood pressure, pulse, respiration, signs of distress, signs and symptoms of adverse drug reaction, and other issues as indicated. These examinations must be documented in the service recipient’s record.

(d) In addition to the above monitoring requirements for chemical restraint, staff must document visual observations of the service recipient’s behavior at intervals no greater than fifteen (15) minutes. The service recipient must be monitored for a time period defined by the prescriber as part of the chemical restraint order. If the prescriber does not define the time period for monitoring, the face-to-face observation shall continue for two (2) hours.

(6) Concurrent Use: Concurrent use of physical restraint with chemical restraint must meet the monitoring requirements for both interventions.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Amendments filed December 26, 2007; effective April 29, 2008.

Tenn. Comp. R. & Regs. 0940-03-06-.13 LOCATION OF USE

(1) Isolation may be provided only in a clean, dry, comfortable location that does not contain anything with which the service recipient might harm self or others. Rooms used for isolation must be designed so that the entire room is visible from the isolation room’s observation window even if a video camera is used. Restraint must be imposed in an area as private as possible.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.14 TERMINATION

(1) Isolation or physical restraint must be terminated when the behavior justifying its use no longer exists or if the face-to-face assessments required under this chapter do not occur. Any threat to a service recipient’s physical health or emotional well being shall require immediate release.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.15 NOTIFICATION OF LEGAL SURROGATES

(1) The hospital must notify the parent/guardian or legal custodian, as appropriate, of an unemancipated child or the conservator, attorney-in-fact under a durable power of attorney which authorizes mental health care, or surrogate decision-maker selected in accordance with TCA §§ 33-3-219 - 33-3-220 of an adult of the use of restraint or isolation as soon as possible but no later than 12 hours following initiation of the intervention. Unsuccessful attempts to notify must be documented in the service recipient's record. The parent/guardian, legal custodian, conservator, attorney-in-fact under a durable power of attorney which authorizes mental health care, or surrogate decision-maker, as appropriate, may modify the notice requirements in a written agreement. Such individuals must be provided the opportunity to participate in a discussion of the episode.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.16 NOTIFICATION OF FAMILY/SIGNIFICANT OTHER

(1) The hospital may notify other family members or significant others as specified in 0940-03- 06-.15 with a signed release by: the service recipient, or legal surrogate, or the authorization by a Treatment Review Committee for an involuntarily committed service recipient or for a voluntary service recipient who lacks capacity to make decisions about release of information, and agreement by the family/significant other that he/she wishes to be notified.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.17 INTERNAL REVIEWS

(1) The hospital must provide and document three types of reviews:

(a) Service Recipient Review. Unless clinically contraindicated, a licensed independent practitioner or mental health personnel who are authorized to initiate isolation or restraint must review the episode upon termination with the service recipient and with his or her legal surrogate, if available. The review shall occur as soon as possible following termination, but no later than twenty-four (24) hours following termination of isolation or restraint. The review must address the event, any identified reasons for the behavior, and strive to alleviate any trauma related to the episode. This review must be documented in the service recipient’s record. If a review is clinically contraindicated, the rationale for the conclusion must be documented in the service recipient’s record.

(b) Episode Review. Within twenty-four (24) hours of initiation of the isolation or restraint, there must be a staff review of the episode to ascertain the circumstances requiring the use and how it might be addressed differently. The staff review must include staff involved in the episode and, if possible, staff who were not party to the episode. The Chief Officer of the hospital or designee may, for good cause, allow an exception to the review within twenty-four (24) hours. Under no circumstances may the review be concluded later than five (5) business days following the episode. The review must also address if there are needed changes to the service recipient’s treatment plan, opportunities for performance improvements and address any need for alleviation of staff trauma associated with the episode.

(c) Systematic Review: The hospital must develop and implement a process for systematic review of all isolation or restraint episodes and identification of trends of use of either isolation or restraint.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.18 PERFORMANCE IMPROVEMENT ACTIVITIES

(1) The hospital shall engage in on-going performance improvement activities that focus on the reduction of the use of isolation and restraint. Information obtained through the review processes (service recipient review, episode review, and systematic review) shall be considered in the identification of specific performance improvement activities and in the evaluation of the effectiveness of the performance improvement activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-06-.19 TRAINING

(1) The hospital must identify specific staff, based on their job responsibilities, who are involved in the use of isolation or restraint and must assure that they are adequately trained and are competent in the following areas:

(a) Medical/physical and psychological risk factors associated with the use of isolation and restraint, (b) Prevention of and early intervention for assaultive, self-injurious behavior, (c) Specific techniques approved by the hospital for the safe and appropriate application and removal of isolation and restraint, including physical holding, (d) Use of specific devices, materials, and/or equipment approved by the hospital for use as mechanical restraints, (e) Procedures to address problems associated with the use of restraints, (f) Hospital policies and procedures regarding isolation and restraint that are in compliance with this chapter, (g) Needs and behaviors of the population served, (h) Legal issues, and (i) Applicable state and federal law and regulations.

(2) The hospital must identify specific staff that must be trained before assuming direct care responsibilities. All other identified staff must be trained within six (6) weeks of initial employment. The hospital must provide annual refresher training on all of the above training elements.

(3) If diploma, associate, or baccalaureate prepared registered nurses are responsible for the assessment of the service recipient’s condition within one (1) hour of the initiation of isolation or physical restraint, the hospital must identify specific registered nurses with this responsibility and must assure that they are adequately trained and are competent in the following areas:

(a) Anticipation of adverse medical/physical and psychological service recipient response(s) which had been identified in the risk assessments required in 0940-03-06- .10;

(b) Anticipation of adverse medical/physical and psychological response(s) based upon the current condition of the service recipient;

(c) Identification and management of adverse medical/physical and psychological response(s) resulting from the use of isolation or physical restraint; and (d) Identification and utilization of the service recipient’s mental preparedness to self regulate and objectively appraise the isolation or physical restraint event.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Amendment filed December 26, 2007; effective April 29, 2007.

Tenn. Comp. R. & Regs. 0940-03-06-.20 REPORTING

(1) Each hospital that uses isolation or restraint must annually report information specified by TDMHSAS to the Commissioner of TDMHSAS. TDMHSAS shall establish reporting guidelines and deadlines necessary to assure uniform reporting of minimum aggregated isolation and restraint data by each hospital.

(2) Any hospital using isolation or restraint must notify the Commissioner of TDMHSAS of any death that occurs while a service recipient is restrained or isolated, or where it is reasonable to assume that a service recipient’s death is attributable to, or results from, restraint or isolation. The hospital must report such deaths by the next business day following the service recipient’s death.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-120, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Chapter 0940-03-07 Severe Impairment

Tenn. Comp. R. & Regs. 0940-03-07-.01 PURPOSE

(1) This chapter establishes a process by which a treatment resource may seek approval to provide services to individuals whose psychiatric condition meets the criteria for “severe impairment” as defined in T.C.A. § 33-6-301. To be eligible, a treatment resource must provide a range of psychiatric services to persons who are believed to be mentally ill, including twenty-four (24) hour crisis services, supervised observation beds, and participation in mandatory pre-screening under T.C.A. § 33-6-104.

(2) If the treatment resource meets these criteria, the Department may approve the treatment resource to provide services to individuals with severe impairments under T.C.A. Title 33,

Chapter 6, Part 3.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-6-3.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-07-.02 DEFINITIONS

(1) For the purpose of these rules, the terms listed below shall be interpreted as follows:

(a) “Commissioner” means the commissioner of the Tennessee Department of Mental Health and Substance Abuse Services or his/her authorized representative.

(b) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services;

(c) “Chief officer” means the person with overall authority for a public or private hospital or treatment resource, or the person’s designee.

(d) “Mandatory pre-screening agent” means a person meeting the qualifications for a qualified mental health professional as defined in T.C.A. § 33-1-101 and specified training criteria under T.C.A. § 33-6-427 and who is designated by the Commissioner to perform mandatory pre-screening of individuals presenting for voluntary or emergency involuntary admission.

(e) “Severe impairment” means a condition in which an adult or an emancipated child:

As a result of a mental illness or serious emotional disturbance:

(i) Is in danger of serious physical harm resulting from the person’s failure to provide for the person’s essential human needs of health or safety, or (ii) Manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over the person’s actions, and 2. Is not receiving care that is essential for the person’s health or safety.

(f) “24 hour crisis services” means mental health services that are available twenty-four hours a day and seven days a week, and are intended to stabilize the individual to prevent the crisis from escalating.

(g) “Triage and referral” means a service that provides preliminary diagnosis, assessment and evaluation for the purpose of directing the service recipient to services that will appropriately address his or her needs.

(h) “Supervised observation bed” means a bed in the designated facility which provides, for up to 72 continuous hours, a safe environment for a service recipient who, in the opinion of the examining physicians, requires care, observation, and treatment of the service recipient’s psychiatric symptoms.

(i) “Continuum of care” means an array of mental health services and supports, which range from least restrictive to most restrictive.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-6-3.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-07-.03 PROCESS FOR DESIGNATION TO PROVIDE SERVICES TO PERSONS WITH

SEVERE IMPAIRMENTS.

(1) Requirements for Application: The applicant must provide documentation that the facility is a treatment resource as defined under T.C.A. § 33-1-101(24) and is licensed by the Department of Health and/or Tennessee Department of Mental Health and Substance Abuse Services.

(2) Organizational Documentation: The applicant must provide the following:

(a) The name, address, and other background and identifying information of the applicant including type of agency, background and history of agency, services currently provided and statement of agency values;

(b) The name, address, and other background and identifying information of the person or persons responsible for the operation of the service to include present position in the agency, educational history, credentials, and work experience;

(d) Evidence of license, certificate of need (as appropriate), and authorization from Secretary of State to do business in Tennessee;

(e) The signature of the applicant, or of the person charged by the applicant, for certifying the correctness and completeness of the application, and for ensuring compliance with the service standards;

(f) The proposed organization and the organizational relationship to the facility’s overall administrative structure;

(g) Relationship of the service location to other medical or psychiatric services provided;

(h) Plan for or evidence of on site psychiatric services, 24-hour crisis services, supervised observation beds and participation in mandatory prescreening;

(3) Service Description: The applicant must provide a proposed service description, which addresses:

(a) A three year plan, updated annually, that includes measurable goals and objectives that are targeted toward providing services to service recipients in the most effective and least restrictive treatment environment possible;

(b) How this service links to other providers of psychiatric services in the community, including mandatory prescreening agents;

(d) Staffing plan that indicates the types of staff, qualifications and numbers of staff by shift to be employed by the treatment resource for this purpose;

(e) Plan for adequately training all staff to perform designated job responsibilities including orientation and ongoing training. Plan must include training that is relative to services to persons with severe impairment as defined in T.C.A. § 33-6-301;

(f) Plan for transitioning and follow up activities for service recipients who are released from the program or referred to other services to include assurance of continuity of care;

(g) A plan or agreement with law enforcement (or other transporting agent, if appropriate) to transport candidates for mental health emergency services;

(h) Policy to ensure safety of service recipient and staff between arrival at site and admission (include behavioral management and medical emergency);

(i) Policy to ensure that the rights of service recipients are protected as indicated under Title 33, Tennessee Code Annotated;

(4) Policy and Procedures: The applicant must provide written policies and procedures on the following:

(a) Policy on notice of rights including those indicated under Title 33, Tennessee Code Annotated;

(b) Policies on ensuring physician assessments are completed within the specific time period as set out in Title 33, Chapter 6, Part 3, Tennessee Code Annotated;

(c) Policy which addresses the procedures for the prescription, procurement, storage and administration of medication, including procedures for verbal and phone orders;

(d) Policy for determining capacity to consent to treatment.

(e) Policy on admission authorization for individuals who lack capacity to consent to treatment including when emergency commitment or other referral is appropriate.

(f) Policy on the program’s conflict resolution procedure (both licensees and non TDMHSAS licensees must comply with the requirements of Title 33, Chapter 2, Part 6, Tennessee Code Annotated);

(g) Policy on Treatment Review Committee responsibilities under T.C.A. § 33-6-107 if the facility is an inpatient provider;

(h) Policy for arranging transportation of service recipients to aftercare placements, alternative treatment sites or voluntary hospitalization;

(i) Policy for addressing medical emergencies including transportation to another treatment service when necessary;

(j) Policy for transportation of a service recipient in need of emergency psychiatric hospitalization;

(k) Release procedures including provision for when a service recipient initiates the release;

(l) Policy on use of isolation and restraint;

(m) Policy on service recipient records including documentation requirements and provisions for ensuring confidentiality;

(n) Policy on notification of persons designated by the service recipient in case of an emergency;

(o) Policy on use of Declarations for Mental Health Treatment, (T.C.A. § 33-2-1202), conservator and attorney-in fact under a durable power of attorney for health care.

(p) Procedure for addressing service recipient complaints.

(5) The applicant must include a letter of support from the appropriate mental health regional planning council.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-6-3.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-07-.06 TERMINATION

(1) The Commissioner may revoke designation at any time with a written notice:

(a) for good cause, (b) failure to meet minimum requirements, (c) violation of the law.

(2) A designated treatment resource may terminate the designation with a thirty (30) day written notice to the Commissioner.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-6-3.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-07-.04 REVIEW AND APPROVAL PROCESS

(1) Upon review of the application and information obtained from a minimum of one (1) site visit, the Commissioner will approve or deny the application. If the application is denied, a request for review of denial can be made in writing to the Commissioner within fifteen (15) days, excluding holidays and weekends. The Commissioner’s decision concerning designation to provide services to persons with severe impairments is final.

(2) Information submitted must follow the format of this Rule. Failure to submit all required information may disqualify the application from consideration.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-6-3.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Tenn. Comp. R. & Regs. 0940-03-07-.05 RENEWAL AND MAINTAINING DESIGNATION

(1) The Commissioner will annually review and designate treatment resource(s) to provide these services.

(2) To renew designation, a treatment resource must continue to meet initial application requirements.

(3) Facility must cooperate with monitoring by the Department or designee, including on-site visits.

(4) Facility must participate in data collection and service evaluation as required by the Department or designee.

History

Authority: T.C.A. §§ 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-6-3.
Administrative History: Original rule filed October 3, 2002; effective December 17, 2002.

Chapter 0940-03-08 Community-Based Screening Process for Emergency Involuntary Admissions

Tenn. Comp. R. & Regs. 0940-03-08-.01 PURPOSE

(1) This chapter establishes a community-based screening process to assure the most appropriate and effective care for service recipients with mental illness or serious emotional disturbance who are evaluated for eligibility for emergency involuntary admission under Title 33, Chapter 6, Part 4, Tennessee Code Annotated. The process includes screening designed to reduce inappropriate utilization of inpatient resources and promote coordinated service delivery in the most appropriate, least restrictive environment available.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004.

Tenn. Comp. R. & Regs. 0940-03-08-.02 SCOPE

(1) This chapter establishes the process by which persons are pre-screened for emergency involuntary admission to a state-owned or operated hospital or treatment resource under Title 33, Chapter 6, Part 4, Tennessee Code Annotated.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004.

Tenn. Comp. R. & Regs. 0940-03-08-.03 DEFINITIONS

(1) “Commissioner” means the Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services or his/her authorized representative.

(2) “Community-based Screening” means a process by which a person is evaluated to determine need for treatment, assess the availability of alternative services and supports, and ensure that services are provided in the most appropriate, least restrictive environment available.

(3) “Crisis Response Service” means a team designated by the Commissioner to provide crisis intervention, pre-screening, and diversion services in a defined service area.

(4) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(5) “Follow-up” means contact with a service recipient within twelve (12) hours of pre-screening to determine post-evaluation status, assess intervention impact, and assure appropriate service referral.

(6) “Mandatory Pre-screening Agent (MPA)” means a person meeting criteria required by T.C.A. § 33-6-427 who is designated by the Commissioner to perform pre-screening of service recipients for emergency involuntary admission.

(7) “Pre-screening” means a face-to-face evaluation, either by physical presence or televideo, of a service recipient to assess eligibility for emergency involuntary admission and determine whether all available and appropriate less drastic alternative services and supports are unsuitable to meet his/her needs.

(8) “Psychologist” means a licensed psychologist with health service provider designation by the board of healing arts and actively practicing as such.

(9) “Qualified Mental Health Professional (QMHP)” means a person who is licensed in Tennessee, if required for the profession, and is a psychiatrist; physician with expertise in psychiatry as determined by training, education, or experience; psychologist with health service provider designation; psychological examiner, or senior psychological examiner; social worker who is certified with two years of mental health experience or licensed; marital and family therapist; nurse who has a Master’s degree in nursing who functions as a psychiatric nurse; professional counselor; or if the person is providing service to service recipients who are children, any of the above educational credentials plus mental health experience with children.

(10) “Service Area” means a geographical area, designated by the Commissioner, to be served by a mandatory pre-screening process.

(11) “Treatment Resource” means any public or private facility, service, or program providing treatment or rehabilitation services for mental illness or serious emotional disturbance, including, but not limited to, detoxification centers, hospitals, community mental health centers, clinics or programs, halfway houses, and rehabilitation centers.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-08-.04 REQUIREMENTS FOR DESIGNATION AS MANDATORY PRE-SCREENING AGENT

(MPA).

(1) Maintain compliance with requirements for qualified mental health professional (QMHP).

(2) Successfully complete Department training as required under T.C.A. § 33-6-427(b)(3).

(3) If providing pre-screening services for children, meet requirements regarding mental health experience with children as required by T.C.A. § 33-1-101(18).

(4) Accept Commissioner’s designation authority as defined in T.C.A. § 33-6-104.

(5) Comply with responsibilities as defined in T.C.A. §§ 33-6-105 and 33-6-106 and Rule 0940- 03-08-.05.

(6) The MPA will immediately notify the Department if he or she:

(a) no longer meets the requirements for QMHP;

(b) requires or makes changes in service area location(s);

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004.

Tenn. Comp. R. & Regs. 0940-03-08-.05 RESPONSIBILITIES OF MANDATORY PRE-SCREENING AGENT

(1) Have access to current information about available community resources and referral procedures to access less restrictive alternatives to hospitalization.

(2) Comply with county protocol(s) for designated modes of transportation.

(3) Pre-screen service recipients to assess eligibility for emergency involuntary admission to state-owned or operated facilities under T.C.A. § 33-6-404.

(4) Determine, if possible, whether the service recipient has a durable power of attorney for health care or a declaration for mental health treatment and comply to the extent possible.

(5) Determine, if possible, whether the service recipient is under a mandatory outpatient treatment obligation from an inpatient provider.

(6) Complete a certificate of need for any service recipient assessed as eligible for emergency involuntary admission under T.C.A. § 33-6-404.

(7) Determine and document level of security required and mode of transportation to the admitting hospital for service recipients eligible for emergency involuntary admission under T.C.A. § 33-6-404.

(8) When a service recipient is referred for emergency involuntary admission or alternative services, provide at least the following information to the treatment resource:

(a) The certificate of need, if referred for emergency involuntary admission;

(b) Acknowledgement and copy, where possible, of a durable power of attorney for health care or a declaration for mental health treatment;

(d) Name of person at referring service provider;

(e) Any known medical condition(s);

(f) Current or recent prescription and/or over-the-counter medication(s), if any;

(g) Current or recent use of alcohol and/or other substance use, if any;

(h) Name of current or most recent community mental health provider, if known; and (i) Recommendations for services and/or supports following discharge.

(9) When a service recipient is evaluated and does not meet emergency involuntary admission criteria, the MPA will:

(a) Assess availability of alternative services and make referral, if appropriate;

(b) Initiate contact with each service recipient not eligible for emergency involuntary admission within twelve (12) hours of evaluation and complete follow-up as necessary.

By agreement, an MPA may designate another QMHP or a crisis response service to meet responsibilities for follow-up as defined in 0940-03-08-.03(5);

Reason/justification for diversion;
Clinical intervention activities, if applicable;
Alternative services available and offered to the service recipient, if appropriate;
Results of follow-up contact and actions taken.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004.

Tenn. Comp. R. & Regs. 0940-03-08-.06 RESPONSIBILITIES OF PHYSICIAN OR PSYCHOLOGIST NOT DESIGNATED AS A

MANDATORY PRE-SCREENING AGENT.

(1) If a service recipient requires evaluation for emergency involuntary admission to a stateowned or operated treatment resource under T.C.A. § 33-6-404 and cannot be examined by a mandatory pre-screening agent within two (2) hours of the request to examine the person, a physician or psychologist may perform the evaluation and provide a certificate of need. The physician or psychologist then has the following responsibilities:

(a) Maintain compliance with requirements for physician under T.C.A. § 33-1-101(15) or psychologist under T.C.A. § 33-6-427(a).

(b) Pre-screen the service recipient for emergency involuntary admission under T.C.A. § 33-6-404.

(c) Determine, if possible, whether the service recipient has executed a durable power of attorney for health care or a declaration for mental health treatment and comply to the extent possible.

(d) Determine, if possible, whether the service recipient is under a mandatory outpatient treatment obligation from an inpatient provider.

(e) Before completing a certificate of need, make a determination, in consultation with a crisis response service that serves the county where the service recipient is being evaluated, that all available and appropriate less drastic alternatives to placement in a hospital or treatment resource are unsuitable to meet the needs of the person and document the consultation. A face-to-face consultation with the crisis response service is not required.

(f) Complete a certificate of need for any service recipient assessed as eligible for emergency involuntary admission under T.C.A. § 33-6-404.

(g) Determine and document level of security required and mode of transportation to the admitting hospital for service recipients eligible for emergency involuntary admission under T.C.A. § 33-6-404.

(h) For service recipients not eligible for emergency involuntary admission, notify a crisis response service that serves the county where the service recipient resides or is receiving services of the need for follow-up. Provide necessary information and document this notification.

(i) When a service recipient is referred for emergency involuntary admission or alternative services, provide at least the following information to the treatment resource:

The certificate of need for emergency involuntary admission;
Acknowledgement and copy, where possible, of a durable power of attorney for health care or a declaration for mental health treatment;
Existence of mandatory outpatient treatment obligation, if applicable, and discharging facility, if known;
Name of person at referring service provider;
Any known medical condition(s);
Current or recent prescription and/or over-the-counter medication(s), if any;
Current or recent use of alcohol and/or other substance use, if any;
Name of current or most recent community mental health provider, if known; and 9. Recommendations for services and/or supports following discharge.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004.

Tenn. Comp. R. & Regs. 0940-03-08-.07 RESPONSIBILITIES OF DESIGNATED CRISIS RESPONSE SERVICE

(1) Upon request, provide consultation to any physician or psychologist regarding the availability of less drastic alternatives to placement in a hospital or treatment resource.

(2) Upon notification that the service recipient has been evaluated by a physician or psychologist as described in 0940-03-08-.06 and does not meet emergency involuntary admission criteria, initiate contact with the service recipient in accordance with T.C.A. § 33-6-106(a) to determine outcome and complete follow-up as necessary.

(3) Document results of follow-up contact and actions taken.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004.

Tenn. Comp. R. & Regs. 0940-03-08-.08 RESPONSIBILITIES OF THE DEPARTMENT

(1) Designate individuals to serve as mandatory pre-screening agents.

(2) Designate service area of mandatory pre-screening agents.

(3) Provide training program required for designation of mandatory pre-screening agents.

(4) Notify the Claims Commission of designated mandatory pre-screening agents.

(5) Maintain and publish an accurate and current list of designated mandatory pre-screening agents per service area and notify the Claims Commission of any changes in MPA status.

(6) Maintain a list of private hospitals or treatment resources that have notified the Commissioner of acceptance of Mandatory Pre-screening Agent authority.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-301, 33-1-303, 33-1-305, 33-6-102, 33-6-104, 33-6- 402, 33-6-403, 33-6-404, 33-6-406, and 33-6-427.
Administrative History: Original rule filed November 7, 2003; effective January 21, 2004.

Chapter 0940-03-09 Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities

Tenn. Comp. R. & Regs. 0940-03-09-.01 PURPOSE

(1) Isolation, mechanical restraint, or physical holding restraint may be used only in an emergency safety situation to assure the physical safety of the service recipient or others nearby or to prevent significant destruction of property, if the process of destroying the property puts the service recipient or persons nearby in danger. Isolation, mechanical restraint, or physical holding restraint may be used only when all less intrusive or restrictive methods have been ineffective or determined to be inappropriate. Isolation, mechanical restraint, or physical holding restraint must be performed in a manner that is safe, proportionate, and appropriate to the service recipient’s age; size; gender; physical, medical, and psychiatric condition; and personal history. Isolation, mechanical restraint, or physical holding restraint must be evaluated continuously and ended at the earliest possible time based on the assessment and evaluation of the service recipient’s condition and behaviors.

Isolation, mechanical restraint, or physical holding restraint must not be imposed in any form as a means of coercion, discipline, convenience of or retaliation by staff or for lack of staff presence or competency.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; 42 C.F.R. § 483.356(a)(1) and (3)(ii) and C.F.R. § 483.356(b).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.02 SCOPE

(1) Chapter 0940-03-09 applies to facilities and services licensed as a Mental Health Residential Treatment Facility for Children and Youth (Chapter 0940-05-37) or as a Mental Health Adult Residential Treatment Facility (Chapter 0940-05-17). Use of isolation, mechanical restraint or physical holding restraint in mental health treatment settings other than mental health residential treatment facilities is governed by other Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) rules. Use of chemical restraint is not permissible in mental health residential treatment facilities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-09-.03 DEFINITIONS

(1) “Chemical restraint” means a medication that is prescribed to restrict the service recipient’s freedom of movement for the control of extreme violent physical behavior. Chemical restraints are medications used in addition to, or in replacement of, the service recipient’s regular drug regimen to control extreme violent physical behavior. The medications that comprise the service recipient’s regular medical regimen (including PRN medications) are not considered chemical restraints, even if their purpose is to treat ongoing behavioral symptoms.

(2) “Conservator” means a person appointed by a court under the conservatorship laws in Title 34, Chapter 3, Tenn. Code Ann. or the Uniform Veterans’ Guardianship Law in Title 34,

Chapter 5, Tenn. Code Ann. with authority to make decisions for an adult who lacks capacity to make informed health care decisions.

(3) “Custodian” means an agency or individual appointed by a juvenile court to have full control of a service recipient who is a child.

(4) “Durable power of attorney for health care” means a legal document authorized by Title 34,

Chapter 6, Part 2, Tenn. Code Ann. that allows the attorney-in-fact to make decisions for health care.

(5) “Emergency safety situation” means service recipient behavior that places the service recipient or others at serious threat of violence or injury or significant destruction of property, if the process of destroying the property puts the service recipient or persons nearby in danger, if no intervention occurs and calls for the use of isolation, mechanical restraint, or physical holding restraint.

(6) “Guardian” means a person appointed by a court under Title 34, Chapter 2, Tenn. Code Ann. with authority to make decisions for a person under eighteen (18) years of age who lacks capacity to make informed health care decisions.

(7) “Hospital” means a licensed public or private inpatient treatment resource or hospital or a part of such treatment resource or hospital that provides inpatient care and treatment for persons with mental illness or serious emotional disturbance.

(8) “Involuntarily committed service recipient” means a service recipient who is receiving services on an involuntary basis under Title 33, Chapter 6, Part 4 or 5, Tenn. Code Ann., T.C.A. §§ 33-3-401—403, 412, 607, 33-7-301 and 303, or 37-1-128.

(9) “Isolation” means the confinement of a service recipient alone in a room or an area where the service recipient is physically prevented from leaving. This definition is not limited to instances in which a service recipient is confined by a locked or closed door. Isolation does not include:

(a) The segregation of a service recipient for the purpose of managing biological contagion consistent with the Centers for Disease Control Guidelines;

(b) Confinement to a locked unit or ward where other service recipients are present.

Isolation is not solely confinement of a service recipient to an area, but separation of the service recipient from other persons; or (c) Time-out, a behavior management procedure in which the opportunity for positive reinforcement is withheld, contingent upon the demonstration of undesired behavior.

Time-out may involve the voluntary separation of an individual service recipient from others.

(10) “Licensed practitioner” means an individual approved by the mental health residential treatment facility to order the use of isolation or mechanical restraint and who is licensed by the Tennessee Health Related Boards as a:

(a) Physician (medical doctor or doctor of osteopathy);

(b) Certified nurse practitioner;

(d) Nurse with a master’s degree in nursing who functions as a psychiatric nurse;

(e) Psychologist with health service provider designation;

(f) Licensed professional counselor;

(g) Senior psychological examiner;

(h) Licensed marriage and family therapist;

(i) Licensed clinical social worker; or (j) Licensed psychological examiner.

(11) “Mechanical restraint” means the application of a mechanical device, material, or equipment attached or adjacent to the service recipient’s body, including ambulatory restraints, which the service recipient cannot easily remove and that restrict freedom of movement or normal access to the service recipient’s body. Mechanical restraint does not include the use of:

(a) Restrictive devices or manual methods employed by a law enforcement agent or other public safety officer to maintain custody, detention, or public safety during the transport of a service recipient under the jurisdiction of the criminal justice system or juveniles with charges in the juvenile justice system;

(b) Restraints for medical immobilization, adaptive support, or medical protection; or (c) Restrictive devices administratively ordered to ensure the safety of the service recipient or others when an involuntary committed service recipient must be transported.

(12) “Mental health personnel” means a staff member who operates under the direct supervision of a licensed practitioner.

(13) “Physical holding restraint” means the use of body contact by staff with a service recipient to restrict freedom of movement or normal access to his or her body. Physical holding restraint does not include the use of:

(a) Physical touch associated with prompting, comforting or assisting that does not prevent the service recipient’s freedom of movement or normal access to his or her body;

(b) Physical escort for the temporary touching or holding of the hand(s), wrist(s), arm(s), shoulder(s) or back for the purpose of inducing the service recipient to walk to a safe location; or (c) Physical intervention for the temporary holding of the hand(s), wrist(s), arm(s), shoulder(s), or leg(s) which does not otherwise restrict freedom of movement or access to one’s body, for the purpose of terminating unsafe behavior.

(14) “PRN” means authorization written to allow a medication or treatment to be given on an asneeded basis.

(15) “Seclusion” means “Isolation.”

(16) “Service recipient,” for purposes of this chapter, means an individual receiving mental health residential treatment services.

(17) “Temporary caregiver” means an individual designated under T.C.A. § 34-6-302 to make decisions as specified in § 34-6-304 for a minor child as assigned by the parent or parents on the form provided by the Department of Children’s Services for this purpose.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. § 483.358(a).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.04 USE OF ISOLATION, MECHANICAL RESTRAINT, AND PHYSICAL HOLDING

RESTRAINT.

(1) Isolation, mechanical restraint or physical holding restraint may be used in mental health residential treatment facilities only in compliance with this chapter and with applicable federal regulations.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. §§ 483.354 et seq.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.05 POLICIES AND PROCEDURES

(1) Any mental health residential treatment facility that uses isolation, mechanical restraint, or physical holding restraint must develop and employ policies and procedures that ensure compliance with this chapter. Policies and procedures must identify approved techniques for the safe and appropriate application and removal of isolation, mechanical restraint, and physical holding restraint; devices, materials, and/or equipment that are approved by the mental health residential treatment facility for use as mechanical restraints; licensed practitioners by profession who are responsible for authorizing the isolation, mechanical restraint, or physical holding restraint; required elements in the order for isolation, mechanical restraint or physical holding restraint; and minimal physical and psychological elements that must be assessed. No policy or procedure may authorize the removal of clothing from a service recipient, other than that which is determined to place the service recipient or others at risk, in conjunction with the use of isolation, mechanical restraint, or physical holding restraint. Policies or procedures may not allow staff to use isolation, mechanical restraint, or physical holding restraint before receiving training under 0940-03-09-.18.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. § 483.356.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.06 INITIATION OF ISOLATION, MECHANICAL RESTRAINT, OR PHYSICAL HOLDING

RESTRAINT.

(1) A licensed practitioner may initiate isolation, mechanical restraint or physical holding restraint.

In the absence of a licensed practitioner, isolation, mechanical restraint, or physical holding restraint may be initiated by a licensed practical nurse, a registered nurse or by mental health personnel. All staff who initiate the use of isolation, mechanical restraint, or physical holding restraint must have completed training requirements in compliance with this chapter prior to initiating isolation, mechanical restraint or physical holding restraint. A licensed practitioner who has been trained in the use of isolation, mechanical restraint, and physical holding restraint must be contacted immediately for order of the isolation, mechanical restraint, or physical holding restraint if a licensed practitioner did not initiate it.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. §§ 483.358(a)-(d), (f), (g), (j) and 483.360.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.07 ORDER

(1) Only a licensed practitioner who has been trained in the use of isolation, mechanical restraint, and physical holding restraint may order the use of isolation, mechanical restraint, or physical holding restraint. The order must be for the least restrictive intervention possible that is most likely to be effective.

(2) All orders must specify isolation, mechanical restraint, or physical holding restraint. If mechanical restraint is ordered, the order must specify the type of restraint device(s) to be used and the number of points of restraint; the licensed practitioner’s name and credentials; the date and time when the order was obtained; and the maximum length of time the intervention was ordered.

(3) If the licensed practitioner who ordered the use of isolation, mechanical restraint, or physical holding restraint is not the service recipient’s treating physician, the treating physician shall be consulted as soon as possible and the consultation must be documented in the service recipient’s record. If the service recipient does not have a designated physician for treatment of mental illness or serious emotional disturbance, the mental health residential treatment facility’s physician shall be consulted and the consultation must be documented in the service recipient’s record.

(4) If the order for restraint or isolation is verbal, the order must be received by a registered nurse or a licensed practical nurse and signed by the ordering licensed practitioner within twenty-four (24) hours of the order.

(5) A new order is required if there is a change in the intervention utilized, including increasing the number of points of restraint or the application of additional restraint devices. If the use of isolation, mechanical restraint, or physical holding restraint has been discontinued, it may be used again only with a new order, even if a previously ordered time limit has not expired.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. §§ 483.358(a)-(e), (g), (j) and 483.360.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.08 . Under no circumstance may isolation, mechanical restraint, or physical holding restraint exceed twenty-four (24) continuous hours.

(2) Isolation, mechanical restraint, and physical holding restraint may not be ordered on a PRN

basis or as a standing order. Mechanical restraint or physical holding restraint may not be used simultaneously with isolation.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. §§ 483.356(a)(2) and (4), 483.362(b), and 483.364(c).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.09 RENEWAL

(1) A licensed practitioner may renew the original order, including a verbal order, if a service recipient continues to need isolation, mechanical restraint, or physical holding restraint beyond the time limit of the original order. Renewals must comply with 0940-03-09-.07 and

Tenn. Comp. R. & Regs. 0940-03-09-.10 ASSESSMENT

(1) Risk assessments must be completed at admission; updated when there is significant change in mental status, behavior, or physical/medical condition; documented in the service recipient’s record and reviewed by the treatment team. The risk assessment must be completed by a licensed practitioner or mental health personnel with a minimum of a bachelor’s degree.

(2) The assessment must identify any specific situations or issues including: chronological and developmental age; size; gender; physical, medical, and psychiatric condition; personal

history, including any history of physical and/or sexual abuse; and cultural issues that may trigger behavior that might require the use of isolation, mechanical restraint, or physical holding restraint.

(3) Assessment of Need:

(a) Prior to the use of isolation, mechanical restraint or physical holding restraint, the service recipient must have an assessment that supports that the use of isolation or restraint is necessary to assure the physical safety of the service recipient or a person nearby and that all less restrictive interventions have been ineffective or determined to be inappropriate.

(b) If the licensed practitioner authorizing the use of isolation, mechanical restraint or physical holding restraint is present at the time of the initiation of isolation or restraint, the licensed independent practitioner shall document the assessment of need in the service recipient’s record.

(c) If the use of isolation, mechanical restraint or physical holding restraint is initiated in the absence of a licensed practitioner, an RN, LPN, or mental health personnel shall document the assessment of need in the service recipient’s record at the time use of isolation or restraint is initiated. The licensed independent practitioner authorizing the use of isolation or restraint must document the rationale for the use of isolation or restraint in the service recipient’s record at the time the verbal/telephone order is authenticated.

(4) Follow-Up Assessment (a) Within one (1) hour of the initiation of the use of isolation, mechanical restraint, or physical holding restraint, a licensed practitioner or a registered nurse trained in accordance with 0940-03-09-.18 must see and assess the service recipient’s condition.

This assessment must be conducted regardless of the length of time the service recipient is in isolation, mechanical restraint, or physical holding restraint. This assessment must be documented by the licensed independent practitioner or registered nurse in the service recipient’s record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. § 483.358(f).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.11 BEHAVIORAL CRITERIA FOR RELEASE

(1) Behavioral criteria for release from isolation, mechanical restraint or physical holding restraint must be specified by a licensed practitioner who may order the use of isolation or mechanical restraint or physical holding restraint. In the absence of a licensed practitioner, the behavioral criteria must be specified by a licensed practical nurse, a registered nurse or by mental health personnel with a minimum of a bachelor’s degree or two (2) years of full time equivalent experience in a mental health inpatient or mental health residential treatment facility. The behavioral criteria must be communicated to the service recipient as soon as possible during the isolation, mechanical restraint or physical holding restraint procedure and documented in the service recipient’s record. Behavioral criteria for release must identify the behaviors necessary to no longer justify the use of isolation, mechanical restraint, or physical holding restraint. The isolation, mechanical restraint, or physical holding restraint must be terminated as soon as the behavioral criteria for release have been met.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.12 MONITORING AND ASSESSMENT OF CONTINUED NEED

(1) To continue the use of isolation, mechanical restraint, or physical holding restraint, there must be ongoing assessment of need that justifies the continued use. To continue use, the justification must indicate that the behavioral criteria for release have not been met. All results of monitoring must be documented in the service recipient’s record. Use of isolation, mechanical restraint, or physical holding restraint must be monitored as outlined below.

(a) Isolation: Staff trained in monitoring isolation must monitor a service recipient in isolation. The service recipient must be continuously monitored. Monitoring must be by direct visual observation.

(b) Mechanical Restraint: Staff trained in the monitoring of mechanical restraint must monitor a service recipient in mechanical restraint. The service recipient must be continuously monitored. Monitoring must be by direct visual observation and staff must remain in the immediate physical presence of and in the same room as the service recipient.

(c) Physical Holding Restraint: Staff trained in the monitoring of physical holding restraint must monitor a service recipient in a physical holding restraint. The service recipient must be continuously monitored. A staff member who is trained in the monitoring of physical holding restraints must be present as an observer at all times while a service recipient is in a physical holding restraint.

(d) At intervals no greater than fifteen (15) minutes, staff must document visual observations of:

Behavior justifying continued need for isolation, mechanical restraint, or physical holding restraint;
If applicable, the application of the mechanical restraint or physical holding restraint;
Respiration;
Negative effects of isolation, mechanical restraint, or physical holding restraint;
Any sign of distress; and 6. If applicable, an evaluation of the fatigue of the staff member employing a physical holding restraint.

(e) At intervals no greater than one (1) hour for isolation, mechanical restraint or physical holding restraint, the service recipient must be allowed to toilet and be offered fluids.

For mechanical and physical holding restraint, the service recipient must also be checked for range of motion. Nourishment must be offered at routine meal and snack times. The facility must document the requirements of 0940-3-8-.12(e) in the service recipient’s record.

(f) At intervals no greater than thirty (30) minutes for physical holding restraint, or one hour for isolation or mechanical restraint, staff who may initiate isolation, mechanical restraint, or physical holding restraint must document an assessment of continued need for isolation, mechanical restraint, or physical holding restraint.

(g) A service recipient must be released from isolation, mechanical restraint, or physical holding restraint when the need for the intervention no longer exists. Before the shift ends, a staff member who may initiate isolation, mechanical restraint, or physical holding restraint must document in the service recipient’s record an assessment of the service recipient’s behavior, mental and physical status at the time the service recipient is released, the time the isolation, mechanical restraint, or physical holding restraint began and ended, and the name of all staff involved.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. §§ 483.358(h), 483.362, and 483.364.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.13 LOCATION OF USE

(1) Isolation may be provided only in a clean, dry, temperate location and be free of potentially hazardous conditions from which the service recipient might harm himself or herself or others. Rooms used for isolation must allow staff full view of the service recipient in all areas of the room. Mechanical restraint must be imposed in a clean, dry, temperate area as private as possible.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. § 483.364(b).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.14 TERMINATION

(1) Isolation, mechanical restraint, or physical holding restraint must be terminated when the behavior justifying its use no longer exists or if the face-to-face assessments required do not occur. Any threat to a service recipient’s physical health or emotional well being requires immediate release.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; 42 C.F.R. § 483.356 (a)(3)(ii); and 42 C.F.R. § 483.358(e)(1) and (f).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.15 NOTIFICATION

(1) Upon admission to the mental health residential treatment facility, both the incoming service recipient and the parent, guardian, temporary caregiver, or legal custodian, as appropriate, of an unemancipated child or the conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker of an adult selected under T.C.A. §§ 33-3-219 and 220 must be informed and provided a copy of the facility’s policy regarding the use of isolation, mechanical restraint, and physical holding restraint during an emergency safety situation. If the parent, guardian, temporary caregiver, or legal custodian, as appropriate, of an unemancipated child or the conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker of an adult selected under T.C.A. §§ 33-3-219 and 220 is not available upon admission, information regarding the policy will be provided as soon as possible. This policy must be communicated in a way that is understood by the service recipient and his or her parent, guardian, temporary caregiver, legal custodian, conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker, as appropriate.

When necessary, the facility must provide interpreters or translators.

(2) An acknowledgement, in writing, from the service recipient and the parent, guardian, temporary caregiver, or legal custodian, as appropriate, of an unemancipated child or the conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker of an adult selected under T.C.A. §§ 33-3-219 and 220 that he or she has been informed of the facility’s policy on the use of isolation, mechanical restraint, and physical holding restraint in an emergency safety situation. The acknowledgement must be placed in the service recipient’s record.

(3) Contact information, including phone number and mailing address, for the Disability Law & Advocacy Center of Tennessee (DLAC) must be provided to the service recipient or his or her parent, guardian, temporary caregiver, legal custodian, conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker, as appropriate, upon admission to the facility.

(4) The mental health residential treatment facility must notify the parent, guardian, temporary caregiver, or legal custodian, as appropriate, of an unemancipated child or the conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker of an adult selected under T.C.A. §§ 33-3-219 and 220 of the use of isolation, mechanical restraint, or physical holding restraint as soon as possible but no later than twelve (12) hours following initiation of the intervention. Notification and/or unsuccessful attempts to notify must be documented in the service recipient's record. The parent, guardian, temporary caregiver, legal custodian, conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker, as appropriate, may choose to modify the notice requirements in a written agreement filed in the service recipient’s record. Such individuals must be provided the opportunity to participate in a discussion with appropriate staff about the episode that precipitated the use of isolation, mechanical restraint or physical holding restraint.

(5) The mental health residential treatment facility may notify other family members or significant others, with their agreement to be notified, as specified in 0940-03-08-.14, when a release has been signed by:

(a) The service recipient who is sixteen (16) years old or older;

(b) The parent, guardian, temporary caregiver, or legal custodian, as appropriate, of an unemancipated child; or (c) The conservator, attorney-in-fact under a durable power of attorney, which authorizes health care or surrogate decision-maker of an adult, selected under T.C.A. §§ 33-3-219 and 220.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; 42 C.F.R. § 483.356(c) and (d); and 42 C.F.R. § 483.366(a) and (b).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.16 INTERNAL REVIEWS

(1) The mental health residential treatment facility must provide and document three (3) types of reviews.

(a) Service Recipient Review:

A licensed practitioner or mental health personnel who can initiate isolation, mechanical restraint, or physical holding restraint must review the episode upon termination of the intervention with the service recipient. When deemed appropriate by the facility, his or her parent, guardian, temporary caregiver, or legal custodian, as appropriate, of an unemancipated child, or the conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker of an adult selected under T.C.A. §§33-3-219 and 220 may participate if available. The review must occur as soon as possible, but no later than twenty-four (24) hours after termination of isolation, mechanical restraint, or physical holding restraint. The review must address the episode; any identified reasons for the behavior, and identify ways to alleviate any related trauma. Staff must document in the service recipient’s record that this review took place and must include the names of staff who were present, the names of any staff excused, and any changes to the service recipient’s treatment plan as a result of the review. Documentation from the review may also be maintained in the mental health residential treatment facility records.
If a review is clinically contraindicated, the rationale for the conclusion must be documented in the service recipient’s record.

(b) Episode Review:

Within twenty-four (24) hours of termination of isolation, mechanical restraint, or physical holding restraint, staff, including supervisory or administrative staff, must review the episode to determine the circumstances requiring the use, how it might be addressed differently, alternative techniques that might have prevented the use, any procedures that need to be implemented to prevent recurrence, and the outcome of the episode. Any injury to the service recipient or staff during the implementation or use of the isolation, mechanical restraint, or physical holding restraint must be included in the review and a plan must be developed to prevent future injuries. The review must also address any need to change the service recipient’s treatment plan, opportunities for performance improvements and any need for alleviation of staff trauma associated with the episode. The staff review must include staff involved in the episode and, if possible, other staff who witnessed or have knowledge about the episode or the service recipient. The mental health residential treatment facility supervisor or designee may, for good cause, allow an exception to the review within twenty-four (24) hours, but the review must be concluded within five (5) business days of the episode. Staff must document in the service recipient’s record that the review occurred and must include the names of staff who were present, the names of any staff excused, and any changes to the service recipient’s treatment plan as a result of the review. Documentation from the review may also be maintained in the mental health residential treatment facility records.

The mental health residential treatment facility must develop and implement a process for systematic review of all isolation, mechanical restraint, or physical holding restraint episodes and the identification of trends of use of isolation, mechanical restraint, or physical holding restraint.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. § 483.370(b) and (c).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.17 PERFORMANCE IMPROVEMENT ACTIVITIES

(1) The mental health residential treatment facility must engage in on-going performance improvement activities that focus on the reduction of the use of isolation, mechanical restraint, and physical holding restraint. Information obtained through the review processes under 0940-03-09-.16 must be considered, at least quarterly, in the identification of specific performance improvement activities and in the evaluation of the effectiveness of performance improvement activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.18 TRAINING

(1) The mental health residential treatment facility must identify specific staff, based on their job responsibilities, who may be involved in the use of isolation, mechanical restraint, or physical holding restraint. Staff must be appropriately trained and demonstrate competency in the correct application and safe usage of isolation, mechanical restraint, and physical holding restraint. Only trained staff who are qualified by education, training, and experience may train others. Staff training must include training exercises in which staff members successfully demonstrate in practice the techniques they have learned for managing emergency safety situations. Staff must be trained and demonstrate competency before assuming direct care responsibilities that include the use of isolation, mechanical restraint, or physical holding restraint. The mental health residential treatment facility must assure that staff are trained and competent in the following areas:

(a) Upon being hired and every six (6) months thereafter:

Specific techniques approved by the mental health residential treatment facility for the safe and appropriate application and removal of isolation, mechanical restraint, and physical holding restraint;
Use of non-physical intervention skills, such as de-escalation, mediation, conflict resolution, active listening, and verbal and observational methods, to prevent emergency safety situations;
Recognition of negative effects of use of isolation, mechanical restraint, and physical holding restraint, including signs of distress, and actions to take if negative effects or signs of distress occur;
Techniques to identify staff and service recipient behaviors, events, and environmental factors that may trigger emergency safety situations;
Use of devices, materials, and/or equipment approved by the mental health residential treatment facility as mechanical restraints; and 6. Procedures for conducting a comprehensive service recipient review and episode review as required in section 0940-03-09-.16.

(b) Upon being hired and annually thereafter:

Medical/physical and psychological risks associated with the use of isolation, mechanical restraint, and physical holding restraint;
Mental health residential treatment facility policies and procedures regarding isolation, mechanical restraint, and physical holding restraint;
Needs and behaviors of the population served;
Liability and other legal issues;
Applicable state and federal law and rules; and 6. Procedures to address problems associated with the use of isolation, mechanical restraint, or physical holding restraint.

(2) If diploma, associate, or baccalaureate prepared registered nurses are responsible for the assessment of the service recipient’s condition within one hour (1) hour of the initiation of isolation, mechanical restraint, or physical holding restraint, the mental health residential treatment facility must identify specific registered nurses with this responsibility and must assure that they are adequately trained and are competent in the following areas:

(a) Anticipation of adverse medical/physical and psychological service recipient response(s) which had been identified in the risk assessments required in 0940-03-09- .10;

(b) Anticipation of adverse medical/physical and psychological response(s) based upon the current condition of the service recipient;

(c) Identification and management of adverse medical/physical and psychological response(s) resulting from the use of isolation, mechanical restraint, or physical holding restraint; and (d) Identification and utilization of the service recipient’s mental preparedness to self regulate and objectively appraise the isolation, mechanical restraint, or physical holding restraint event.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. §§ 483.376.
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008.

Tenn. Comp. R. & Regs. 0940-03-09-.19 MEDICAL TREATMENT FOR INJURIES AND REPORTING

(1) If a service recipient is injured as a result of the use of isolation, mechanical restraint, or physical holding restraint, staff must immediately obtain medical treatment. Staff must document in the service recipient’s record all injuries that occur as a result of isolation, mechanical restraint, or physical holding restraint.

(2) The mental health residential treatment facility must report serious occurrences that result from the use of isolation, mechanical restraint, or physical holding restraint to the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), the Disability Law & Advocacy Center of Tennessee (DLAC), and the Centers for Medicare and Medicaid Services if applicable. Occurrences include a service recipient’s death, serious injury, suicide attempt, or injuries to staff and must be reported no later than close of business the next business day after the serious occurrence.

(3) The mental health residential treatment facility must notify immediately the parent, guardian, temporary caregiver, or legal custodian, as appropriate, of an unemancipated child or the conservator, attorney-in-fact under a durable power of attorney which authorizes health care, or surrogate decision-maker of an adult selected under T.C.A. §§ 33-3-219 and 220 when a serious injury occurs as the result of the use of isolation, mechanical restraint, or physical holding restraint.

(4) Staff must document in the service recipient’s record that appropriate entities have been notified, the date notified, and the name of the person spoken to or sent a notice.

(5) In addition to any other required notices, each mental health residential treatment facility that uses isolation, mechanical restraint, or physical holding restraint must annually report information specified by the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) as required under T.C.A. §§ 33-1-307 and 33-3-120.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, and 33-3-120; and 42 C.F.R. §§ 483.372(c), 483.374(b), 483.374(b)(2), and 483.374(c).
Administrative History: Original rule filed March 3, 2008; effective May 17, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Chapter 0940-03-10 Community Mental Health Center Cooperation

Tenn. Comp. R. & Regs. 0940-03-10-.01 PURPOSE

(1) These rules implement the Community Mental Health Center Cooperation Act of 1998 (“Act”), Tennessee Code Annotated, Section 33-2-701 et seq. The Act, under certain circumstances, allows two or more community mental health centers within the State of Tennessee to negotiate and enter into a cooperative agreement between or among themselves upon making an application to the Department for a certificate of public advantage (“COPA”). The Tennessee Department of Mental Health and Substance Abuse Services shall issue a COPA to applicants if the Department determines, in consultation with the Office of Attorney General for the State of Tennessee, that the likely benefits resulting from the cooperative agreement outweigh any disadvantages attributable to a reduction in competition that may result from the cooperative agreement. Once a COPA is issued, the Department shall actively and continually supervise and oversee the implementation and operation of the cooperative agreement to the fullest extent required by law.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302(a)(3), 33-1-304, 33-1-305(1), 33-1-309, 33-2- 101, and 33-2-701, et seq.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-10-.02 DEFINITIONS

The following definitions shall apply to terms as they appear in these rules unless the context clearly requires otherwise.

(1) “Applicant” or “applicants” means a community mental health center that is a party to a cooperative agreement for which an application for a certificate of public advantage is submitted.

(2) “Attorney General” means the Office of the Attorney General for the State of Tennessee.

(3) “Certificate Holder” means a community mental health center that is a party to a cooperative agreement that has received a certificate of public advantage.

(4) “Certificate of Public Advantage” or “COPA” means the certificate, issued by the Department, that approves and authorizes a cooperative agreement.

(5) “Commissioner” means the Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services or his or her designee.

(6) “Community mental health center” means:

(a) A community mental health center as defined in Tennessee Code Annotated, Section 33-1-101(6); or (b) Any parent or corporate affiliate of a community mental health center.

(7) “Cooperative agreement” means an agreement among two (2) or more community mental health centers for the offering, provision, operation, coordination, planning, funding, pricing, contracting, utilization review, or management of mental health and related services pursuant to programs funded or administered by departments or agencies of state government, including, but not limited to, the TennCare program, or the sharing, allocation, or referral of service recipients, personnel, instructional programs, support services, ancillary services, and facilities, or other services traditionally offered by community mental health centers for such programs.

(8) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(9) “Intervenor” means any hospital, physician, allied health professional, healthcare provider or other person furnishing goods or services to, or in competition with, a community mental health center, insurer, hospital service corporation, medical service corporation, hospital and medical services corporation, preferred provider organization, health maintenance organization, behavioral health organization, or any employer or association that directly or indirectly provides health care benefits to its employees or members.

(10) “Initial filing” means a summary of the proposed cooperative agreement, describing the affected geographic area, and the proposed benefits and disadvantages of the cooperative agreement.

(11) “Newspaper of General Circulation” means a publication regularly issued at least as frequently as once a week for a definite price, having a second-class mailing privilege, being not less than four (4) pages, published continuously during the immediately preceding oneyear period, which is published for the dissemination of news of general interest, and is circulated generally in the county or counties in which it is published and in which notice is given. A “newspaper of general circulation” shall not be construed to include a newspaper which is not engaged in the distribution of news of general interest to the public, but which is primarily engaged in the distribution of news of interest to a particular group of citizens.

(12) “Notice of Completion of Application” means a written notice from the Department to the applicants indicating that their application is complete.

(13) “Person” is as defined in Tennessee Code Annotated, Section 68-11-102(13).

(14) “Renewal Application” means an application submitted by certificate holders in order to renew a COPA.

(15) “Shall” or “Must” indicates a mandatory provision.

(16) “Should” or “May” indicates a suggestion or a recommendation.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302(a)(3), 33-1-304, 33-1-305(1), 33-1-309, 33-2- 101, and 33-2-701, et seq.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-10-.03 APPLICATION PROCEDURES

(1) The application procedures for obtaining a COPA are as follows:

(a) Parties to a cooperative agreement shall jointly apply to the Department for a COPA by submitting one COPA application form on behalf of all parties to a single cooperative agreement.

(b) The original and two copies of the application must be submitted to the Department.

(c) A copy shall also be submitted by the applicants to the Attorney General the same day that the original is filed with the Department.

(2) The COPA application form:

(a) Shall identify the legal name or names of each applicant and the address of the principal business office of each applicant;

(b) Shall identify the person(s) authorized to receive notices and communications with respect to each party’s application as well as answer questions regarding the cooperative agreement. Included shall be the person(s) name, business address, business telephone number, facsimile copier number and electronic mail address;

(d) Shall present a description of the activity that is the subject of the cooperative agreement, including the duration of the cooperative agreement, and a description of the relevant market;

(e) Shall present a description of any consideration, direct or indirect, attributable to the activity contemplated under the cooperative agreement that passes to any party to the cooperative agreement;

(f) Shall address each of the following benefits that might result from the cooperative agreement:

Enhancement of the quality of mental health and mental health -related care provided to Tennessee citizens, especially those receiving such services pursuant to programs funded or administered by departments or agencies of state government;
Preservation of community mental health facilities in geographical proximity to the communities traditionally served by those facilities;
Gains in the cost-efficiency of services provided by the community mental health centers involved;
Improvements in the utilization of mental health resources and equipment;
Avoidance of duplication of mental health resources; and 6. Enhancement of the efficiency of the administration of programs of state government to provide mental health services to citizens of Tennessee.

(g) Shall address each of the following potential disadvantages that might be attributable to any reduction in competition likely to result from the cooperative agreement:

The extent of any likely adverse impact on the ability of health maintenance organizations, preferred provider organizations, managed health care organizations, behavioral health care organizations or other health care payers to negotiate optimal payment and service arrangements with community mental health centers, or other health care providers;
The extent of any reduction in competition among physicians, mental health professionals, allied health professionals, other health care providers, or other persons furnishing goods or services to, or in competition with, community mental health centers that is likely to result directly or indirectly from the cooperative agreement;
The extent of any likely adverse impact on persons with mental illness or serious emotional disturbance in the quality, availability, and price of health care services; and 4. The availability of arrangements that are less restrictive to competition and achieve the same benefits or a more favorable balance of benefits over disadvantages attributable to any reduction in competition likely to result from the agreement.

(h) Shall attach copies of all required public notifications.

(3) The rules governing the acceptance of the application and the application filing fee are as follows:

(a) The Department shall accept an application for review and may issue a Notice of Completion of Application once the following occur:

The application has been received by the Department and the Attorney General;
All public notice provisions have been satisfied; including a public hearing if determined necessary by the Department, 3. A non-refundable application fee of $5,000.00 has been received.

(b) If the Department determines that the application is incomplete, the Department shall not issue the Notice of Completion of Application until the deficiencies in the Application have been cured.

(c) In the event that a material change occurs with respect to any information submitted by the applicant(s) in the application, the applicant(s) shall timely provide to the Department a detailed written description of the change. Failure to provide the Department with such written description may result in the rejection of the application by the Department.

(d) If the cooperative agreement primarily relates to a program funded or administered by another department or agency of the government of the state of Tennessee, the Department may refer the application to that other department or agency to conduct the review and render the decision required by rule 0940-03-10-.05(4).

(4) The rules governing public notice are as follows:

(a) The applicants shall jointly submit a proposed state register notice for approval by the Department. The Department shall amend the notice, if necessary, to provide sufficient or accurate information and publish the notice in the Tennessee Administrative Register. The state register notice shall contain the following information:

The filing date of the application;
The name, address, and telephone number of the person authorized to receive notices and communications with respect to the application for each applicant; and 3. A general description of the activity.

(b) The applicants shall jointly post public notice in newspapers of general circulation covering the proposed area to be served.

The format shall be in a manner prescribed by the Department.
The notice shall be for one day only.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302(a)(3), 33-1-304, 33-1-305(1), 33-1-309, 33-2- 101, and 33-2-701, et seq.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-03-10-.04 COMMENTS AND PUBLIC HEARING

(1) Any intervenor shall have standing under Tennessee Code Annotated, Title 4, Chapter 5.

(2) Any intervenor may provide written comments to the Department, or the other department or agency conducting the review, regarding the activity proposed in the public notice required by

rule 0940-03-10-.03(4) by mailing such comments within fifteen (15) days after the notice’s publication date, in the State Register (TAR).

(3) A public hearing may be held at the discretion of the Department or after receiving a written request by an intervenor or an applicant within thirty (30) days after the notice’s publication date, in the State Register (TAR).

(4) The public hearing may be held for the purpose of gathering information pertinent to the issues listed in rule 0940-03-10-.03(2)(f, g) or any portion of the Act.

(5) Notice of the public hearing shall be provided as follows:

(a) The person(s) requesting the hearing shall submit a proposed state register notice for approval by the Department. The Department shall amend the notice, if necessary, to provide sufficient or accurate information. The notice shall be published in the Tennessee Administrative Register at least thirty (30) days prior to the hearing.

(b) The person(s) requesting the hearing may publish an advertisement in a newspaper of general circulation at least five (5) working days prior to the public hearing.

(c) The person(s) requesting the hearing shall provide notice to known applicants and intervenors by telephone, fax, or electronic mail and letter timed so that the notice shall be received at least five (5) working days before the hearing.

(6) The hearing shall be conducted pursuant to the applicable sections of the Uniform Administrative Procedures Act, T.C.A., Title 4, Part 5. An initial decision shall be rendered no later than forty-five (45) days from the final date of the hearing, unless the time period is tolled pursuant to Rule 0940-03-10-.05 below; by agreement of the parties; or by order of a court of competent jurisdiction.

(7) The initial decision shall become final within fifteen (15) days of rendering of the initial decision unless the Department receives a written request for reconsideration prior to the close of business of the fifteenth (15 th ) day. Upon timely receipt of the request for reconsideration the Commissioner shall review the record of the hearing and render a decision within fifteen (15) business days of receipt of the request. The Commissioner’s decision shall be a final decision of the Department.

(8) A party aggrieved by a final decision may seek judicial review pursuant to the applicable sections of the Uniform Administrative Procedures Act, T.C.A., Title 4, Part 5.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302(a)(3), 33-1-304, 33-1-305(1), 33-1-309, 33-2- 101, and 33-2-701, et seq.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-03-10-.07 TERMINATION OF THE COPA BY CERTIFICATE HOLDERS

Any party to a cooperative agreement that terminates the agreement shall file a notice of termination with the Department. Upon the consent of all certificate holders, certificate holders may voluntarily terminate a COPA by promptly giving joint written notice to the Department.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302(a)(3), 33-1-304, 33-1-305(1), 33-1-309, 33-2- 101, and 33-2-701, et seq.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-03-10-.05 REVIEW AND FINDINGS

(1) The Department shall consult with the Attorney General regarding its evaluation of any potential reduction in competition resulting from a cooperative agreement.

(a) The Attorney General may consult with the United States Department of Justice or the Federal Trade Commission regarding its evaluation of any potential reduction in competition resulting from a cooperative agreement.

(b) If the Attorney General and Reporter, after consultation with the Department, determines it is necessary to consult with the United States Department of Justice or the Federal Trade Commission, or determines that further information is needed to review the application, the Department may, upon written notice to the applicant, Attorney General and Reporter, and any intervenor, extend its review of the application an additional forty-five (45) days.

(2) The Department shall grant or deny an application within sixty (60) days of the date of filing of the application. This time period shall be tolled upon issuance of a notice to hold an application hearing until completion of the hearing. The time period may also be tolled if the Department determines that additional time is needed to review the application. Upon written notice to the applicants, the Attorney General and Reporter, and any intervenor, the Department may extend the time for review for a period of thirty (30) days, which, at the discretion of the commissioner, may be extended for an additional thirty (30) days.

(3) Prior to making an application the parties may submit an initial filing to the Department.

(a) The initial filing shall be filed at least forty-five (45) days prior to the filing of the application.

(b) The initial filing shall include the following:

Summarize the proposed agreement;
Describe the geographic market area; and 3. Include those factors described in 0940-03-10-.03(2)(f) and (g).

(c) The Department shall review the initial filing within thirty (30) days of its receipt and inform the parties of any deficiency along with a proposed remedy to correct these deficiencies.

(d) Review of an initial filing by the Department does not constitute approval of the final application.

(4) The Department shall issue a COPA if it determines that the likely benefits outweigh any disadvantages attributable to a reduction in competition that may result from the agreement.

This determination shall be made by considering the following:

(a) The potential benefits of the cooperative agreement including but not limited to those listed in rule 0940-03-10-.03(2)(f);

(b) The potential disadvantages of the agreement attributable to any reduction in competition likely to result from the cooperative agreement, including but not limited to those listed in rule 0940-03-10-.03(2)(g); and (c) The evaluation done by the Attorney General of any potential reduction in competition resulting from the agreement.

(5) Upon making the determination to grant or deny an application, the Department shall send a copy of the decision notice to the applicants, the Attorney General, and any intervenor.

(6) If the Department determines at any time that the likely benefits resulting from a cooperative agreement do not outweigh any disadvantages attributable to any potential reduction in competition resulting from the agreement, the Department shall notify the applicant(s) that the agreement is invalid and has no further force or effect.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302(a)(3), 33-1-304, 33-1-305(1), 33-1-309, 33-2- 101, and 33-2-701, et seq.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-03-10-.06 REGULATION AND SUPERVISION

(1) Each COPA, and every party thereto, shall be subject to the active regulation of and supervision by the Department with respect to the activity or activities contemplated under the COPA.

(a) Active regulation and supervision of the COPA and the parties thereto shall include, but not be limited to, an inspection (one of which may be unannounced) and review at least twice annually of the following materials and matters:

All records, correspondence, documents or other material of the parties to the COPA regarding development and maintenance of the COPA;
All records, correspondence, documents or other material of the parties to the COPA addressing the continued benefits or potential disadvantages of continuation of the COPA;
Any other matter deemed relevant by the Department to the continued operation of the COPA and its cooperative agreements.

(2) The Department shall maintain on file all cooperative agreements for which a COPA remains in effect.

(3) All certificate holders must annually reapply for a COPA as follows:

(a) Parties to a cooperative agreement shall jointly submit a single renewal application on behalf of all parties to a single cooperative agreement.

(b) The original and two copies of the renewal application must be submitted to the Department or the department or other agency that conducted the review;

(c) The renewal application shall be accompanied by the Department’s renewal form on which the certificate holder shall indicate its compliance with the requirements of rule 0940-03-10-.03(2). The certificate holder shall also address and describe any material changes in the implementation or operation of the cooperative agreement, and must address any changes in competition in the relevant market bearing on the cooperative agreement; and (d) Submit a renewal fee equal to that of the initial application fee.

(4) If the Department determines that the COPA continues to comply with the standards listed in

rule 0940-03-10-.05(4), the Department shall renew the COPA. If the Department determines that the disadvantages attributable to the COPA outweigh its likely benefits, the COPA is invalid, with no further force or effect. The Department shall give fourteen (14) days notice of its termination of the COPA under this section. The COPA shall be rendered invalid at 12:01 a.m. on the 15 th day.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302(a)(3), 33-1-304, 33-1-305(1), 33-1-309, 33-2- 101, and 33-2-701, et seq.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Chapter 0940-03-11 Transfer of Service Recipients to and from the MTMHI Forensic Services Program

Tenn. Comp. R. & Regs. 0940-03-11-.01 DEFINITIONS

(1) “Assistant Commissioner” means the Tennessee Department of Mental Health and Substance Abuse Services Assistant Commissioner of Policy and Legislation or the Assistant Commissioner with administrative responsibility for the Office of Forensic Services.

(2) “Chief Officer” means, for the purposes of this chapter, the person with overall authority for a regional mental health institute or the person’s designee.

(3) “Commissioner” means the Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services.

(4) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(5) “Forensic Services Program” means a service or facility operated directly or through agreement by the Tennessee Department of Mental Health and Substance Abuse Services to provide assessment and/or treatment for service recipients who need a secure setting.

(6) “Office of Forensic Services” means the Tennessee Department of Mental Health and Substance Abuse Services Office of Forensic and Juvenile Court Services.

(7) “Transfer Committee” means a committee of five (5) persons established, pursuant to T.C.A. §§ 33-3-404 through 33-3-406, to review the transfer of service recipients who are inmates between the Department of Correction and the Tennessee Department of Mental Health and Substance Abuse Services.

(8) “Service recipient” means, for the purposes of this chapter, a person with mental illness who is receiving services in a facility operated by the Tennessee Department of Mental Health and Substance Abuse Services or the Department of Correction.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, and 33-1-305.
Administrative History: Original rule filed March 18, 2010; effective June 16, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-11-.02 REGULAR TRANSFER TO MTMHI FORENSIC SERVICES PROGRAM FROM

REGIONAL MENTAL HEALTH INSTITUTE.

(1) The Commissioner may authorize a transfer to the Forensic Services Program at Middle Tennessee Mental Health Institute (MTMHI) of a service recipient who was admitted, committed, or hospitalized at a Regional Mental Health Institute when:

(a) The service recipient can more properly be cared for and treated in the Forensic Services Program at MTMHI than at the facility where the service recipient currently receives services;

(b) The transfer is in the service recipient’s best interest; and (c) The Commissioner determines that the service recipient is substantially likely to injure himself/herself or others if not treated in a secure facility.

(2) Upon recommendation by the treatment team, the Chief Officer of the referring facility shall prepare and send a transfer packet to the Commissioner by way of the Office of Forensic Services. The transfer packet shall, at a minimum, include:

(a) A cover letter from the Chief Officer requesting the transfer with:

The rationale for the request; and 2. Documentation of the treatment interventions used to manage the service recipient’s behavior in the Regional Mental Health Institute.

(b) Certificate of need for transfer from a licensed physician with expertise in psychiatry or a licensed psychologist with a health service provider designation that includes documentation related to the service recipient’s behavior and attempted treatment interventions including, but not limited to, the use of isolation and/or restraint, a new unit assignment, and/or changes in medication;

(d) A physical examination completed within the last six (6) months prior to the request for transfer with an addendum verifying that a physical exam was updated within the past twenty-four (24) hours;

(e) A copy of the court commitment order;

(f) A copy of the most recent risk assessment, if forensic; and (g) Documentation that the service recipient and his or her conservator, spouse or responsible relative have been notified of the transfer request by the Chief Officer.

(3) Unless the service recipient, conservator, spouse or responsible relative is in agreement with the transfer, the transfer cannot occur for twenty-four (24) hours from the time of the request for approval.

(4) Upon receipt of the transfer request, the Office of Forensic Services shall review the request and determine within five (5) business days whether:

(a) All reasonable treatment interventions have been conducted and the service recipient should be transferred to the Forensic Services Program; or (b) All reasonable treatment interventions have not been conducted.

(5) If the Office of Forensic Services concludes that all reasonable treatment interventions have not been conducted, the Office may write to the Chief Officer requesting that additional specific interventions be attempted. The Office of Forensic Services shall notify the Assistant Commissioner of this request.

(6) The Chief Officer may submit additional information clarifying the treatment interventions used to manage the service recipient’s behavior safely in the RMHI or, after a reasonable period of time, reapply for this transfer after the recommended interventions have been tried, evaluated, and been deemed not to have succeeded in ameliorating the conditions that triggered the original transfer request.

(7) If the Office of Forensic Services determines that a service recipient should be transferred to the Forensic Services Program, a memorandum and the transfer packet shall be sent to the Assistant Commissioner notifying him or her of the recommendation to transfer.

(8) If the Assistant Commissioner concludes that all reasonable treatment interventions have not been conducted, then the Assistant Commissioner shall instruct the Office of Forensic Services to write to the Chief Officer requesting that additional specific interventions be attempted.

(9) If the Assistant Commissioner concludes that a service recipient should be transferred, then the Office of Forensic Services shall prepare the following documents:

(a) A memo to the Commissioner from the Assistant Commissioner requesting approval for the transfer; and (b) Three authorization forms to be signed by the Director of Forensic Services, the Assistant Commissioner and the Commissioner.

(10) If the Commissioner concludes that all reasonable treatment interventions have not been conducted, then the Commissioner shall instruct the Office of Forensic Services to write to the Chief Officer requesting that additional specific interventions be attempted.

(11) If the Commissioner concludes that all reasonable treatment interventions have been conducted, then the Office of Forensic Services shall prepare for the Commissioner’s signature the following documents:

(a) A letter approving the transfer to the Chief Officer of the referring facility with a receipt of transfer notice form, an authorization letter to the service recipient, a form for the service recipient to file a complaint objecting to the transfer in Circuit Court as specified in Title 33, Chapter 7, and a signed authorization form;

(b) A letter approving transfer to the Chief Officer of MTMHI with a signed authorization form; and (c) A letter to the appropriate relative or conservator with a complaint form for objecting to the transfer, sent via certified mail.

(12) The following people may file a complaint in circuit court if they object to the transfer: service recipient; legal custodian, conservator, spouse or responsible relative of the service recipient.

If a complaint is filed, the circuit court shall determine whether a service recipient may be transferred to a facility.

(13) Upon receipt of the transfer approval, the Chief Officer shall deliver the transfer authorization letter, the complaint form, and an acknowledgement of receipt form to the service recipient.

The service recipient shall be given the opportunity to sign the acknowledgement of receipt at the time the notice is delivered. If the service recipient refuses to sign the acknowledgement of receipt, the person who delivers the notice of the transfer shall, in the presence of a witness, write on the receipt, “refused to sign receipt.” After the service recipient either signs or fails to sign the acknowledgement of receipt, it shall be co-signed by the person who delivered the notice and a witness. The Chief Officer shall keep the signed receipt for their files and place a copy in the service recipient’s record.

(14) When the transfer is approved, the Chief Officer shall:

(a) Send written notice of the transfer to the committing court;

(b) Communicate with the MTMHI Forensic Services Program Director to arrange the transfer;

(c) Verify available suitable accommodations at the MTMHI Forensic Services Program by obtaining a confirmation number from MTMHI;

(d) Arrange for transportation and transfer of the service recipient within two (2) business days of receiving confirmation of available suitable accommodations; and (e) Set up a teleconference between the referring physician and/or psychologist with health services provider designation and the receiving physician to discuss diagnosis and medication decisions prior to the transfer. This discussion shall be documented in the service recipient’s record.

(15) The MTMHI Forensic Services Program Director shall notify the referring Forensic Services Coordinator of the admission of the transferred service recipient.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, 33-3-301, and 33-3-701, et seq.
Administrative History: Original rule filed March 18, 2010; effective June 16, 2010.

Tenn. Comp. R. & Regs. 0940-03-11-.03 EMERGENCY TRANSFER TO MTMHI FORENSIC SERVICES PROGRAM FROM

REGIONAL MENTAL HEALTH INSTITUTE.

(1) The Office of Forensic Services shall ensure that the emergency transfer of a service recipient from a Regional Mental Health Institute to the Forensic Services Program is expeditious, complies with statutory criteria for emergency transfer and considers the welfare and safety of the service recipient, other service recipients and staff.

(2) An emergency transfer shall be approved if, and only if, all appropriate interventions have been tried and documented and deemed unsuccessful.

(3) The licensed physician or licensed psychologist with health service provider designation shall make a determination that a service recipient meets all of the following criteria in order for a transfer to be considered:

(a) The service recipient requires emergency care and treatment that cannot be provided by the transferring facility;

(b) The transfer is in the service recipient’s best interest;

(c) The service recipient has a substantial likelihood of injuring himself or herself or others if not treated in a secure facility; and (d) The service recipient is not under a voluntary commitment.

(4) After the licensed physician or licensed psychologist with health service provider designation determines that the service recipient meets the criteria specified in 0940-03-11-.03(3) for an emergency transfer, the Chief Officer of the referring Regional Mental Health Institute shall:

(a) Telephone the MTMHI Forensic Services Program Director and the Office of Forensic Services. If after normal working hours, the Assistant Commissioner may approve the transfer.

(b) Send by facsimile within two (2) hours of the verbal request for an emergency transfer the following information:

Recommendations for transfer from the referring Chief Officer that includes the rationale for transfer and the interventions taken to treat the service recipient including, but not limited to, use of restraint or isolation, changes in medication, use of PRN medications, and/or changes in unit assignment.
Documentation of the need for transfer from either a licensed physician with expertise in psychiatry or a licensed psychologist with health service provider designation.
A written report of a physical examination completed by a licensed physician within the last six (6) months with an addendum within the last twenty-four (24) hours.
The most recent risk assessment, if a forensic service recipient.

(5) After receiving the documentation specified in 0940-03-11-.03(4), the Office of Forensic Services shall review the request and send this documentation with a recommendation to approve or disapprove the transfer to the Assistant Commissioner and the Commissioner.

(6) Upon review of this information, the Director of the Office of Forensic Services, the Assistant Commissioner, and the Commissioner shall verbally authorize the transfer or request that further information be received prior to authorization or deny the transfer.

(7) If the emergency transfer request is denied, the Forensic Coordinator at the Regional Mental Health Institute and the Office of Forensic Services shall develop an alternative safety plan and identify an appropriate period of time for the review of the safety plan. The safety plan may include, but is not limited to, behavioral modification, change in medications, and moving the service recipient to a different unit.

(8) After an emergency transfer request is approved, then the Office of Forensic Services shall:

(a) Convey verbally the decision to the Chief Officer of the referring facility and the Chief Officer of MTMHI;

(b) Prepare a letter to the service recipient from the Commissioner of TDMHSAS stating that the transfer was approved. A copy of this letter shall be sent by facsimile and by mail to both the sending and receiving Chief Officers.

(9) If the emergency transfer request is approved, the Chief Officer of the referring facility shall:

(a) Ensure that the service recipient receives a signed statement and a receipt of transfer notification from the referring Chief Officer notifying the service recipient of the authorized transfer;

(b) Provide the service recipient with the opportunity to sign the receipt of transfer notification at the time the notice is delivered. If the service recipient refuses to sign the acknowledgement, the person who delivers the notice of the transfer shall, in the presence of a witness, write on the receipt, “refused to sign receipt.” After the service recipient either signs or fails to sign the acknowledgement of receipt, it shall be cosigned by the person who delivered the notice and a witness. The completed acknowledgement of receipt shall be filed in the office of the Chief Officer;

(c) Verbally contact the appropriate relative or conservator and send by mail a written notice of transfer; these contacts shall be documented in the service recipient’s record;

(d) Set up a teleconference between the referring physician or psychologist and the receiving physician to discuss diagnosis and medication decisions: this discussion shall be documented in the service recipient’s record;

(e) If the service recipient has not already been judicially committed, file a complaint for commitment under T.C.A. Title 33, Chapter 6, Part 5;

(f) Notify the committing court of the transfer; and (g) Send a copy of the following documents to the Office of Forensic Services:

A copy of the court commitment order;
A copy of the court notification; and 3. A copy of the notification of the transfer to the service recipient and to the appropriate relative or conservator.

(h) Verify available suitable accommodations at the MTMHI Forensic Services Program by obtaining a confirmation number from MTMHI.

(10) The service recipient shall be transferred to the MTMHI Forensic Services Program, accompanied by a copy of his or her clinical record, within twenty-four (24) hours of the receipt of the verbal approval of the transfer request and confirmation of available suitable accommodations.

(11) After the service recipient is transferred, the Office of Forensic Services shall prepare a letter to the service recipient from the Commissioner of TDMHSAS indicating that the continued need for treatment in the secure facility shall be determined within seventy-two (72) hours.

(12) Within seventy-two (72) hours of the transfer, the treatment team at the Forensic Services Program shall make a recommendation to the Chief Officer of MTMHI about the need for continued care and treatment for up to thirty (30) days.

(13) If the Chief Officer determines that there is a need for continued care and treatment for up to thirty (30) days, then the:

(a) Chief Officer of MTMHI shall send written notification to the service recipient of the need for continued care and treatment up to thirty (30) days and send a copy of the notification to the Office of Forensic Services; and (b) Commissioner shall send written notice to the service recipient of the authorization of the continued need for care and treatment in the Forensic Services Program and send a copy of the letter to the referring and receiving Chief Officers.

(14) If continued treatment for up to thirty (30) days at the Forensic Services Program is not needed, then the MTMHI Forensic Services Program Director shall:

(a) Notify the referring Regional Mental Health Institute Chief Officer by telephone and letter;

(b) Verify available suitable accommodations by obtaining a confirmation number from MTMHI;

(c) Transfer the service recipient to the referring facility within twenty-four (24) hours of confirming available suitable accommodations; and (d) Notify the Office of Forensic Services by telephone and letter and send a copy of the letter to the Chief Officer of the referring Regional Mental Health Institute.

(15) Within thirty (30) days of the transfer to the Forensic Services Program, the Forensic Services Program treatment team shall determine if continued care and treatment at the Forensic Services Program is required beyond thirty (30) days.

(16) If the treatment team recommends continued treatment beyond thirty (30) days, then the Chief Officer of MTMHI shall:

(a) Notify the service recipient by letter;

(b) Request approval from the Commissioner by having the Director of the Forensic Services Program prepare a letter to the Commissioner justifying the need for continued care and treatment in the secure facility; and (c) Send copies of the letter for continued care and treatment at the Forensic Services Program to the Director of the Office of Forensic Services.

(17) After receiving the letter for continued care and treatment, the Office of Forensic Services Program shall review the request and send this documentation with a recommendation to approve or disapprove the transfer to the Assistant Commissioner and Commissioner.

(18) If the Commissioner approves the need for continued care and treatment beyond thirty (30) days, the Commissioner shall:

(a) Send written notification to the Chief Officer of the referring facility by sending an authorization memorandum;

(b) Send written notification to the Chief Officer of MTMHI by sending an authorization memorandum;

(c) Send written notification to the service recipient and include a complaint form to object to the authorization; and (d) Send written notification to the appropriate relative/conservator and include a complaint form to object to the authorization.

(19) If the need for continued care and treatment in the Forensic Services Program beyond thirty (30) days is approved, the MTMHI Forensic Services Program Director shall notify the committing court of the authorization for continued care and treatment in the secure facility.

(20) If continued care and treatment in the Forensic Services Program beyond thirty (30) days is not recommended, the Chief Officer of MTMHI shall:

(a) Send written notification to the Chief Officer of the referring facility and send a copy of the notice to the Office of Forensic Services;

(b) Return the service recipient to the referring facility within of seventy-two (72) hours, excluding week-ends and holidays, of providing notice of the decision.

(21) If continued care and treatment in the MTMHI Forensic Services Program beyond thirty (30) days is not recommended, the Forensic Services Coordinator of the referring Regional Mental Health Institute shall:

(a) Send written notification to the appropriate relative or conservator that the service recipient has been transferred from the MTMHI Forensic Services Program to a Regional Mental Health Institute; and (b) Send written notification to the committing court that the service recipient has been transferred from the MTMHI Forensic Services Program to a Regional Mental Health Institute.

(22) The MTMHI Forensic Services Program Director shall notify the Office of Forensic Services of the date of the service recipient’s return to the referring facility.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, 33-3-301, and 33-3-701, et seq.
Administrative History: Original rule filed March 18, 2010; effective June 16, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-11-.04 TRANSFER FROM MTMHI FORENSIC SERVICES PROGRAM TO A REGIONAL

MENTAL HEALTH INSTITUTE.

(1) The Commissioner may authorize the transfer of any service recipient admitted, committed, or hospitalized under T.C.A. Title 33, Chapter 5 or Chapter 7 to the MTMHI Forensic Services Program back to a regional mental health institute when:

(a) The service recipient can be more properly cared for and treated in a non-secure facility;

(b) The transfer is in the service recipient’s best interest;

(c) The transfer is not contrary to the safety and welfare of the service recipient, other service recipients or the staff of the receiving facility; and (d) The service recipient no longer requires treatment in a secure facility.

(2) If the treatment team recommends that a service recipient be transferred from the MTMHI Forensic Services Program to a Regional Mental Health Institute, the MTMHI Forensic Services Program Director shall forward the following reports to the Chief Officer of MTMHI:

(a) A certified copy of the commitment order;

(b) A copy of the most recent staff conference report;

(c) A copy of the most recent physical examination completed within the last six (6) months and updated within the past twenty-four (24) hours;

(d) A copy of the most recent risk assessment, if forensic;

(e) A report of mental assessment and evaluation for transfer if not already included in the conference report; and (f) A copy of the notifications provided to the court, to the service recipient, and to the service recipient’s nearest relative or conservator, as applicable, regarding the request for transfer.

(3) The Chief Officer of MTMHI shall review and approve the transfer request within seventy-two (72) hours of receipt and provide to the MTMHI Forensic Services Program Director a signed cover letter to the Commissioner that includes the following:

(a) Documentation of specific reasons for transfer and the service recipient’s past and present behavior;

(b) Certification that the transfer is in the best interest of the service recipient; and (c) Certification that the transfer will not be contrary to the safety and welfare of the service recipient or other service recipients and staff of the receiving facility.

(4) Within twenty-four (24) hours of receiving the cover letter signed by the Chief Officer of MTMHI, the MTMHI Forensic Services Program Director shall forward the signed cover letter to the Office of Forensic Services with the following documents:

(a) Documents listed in Rule 0940-03-11-.04(2)(a) through (f); and (b) A copy of the signed receipt of transfer notification. If the service recipient refuses to sign the receipt of transfer notification, the person who delivers the notice of the transfer shall, in the presence of a witness, write on the receipt, “refused to sign receipt.” After the service recipient either signs or fails to sign the acknowledgement of receipt, it shall be co-signed by the person who delivered the notice and a witness. The completed acknowledgement of receipt shall be filed in the office of the Chief Officer.

(5) At the time the transfer request is made to the Commissioner, the Chief Officer of MTMHI shall send a referral letter to the Chief Officer of the receiving facility along with:

(a) A copy of the documents listed in Rule 0940-03-11-.04(2)(a) through (f); and (b) The service recipient’s record.

(6) The receiving Chief Officer may challenge the transfer request to the Commissioner within ten (10) days of receiving notice of the transfer request. A physician-to-physician teleconference may be conducted as part of this review process. The written challenge to the transfer request shall include:

(a) Justification for the challenge; and (b) An alternative Regional Mental Health Institute who has agreed to accept the transfer of the service recipient.

(7) Upon receipt of the transfer documents, the Office of Forensic Services shall:

(a) Review documents sent by the Chief Officer of MTMHI;

(b) Interview the service recipient within forty-eight (48) hours of receipt of the transfer request, excluding Saturdays, Sundays, and legal holidays;

(c) Interview staff members involved in the service recipient’s treatment; and (d) Review the clinical chart at the MTMHI Forensic Services Program.

(8) Following a review of the facts of the transfer request, the Office of Forensic Services shall prepare a report summarizing the clinical and legal information specific to the service recipient including the following:

(a) A statement that the transfer is or is not in the best interest of the service recipient;

(b) A statement that the transfer would or would not be contrary to the safety and wellbeing of other service recipients and staff;

(d) A recommendation for or against transfer with the rationale for this recommendation; and (e) The date of the last aggressive behavior and/or attempted elopement and therapeutic intervention.

(9) If the Office of Forensic Services concurs with the recommendation for transfer, the Director of the Office of Forensic Services shall prepare a recommendation memo to the Assistant Commissioner.

(10) If the Office of Forensic Services does not concur with the recommendation for transfer, the Director of the Office of Forensic Services shall consult with the Director of the MTMHI Forensic Services Program to:

(a) Identify barriers to transfer;

(b) Develop a plan to eliminate barriers to transfer; and (c) Establish a timeframe for reviewing progress.

(11) The Office of Forensic Services shall notify the Chief Officers of MTMHI and the receiving facility and the Assistant Commissioner of the decision to delay the transfer and the recommended plan for addressing barriers to transfer.

(12) When the barriers to transfer have been eliminated, the Director of the MTMHI Forensic Services Program shall submit an updated report to the Office of Forensic Services and the Director of Forensic Services shall complete a recommendation memorandum to the Assistant Commissioner.

(13) The Assistant Commissioner shall review the transfer request upon receipt of the recommendation memorandum.

(14) If the Assistant Commissioner approves the transfer request, the Office of Forensic Services shall draft a recommendation memorandum to the Commissioner supporting the transfer request.

(15) If the Assistant Commissioner does not concur with the recommendation of the Office of Forensic Services, the Director of the Office of Forensic Services shall:

(a) Consult with the Director of the MTMHI Forensic Services Program to identify barriers to transfer;

(b) Develop a plan to eliminate barriers to transfer; and (c) Establish a time frame for reviewing progress.

(16) Once the barriers to transfer have been eliminated, the Director of the MTMHI Forensic Services Program shall submit an updated report to the Director of the Office of Forensic Services who shall submit the updated request to the Assistant Commissioner for review.

(17) If the Assistant Commissioner does not approve the request, consultation and planning as described in 0940-03-11-.04(16), shall continue until the Assistant Commissioner concurs with the request.

(18) When the Director of the Office of Forensic Services and the Assistant Commissioner approve the transfer request, then the Office of Forensic Services shall prepare the following materials for the Commissioner to review:

(a) A letter from the Commissioner to the Chief Officer of MTMHI approving the transfer request;

(b) A letter from the Commissioner to the Chief Officer of the receiving facility: this letter shall indicate that the transfer is to occur within thirty (30) days of the approval;

(c) Three (3) authorization forms, each with original signatures, to be signed by the Director of the Office of Forensic Services, the Assistant Commissioner and the Commissioner; these forms are attachments to the memorandum to the referring facility, the receiving facility and for Department files;

(d) A letter from the Commissioner to the service recipient at the MTMHI Forensic Services Program with a complaint form;

(e) A letter from the Commissioner to the appropriate relative or conservator of the service recipient with a complaint form; and (f) A completed transfer cover sheet.

(19) If the Commissioner concurs with the transfer request, he or she shall complete the items specified in 0940-03-11-.04(18)(a) through (e).

(20) The Office of Forensic Services shall distribute the notifications specified in Rule 0940-03-11- .04(18)(a) through (f) after they have been completed by the Commissioner.

(21) If the Commissioner does not concur with the transfer request, the Director of the Office of Forensic Services shall consult with the Director of the MTMHI Forensic Services Program to:

(a) Identify barriers to transfer;

(b) Develop a plan to eliminate barriers to transfer; and (c) Establish a time frame for reviewing progress.

(22) Once the barriers to transfer have been eliminated, the Director of the MTMHI Forensic Services Program shall submit an updated report to the Office of Forensic Services who shall submit this report to the Assistant Commissioner for review prior to sending it to the Commissioner. If the Commissioner does not approve the updated request, consultation and planning as described under Rule 0940-03-11-.04(21) shall continue until the Commissioner approves an updated request.

(23) After receiving notification of transfer approval, the Director of the MTMHI Forensic Services Program shall:

(a) Set up a teleconference between the referring physician and the receiving physician to discuss diagnosis and medication decisions prior to the transfer of the service recipient; this discussion shall be documented in the service recipient’s record; and (b) Arrange for transportation and the transfer of the service recipient within thirty (30) days of the receipt of the letter from the Commissioner to the Chief Officer of the receiving Regional Mental Health Institute.

(24) The Chief Officer of MTMHI shall notify the committing court of the date for transfer.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, 33-3-301, and 33-3-701, et seq.
Administrative History: Original rule filed March 18, 2010; effective June 16, 2010.

Tenn. Comp. R. & Regs. 0940-03-11-.05 REGULAR TRANSFER TO MTMHI FORENSIC SERVICES PROGRAM FROM

DEPARTMENT OF CORRECTION.

(1) A service recipient may be transferred immediately to the MTMHI Forensic Services Program from a Department of Correction facility when the Director of a Department of Correction facility makes a determination, based on a written report of a licensed physician or psychologist with health services provider designation, that a service recipient in the director’s custody:

(a) Has a mental illness;

(b) Is in need of residential care and treatment for the condition that cannot be provided at an appropriate facility of the Department of Correction and that can be provided at the MTMHI Forensic Services Program; and (c) Waives in writing the right to a transfer hearing.

(2) The following information shall accompany a service recipient transferred to the MTMHI Forensic Services Program from the Department of Correction:

(a) A letter affirming the transfer to the MTMHI Forensic Services Program;

(b) A copy of the signed statement from the service recipient waiving the right to a transfer hearing; and (c) The written report documenting that the service recipient meets the transfer criteria in 0940-03-11-.05(1)(a) and (b).

(3) If the service recipient does not waive the right to a transfer hearing, the service recipient shall remain in the facility of the Department of Correction until the Director of a Department of Correction Facility convenes a transfer committee not less than seven (7) days or more than fourteen (14) days thereafter.

(4) The transfer committee shall meet the requirements of T.C.A. §§ 33-3-404 et seq.

(5) The transfer committee shall approve the transfer if the transfer meets the criteria in Rule 0940-03-11-.05(1)(a) and (b).

(6) The chair of the transfer committee shall provide the service recipient with the following information if the transfer is approved:

(a) A written notice of the transfer committee’s decision and a summary of the factual basis for the decision; and (b) A complaint form for review of the transfer in circuit court under T.C.A., Title 33,

Chapter 3, Part 7.

(7) The Director of the Department of Correction facility shall transfer the service recipient five (5) days after the receipt of the transfer committee’s notice to the service recipient if the following conditions are met:

(a) The transfer meets the criteria specified in Rule 0940-03-11-.05(1)(a) and (b); and (b) The service recipient has not filed a complaint under T.C.A., Title 33, Chapter 3, Part 7; and (c) The Director verifies available suitable accommodations at the MTMHI Forensic Services Program by obtaining a confirmation number from MTMHI.

(8) When a transfer is approved by the transfer committee, the Director of the Department of Correction Facility shall provide the MTMHI Forensic Service Program with:

(a) A letter affirming the transfer to the MTMHI Forensic Services Program; and (b) A summary of the factual basis for the transfer committee decision.

(9) The transfer committee shall disapprove the transfer if the transfer does not meet the criteria specified in Rule 0940-03-11-.05(1)(a) and (b).

(10) If the transfer is disapproved, the chair of the transfer committee shall provide the service recipient with a written notice of the transfer committee’s decision and a summary of the factual basis for the decision.

(11) If the transfer is disapproved and the service recipient has already been transferred, the transfer committee shall order the service recipient returned to the Department of Correction facility.

(12) The Chief Officer of MTMHI shall determine, within five (5) days, excluding Saturdays, Sundays, and legal holidays, whether a transfer is appropriate based on the advice of a licensed physician.

(a) If the transfer is not appropriate, the Chief Officer of MTMHI shall immediately transfer the service recipient back to the custody of the Department of Correction.

(b) If the transfer is appropriate, the Chief Officer of MTMHI shall:

Ensure that the service recipient receives a signed statement and a receipt of transfer notification notifying the service recipient of the authorized transfer;
Provide the service recipient with the opportunity to sign the receipt of transfer notification at the time the notice is delivered. If the service recipient refuses to sign the acknowledgement, the person who delivers the notice of the transfer shall, in the presence of a witness, write on the receipt, “refused to sign receipt.”

After the service recipient either signs or fails to sign the acknowledgement of receipt, it shall be co-signed by the person who delivered the notice and a witness. The completed acknowledgement of receipt shall be filed in the office of the Chief Officer;

Verbally contact the appropriate relative or conservator and send by mail a written notice of transfer; these contacts shall be documented in the service recipient’s record;
Set up a teleconference between the referring physician or psychologist with health service provider designation and the receiving physician to discuss diagnosis and medication decisions: this discussion shall be documented in the service recipient’s record;
Send to the Office of Forensic Services a copy of the notification of the transfer to the service recipient and to the appropriate relative or conservator;

(13) All complaints filed with circuit court to review whether a service recipient may be transferred to a facility shall follow the requirements in Title 33, Chapter 3, Part 7.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, 33-3-301, 33-3-402, 33-3-404, 33-3-405, 33-3-406, 33-3-408, 33-3-409, and 33-3-701, et seq.
Administrative History: Original rule filed March 18, 2010; effective June 16, 2010.

Tenn. Comp. R. & Regs. 0940-03-11-.06 EMERGENCY TRANSFER TO MTMHI FORENSIC SERVICES PROGRAM FROM

DEPARTMENT OF CORRECTION.

(1) The emergency transfer of a service recipient to the MTMHI Forensic Services Program from the Department of Correction may occur when:

(a) The Director of a Department of Correction facility determines, based on a written report of a licensed physician or a licensed psychologist designated as a health services provider, that a service recipient in the Director’s custody:

Has mental illness; and 2. Is in need of emergency residential care and treatment for the condition that cannot be provided at an appropriate facility of the Department of Correction and that can be provided at an appropriate residential program of the Tennessee Department of Mental Health and Substance Abuse Services.

(2) If the Director of the Department of Correction facility orders the emergency transfer to the MTMHI Forensic Services Program, the Director shall:

(a) Telephone the MTMHI Forensic Services Program Director and the Office of Forensic Services.

(b) Send by facsimile the following information:

Recommendations for transfer from the referring Director of the Department of Correction facility that includes the rationale for transfer; and 2. Documentation of the need for transfer from either a licensed physician or a licensed psychologist with health service provider designation.

(c) Verify available suitable accommodations at the MTMHI Forensic Services Program by obtaining a confirmation number from MTMHI.

(3) After documentation is received by MTMHI and a confirmation number has been provided, the service recipient may be transferred immediately to the MTMHI Forensic Services Program.

(4) When an service recipient is transferred to the MTMHI Forensic Services Program from the Department of Correction, the Chief Officer of MTMHI shall convene a transfer committee, as defined by T.C.A. §§ 33-3-404 et seq., not less than seven (7) days or more than fourteen (14) days thereafter unless the service recipient is returned to the Department of Correction before the hearing date.

History

Authority: T.C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, 33-3-403, 33-3-404, 33-3-405, 33-3-406, and 33-3-701, et seq.
Administrative History: Original rule filed March 18, 2010; effective June 16, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-11-.07 TRANSFER FROM MTMHI FORENSIC SERVICES PROGRAM TO THE

DEPARTMENT OF CORRECTION.

(1) The Chief Officer of MTMHI may order a service recipient’s return to the Department of Correction more than five (5) days after the transfer, excluding Saturdays, Sundays and legal holidays, if:

(a) A service recipient no longer meets the standards for transfer specified in Rule 0940- 03-11-.05(1)(a) or (b); or (b) Residential care and treatment in the facility is no longer advisable or beneficial.

(2) Not less than seventy-two (72) hours in advance of the transfer, the Chief Officer of MTMHI shall:

(a) Ensure that the service recipient receives a signed statement notifying the service recipient of the authorized transfer; a receipt of transfer notification; a form to object to the transfer; and (b) Provide the opportunity for the service recipient to sign the receipt of transfer notification at the time the notice is delivered. If the service recipient refuses to sign the acknowledgement, the person who delivers the notice of the transfer shall, in the presence of a witness, write on the receipt, “refused to sign receipt.” After the service recipient either signs or fails to sign the acknowledgement of receipt, it shall be cosigned by the person who delivered the notice and a witness. The completed acknowledgement of receipt shall be kept on file in the office of the Chief Officer.

(3) If the service recipient does not object to the transfer within seventy-two (72) hours of receiving the transfer notice of the proposed return, the service recipient shall be returned to the Department of Correction.

(4) If the service recipient objects to the transfer within seventy-two (72) hours of receiving the transfer notice, the Chief Officer of MTMHI shall convene a transfer committee, as defined by T.C.A. §§ 33-3-404 et seq., to review the decision not less than seven (7) days or more than fourteen (14) days thereafter.

(5) The transfer committee shall approve the transfer if it determines that the service recipient no longer meets the standards specified in Rule 0940-03-11-.05(1)(a) or (b) or that residential care and treatment in the facility are no longer advisable or beneficial.

(6) The decision of the transfer committee approving or disapproving a transfer from the MTMHI Forensic Services Program is final and not subject to judicial review.

History

Authority: T. C.A. §§ 4-4-103, 33-1-201, 33-1-202, 33-1-203, 33-1-204, 33-1-302, 33-1-305, 33-3-408, and 33-4-409.
Administrative History: Original rule filed March 18, 2010; effective June 16, 2010.

Chapter 0940-03-12 Reserved

Tenn. Comp. R. & Regs. 0940-03-12 Reserved

December, 2022 1 RULES OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

Chapter 0940-03-13 Admissions to a Regional Mental Health Institute

Tenn. Comp. R. & Regs. 0940-03-13-.01 DEFINITIONS

(1) “Available suitable accommodations” means that an RMHI has the capacity, as reasonably determined by the Commissioner in accordance with these rules, and the medical capability, equipment and staffing to provide an appropriate level of care, treatment and physical security to a service recipient in an unoccupied and unassigned bed.

(2) “Certificate of need” means, for the purposes of this chapter, a certification of need for care and treatment for a service recipient with mental illness or serious emotional disturbance who meets the criteria for involuntary commitment under T.C.A. Title 33, Chapter 6, Part 4 or Part 5.

(3) “Commissioner” means the Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services.

(4) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(5) “Forensic” means admission legal status resulting from a court order for admission under T.C.A. Title 33, Chapter 7, Part 3.

(6) “Geographic Catchment Area” means those counties assigned to an RMHI by the Commissioner.

(7) “Local RMHI” means the RMHI for a geographic catchment area.

(8) “Mandatory Pre-screening Agent” means a person meeting criteria required by T.C.A. § 33-6- 427 who is designated by the Commissioner to perform pre-screening of service recipients for emergency involuntary admission.

(9) “Medical capability” means that an RMHI has the ability to treat a service recipient’s medical needs onsite or that the service recipient’s medical needs do not exceed the onsite capability of the RMHI to treat.

(10) “Regional Mental Health Institute or RMHI” means a state owned or operated hospital for service recipients with mental illness or serious emotional disturbance.

(11) “Service Recipient” means, for the purposes of this chapter, a person who is receiving service, has applied for service, or for whom someone has applied for or proposed service because the person has mental illness or a serious emotional disturbance.

(12) “Transportation agent” means, for the purposes of this chapter:

(a) The sheriff in a county in which a service recipient with mental illness or serious emotional disturbance is detained;

(b) A secondary transportation agent under T.C.A. § 33-6-901;

(c) A municipal law enforcement agency that meets the requirements as a secondary transportation agent; or (d) One or more friends, neighbors or other mental health professionals familiar with the service recipient, relatives of the service recipient, or a member of the clergy.

(13) “Written Verification Statement” means a written statement verifying available suitable accommodations provided by a referral source who has contacted the RMHI about the availability of suitable accommodations. This statement shall include the name of the service recipient, the name of the RMHI with available suitable accommodations, a confirmation number from the RMHI, and the name and phone number of the referral source or the referral source’s designated contact person.

History

Authority: T.C.A. §§ 4-4-103, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-6-105, and 33-6- 108.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-13-.02 GENERAL ADMISSION REQUIREMENTS

(1) All admissions or transfers to an RMHI shall be subject to available suitable accommodations.

(2) Verification of available suitable accommodations does not guarantee admission into an RMHI. Admissions for service recipients under T.C.A. Title 33, Chapter 6, Part 2 or 4 are dependent on the service recipient meeting admission criteria and being evaluated for admission by the receiving RMHI.

(3) Priority for admission shall be given to persons referred for an emergency admission.

(4) All admissions or transfers to an RMHI shall be subject to specific geographic catchment areas defined by the Commissioner or designee, unless the Commissioner or designee determines otherwise.

(5) Before sending a service recipient to an RMHI, the referral source shall contact the RMHI’s Admission Office to determine whether there are available suitable accommodations.

(6) If the RMHI has available suitable accommodations, the RMHI shall provide a verification of available suitable accommodations with a confirmation number to the referral source or designee.

(7) The RMHI shall provide written verification of available suitable accommodations with a confirmation number to the referral source or designee by fax or email when possible. When it is not possible to provide written verification of available suitable accommodations, the RMHI may provide verification with a confirmation number by telephone to the referral source or the referral source’s designated contact person.

(8) If a local RMHI does not have available suitable accommodations, the local RMHI shall offer to contact the other RMHIs to determine if there are available suitable accommodations in an alternate RMHI and to provide contact information for the RMHI with available suitable accommodations.

(9) The referral source may decide to place a service recipient on a waiting list at a local RMHI if:

(a) The local RMHI has no available suitable accommodations and the referral source declines a referral to an alternate RMHI; or (b) None of the RMHIs have available suitable accommodations.

(10) If a service recipient is placed on a waiting list of a local RMHI, the RMHI shall check at least daily with other RMHIs until available suitable accommodations are located at either the local or other RMHIs, or the referral source requests that the service recipient be removed from the waiting list.

(11) If a service recipient arrives at an RMHI without a written verification statement from the referral source or designee, including a confirmation number from the RMHI, a bed may not be available in the RMHI.

(12) If during the evaluation for admission, it is determined that the service recipient has a physical disorder or medical condition that requires immediate medical care that the RMHI cannot appropriately provide, the service recipient shall be sent for treatment of the medical condition prior to being admitted to the RMHI. Any service recipient diverted for medical treatment with a valid confirmation number may be transported back to the RMHI for an evaluation for admission.

(13) The RMHI may cancel a confirmation number when it is reasonable to do so. Prior to canceling a confirmation number, the RMHI shall contact the referral source or designee.

When a service recipient’s confirmation number is canceled, that service recipient may be placed on a waiting list for possible future admission.

History

Authority: T.C.A. §§ 4-4-103, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-6-108.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010.

Tenn. Comp. R. & Regs. 0940-03-13-.03 DETERMINATION OF BED CAPACITY

(1) The Commissioner or designee shall at least annually establish the bed capacity for each RMHI no later than 30 days after the beginning of the fiscal year.

(2) The Commissioner or designee may consider bed utilization trends and the geographic distribution of admissions to determine bed capacity.

(3) The Commissioner or designee may, at his or her discretion, change the bed capacity at any RMHI based on the following considerations:

(a) The need to provide an appropriate level of care, treatment and physical security;

(b) The need to reduce admission delays;

(d) The ability of facilities to respond to unusual events or disasters;

(e) Contractual relationships with health plans; and/or (f) The need to respond to other factors that may arise.

(4) The Department shall maintain information concerning the bed capacity of each RMHI that shall be available to the public.

(5) The number of children and youth beds within an RMHI shall be calculated separately from the adult beds at the RMHI.

(6) The number of beds at the Forensic Services Program at Middle Tennessee Mental Health Institute shall be calculated separately from other beds at the RMHI.

(7) Forensic beds may be designated separately from the other adult beds at the RMHI.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-6-108.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010.

Tenn. Comp. R. & Regs. 0940-03-13-.04 DETERMINATION OF GEOGRAPHIC CATCHMENT AREAS

(1) The Commissioner or designee shall establish, at least annually, the geographic catchment area for each RMHI no later than thirty (30) days after the beginning of the fiscal year.

(2) The Commissioner or designee may consider bed utilization trends and the geographic distribution of admissions to determine geographic catchment areas.

(3) The Commissioner or designee may, at his or her discretion, change the geographic catchment area at any RMHI based on the following considerations:

(a) The need to provide an appropriate level of care, treatment and physical security;

(b) The need to reduce admission delays;

(d) The ability of facilities to respond to unusual events or disasters;

(e) Contractual relationships with health plans;

(f) Proximity of the RMHI to a county seat; and/or (g) The need to respond to other factors that may arise.

(4) The Department shall inform courts, law enforcement and major referral sources such as crisis response providers, emergency departments of general hospitals, and mental health and substance abuse providers of changes in the geographic catchment areas.

(5) The Department shall maintain information concerning the geographic catchment area of each RMHI that will be available to the public.

(6) The geographic catchment area for children and youth beds within an RMHI may be determined separately from the adult beds at an RMHI.

(7) The geographic catchment area for the Forensic Services Program at Middle Tennessee Mental Health Institute shall be determined separately from the other beds at the RMHI.

(8) The geographic catchment area for forensic beds may be determined separately from the other beds at the RMHI.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-301.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010.

Tenn. Comp. R. & Regs. 0940-03-13-.05 VERIFICATION OF AVAILABLE SUITABLE ACCOMMODATIONS

(1) An RMHI shall provide verification of available suitable accommodations, including a confirmation number, if the following conditions occur:

(a) The RMHI can provide an appropriate level of care, treatment and physical security to an individual in an unoccupied and unassigned bed; and (b) A referral for admission has been made through any of the following means:

A certificate of need for emergency involuntary hospitalization for a service recipient under T.C.A. Title 33, Chapter 6, Part 4;
An order from a court with proper jurisdiction under T.C.A. § 33-7-301(a);
An order from a court with proper jurisdiction under T.C.A. § 33-7-301(b);
An order from a court with proper jurisdiction under T.C.A. § 33-7-303(c);
An order from a court with proper jurisdiction under T.C.A. § 37-1-128;
An order from a court with proper jurisdiction under T.C.A. Title 33, Chapter 6,

Part 5;

An order from a court with proper jurisdiction for admission under T.C.A. § 33-3- 607;
An order from a court with proper jurisdiction for recommitment for failure or inability to comply with a treatment plan under T.C.A. § 33-6-610 or § 33-6-611;
A written statement from a qualified mental health professional that the service recipient meets the conditions for recommitment for failure or inability to comply with a treatment plan under T.C.A. § 33-6-615;
A written report from a licensed physician or licensed psychologist designated as a health service provider that a service recipient in a youth development center meets the conditions for admission under T.C.A. § 33-3-401 or § 33-3-412;
A written report from a licensed physician or licensed psychologist designated as a health service provider that a service recipient in an RMHI of the Department of Corrections meets the conditions for admission under T.C.A. § 33-3-402 or § 33- 3-403;
A letter from the Commissioner authorizing the transfer of the service recipient from another facility or from a state owned or operated developmental center under T.C.A. § 33-3-301;
A letter from the TDMHSAS Interstate Compact Coordinator indicating that the service recipient has been approved for interstate transfer under T.C.A. § 33-9- 201;
Approval by the RMHI chief executive officer or designee for the transfer of a service recipient from a private facility under T.C.A. § 33-3-301; or 15. Application for voluntary admission under T.C.A. § 33-6-201.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-301.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-13-.06 POLICIES AND PROCEDURES

(1) Each RMHI shall have written policies and procedures approved by the Department to govern the determination of available suitable accommodations at the RMHI including, but not limited to, the following:

(a) A policy stating that a bed assigned to a service recipient is not available until that service recipient has been discharged;

(b) Policies and procedures for maintaining waiting lists including, but not limited to, the following:

Internal review and oversight of waiting lists at an RMHI; and 2. Identifying available suitable accommodations at other facilities when a suitable accommodation is not available in the RMHI;

(c) Procedures for managing service recipients who arrive at the RMHI without written verification of available suitable accommodations; and (d) Procedures for tracking and reporting data pertinent to this chapter.

(2) The Department shall review RMHI policies and procedures governing the determination of available suitable accommodations to ensure that the policies are as uniform as possible.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-301.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010.

Tenn. Comp. R. & Regs. 0940-03-13-.07 WAITING LISTS

(1) Each RMHI shall establish waiting lists for service recipients referred for admission when:

(a) An RMHI has no available suitable accommodations and the referral source seeking a bed declines to accept a referral to an RMHI in another catchment area; or (b) All RMHIs have no available suitable accommodations.

(2) Each RMHI shall maintain waiting lists for service recipients referred from its catchment area and a service recipient shall not be placed on a waiting list for more than one RMHI unless approved by the Commissioner or designee.

(3) Each RMHI shall work their waiting lists on a daily basis and continue to check for available suitable accommodations at the other RMHIs to minimize the length of time a service recipient waits for services.

(4) Any referral source who decides to place a service recipient on a waiting list of a local RMHI shall provide the RMHI with:

(a) The service recipient’s name; and (b) The name and contact information for the referral source or designee.

(5) The RMHI shall notify the referral source or designee as soon as a bed becomes available and provide verification of available suitable accommodations with a confirmation number.

(6) As beds become available, they shall be offered to service recipients in the order in which they were placed on a waiting list based on the following priority order:

(a) Referrals for emergency involuntary admission;

(b) Referrals for non-emergency involuntary admission, including forensic admission; and (c) Referrals for voluntary admission.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-301.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010.

Tenn. Comp. R. & Regs. 0940-03-13-.08 TRANSPORTATION TO AN RMHI

(1) General Transportation Requirements. Transportation to an RMHI should only commence when the transporting person has been provided with:

(a) A written verification statement from the referral source or designee that that RMHI has been contacted and has verified available suitable accommodations with a confirmation number; and (b) Evidence that the person in need of treatment meets criteria for referral. Evidence shall be one of the following:

A certificate of need for emergency involuntary hospitalization for a service recipient under T.C.A. Title 33, Chapter 6, Part 4;
An order from a court with proper jurisdiction under T.C.A. § 33-7-301(a);
An order from a court with proper jurisdiction under T.C.A. § 33-7-301(b);
An order from a court with proper jurisdiction under T.C.A. § 33-7-303(c);
An order from a court with proper jurisdiction under T.C.A. § 37-1-128;
An order from a court with proper jurisdiction under T.C.A. Title 33, Chapter 6,

Part 5;

An order from a court with proper jurisdiction for admission under T.C.A. § 33-3- 607;
An order from a court with proper jurisdiction for recommitment for failure or inability to comply with a treatment plan under T.C.A. § 33-6-610 or § 33-6-611;
A written statement from a qualified mental health professional that the service recipient meets the conditions for recommitment for failure or inability to comply with a treatment plan under T.C.A. § 33-6-615;
A written report from a licensed physician or licensed psychologist designated as a health service provider that a service recipient in a youth development center meets the conditions for admission under T.C.A. § 33-3-401 or § 33-3-412;
A written report from a licensed physician or licensed psychologist designated as a health service provider that a service recipient in an RMHI of the Department of Corrections meets the conditions for admission under T.C.A. § 33-3-402 or § 33- 3-403;
A letter from the Commissioner authorizing the transfer of the service recipient from another RMHI or from a state owned or operated developmental center under T.C.A. § 33-3-301;
A letter from the Interstate Compact Coordinator of the Tennessee Department of Mental Health and Substance Abuse Services indicating that the service recipient has been approved for interstate transfer under T.C.A. § 33-9-201; or 14. Approval by the RMHI chief executive officer or designee for the transfer of a service recipient from a private facility under T.C.A. § 33-3-301.

(2) Transportation to an RMHI by a Sheriff or Secondary Transportation Agent for Emergency Involuntary Hospitalization under T.C.A. Title 33, Chapter 6, Part 4.

(a) If the certificate of need and the written statement verifying that the RMHI has available suitable accommodations is not provided, then the sheriff or secondary transportation agent is not required to take custody of the service recipient for transportation.

(b) Failure of the sheriff or secondary transportation agent to provide both a certificate of need and the written statement verifying that the RMHI has available suitable accommodations shall result in all costs of the service recipient’s admission and treatment being assessed to the transporting county.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-6-406(a).
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-03-13-.09 REPORTING REQUIREMENT

(1) The Department shall report quarterly to the House Health and Human Resources Committee, the Senate General Welfare, Health and Human Resources Committee, and the Finance, Ways and Means Committees of both the House and Senate the implementation and the impact of available suitable accommodations, including the number and length of any delayed admissions.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-6-109.
Administrative History: Original rule filed March 31, 2010; effective June 29, 2010.

Chapter 0940-04-01 Repealed (Rule renumbered 0465-01-01)

Tenn. Comp. R. & Regs. 0940-04-01-.01 REPEALED

History

Authority: T.C.A. §§ 4-3-2708 and 33-5-301, et seq., and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984. Repeal filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0940-04-01-.02 REPEALED

History

Authority: T.C.A. §§ 4-3-2708 and 33-5-301, et seq., and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984. Repeal filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0940-04-01-.03 REPEALED

History

Authority: T.C.A. §§ 4-3-2708 and 33-5-301, et seq., and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment fil ed February 1, 1979; effective March 17, 1979. Amendment by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984. Repeal filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0940-04-01-.04 REPEALED

History

Authority: T.C.A. §§ 4-3-2708 and 33-5-301, et seq., and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repeal filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0940-04-01-.05 REPEALED

History

Authority: T.C.A. §§ 4-3-2708 and 33-5-301, et seq., and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Amendment filed July 2, 1979; effective August 16, 1979. Amendment by Public Chapter 969; effective July 1, 1984. Amendment filed July 11, 1984; effective August 10, 1984. Repeal filed February 11, 2013; effective July 29, 2013.

Tenn. Comp. R. & Regs. 0940-04-01-.06 REPEALED

History

Authority: T.C.A. §§ 4-3-2708 and 33-5-301, et seq., and Public Acts of 2012, Chapter No. 636.
Administrative History: Original rule filed October 17, 1978; effective December 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984. Repeal filed February 11, 2013; effective July 29, 2013.

Chapter 0940-04-02 Repealed

Tenn. Comp. R. & Regs. 0940-04-02-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1-305, and 33-5-101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repealed by Public Chapter 969; effective July 1, 1984. New rule filed July 11, 1984; effective August 10, 1984. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-02-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1-305, 33-104, 33-105, and 33-504.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-02-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1-305, and 33-5-101.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-02-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-104, 33-1-105, 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1-305, and 33- 504.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-02-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1-305, 33-104, 33-105, and 33-504.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-02-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-203, 33-1-204, 33-1-302, 33-1-303, 33-1-305, 33-104, 33-105, and 33-504.
Administrative History: Original rule filed May 31, 1978; effective July 1, 1978. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-04-03 Repealed

Tenn. Comp. R. & Regs. 0940-04-03-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.19 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Emergency rule filed June 17, 2013; effective through December 14, 2013. Emergency rule filed June 17, 2013; effective through December 14, 2013. On December 15, 2013, the rule expired and reverted to its previous status. Repeal filed July 29, 2015; effective October 27, 2015.

Tenn. Comp. R. & Regs. 0940-04-03-.14 filed January 14, 2005; effective through June 28, 2005. Public necessity rules filed on January 14, 2005, expired June 29, 2005; chapter reverted to reserved status. Original rule filed October 20, 2005; effective January 3, 2006. Public necessity rule filed February 24, 2009; effective through August 8, 2009. Public necessity rule filed August 7, 2009; effective through February 3, 2010. Public necessity rule filed August 7, 2009 expired on February 4, 2010; rule reverted to its previous status.

Emergency rule filed May 6, 2010; effective through November 2, 2010. Emergency rule filed June 30, 2010; effective through December 27, 2010. Emergency rule filed August 6, 2010; effective through February 2, 2011. Amendment filed June 30, 2010; to have been effective November 28, 2010; amendment was petitioned on August 3, 2010. Repeal and new rule filed November 5, 2010; effective February 3, 2011. Emergency rule filed June 17, 2013; effective through December 14, 2013. On December 15, 2013, the rule expired and reverted to its previous status. Repeal filed July 29, 2015; effective October 27, 2015.

Tenn. Comp. R. & Regs. 0940-04-03-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Emergency rule filed May 6, 2010; effective through November 2, 2010. Emergency rule filed June 30, 2010; effective through December 27, 2010. Emergency rule filed August 6, 2010; effective through February 2, 2011. Amendment filed June 30, 2010; to have been effective November 28, 2010; amendment was petitioned on August 3, 2010. Repeal and new rule filed November 5, 2010; effective February 3, 2011. Emergency rule filed June 17, 2013; effective through December 14, 2013. On December 15, 2013, the rule expired and reverted to its previous status. Repeal filed July 29, 2015; effective October 27, 2015.

Tenn. Comp. R. & Regs. 0940-04-03-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.11 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.12 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.13 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.15 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Public necessity rules 0940-04-03-.01 through

Tenn. Comp. R. & Regs. 0940-04-03-.16 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Emergency rule filed June 30, 2010; effective through December 27, 2010. Emergency rule filed August 6, 2010; effective through February 2, 2011. Amendment filed June 30, 2010; to have been effective November 28, 2010; amendment was petitioned on August 3, 2010. Repeal and new rule filed November 5, 2010; effective February 3, 2011. Emergency rule filed June 17, 2013; effective through December 14, 2013. On December 15, 2013, the rule expired and reverted to its previous status. Repeal filed July 29, 2015; effective October 27, 2015.

Tenn. Comp. R. & Regs. 0940-04-03-.17 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Emergency rule filed June 30, 2010; effective through December 27, 2010. Emergency rule filed August 6, 2010; effective through February 2, 2011. Amendment filed June 30, 2010; to have been effective November 28, 2010; amendment was petitioned on August 3, 2010. Repeal and new rule filed November 5, 2010; effective February 3, 2011. Emergency rule filed June 17, 2013; effective through December 14, 2013. On December 15, 2013, the rule expired and reverted to its previous status. Repeal filed July 29, 2015; effective October 27, 2015.

Tenn. Comp. R. & Regs. 0940-04-03-.18 REPEALED

History

Authority: T.C.A. §§ 33-1-204, 33-1-302, 33-1-303, and 33-1-309(d); Executive Orders of the State of Tennessee Nos. 9, 10, 21 & 34 dated February 7, 1996, October 14, 1996, July 29, 1999, and October 19, 1999 respectively; State of Tennessee Delegated Purchase Authority DP 10-28649-00 Reg. 515; T.C.A. §§ 4-5-208, et seq., and its applicable regulations concerning emergency rules; and the “Reimbursement Rate” for Medical Services under DIDS federal waiver(s) for provision of services as administered by TennCare.
Administrative History: Emergency rule filed June 17, 2013; effective through December 14, 2013. Emergency rule filed June 17, 2013; effective through December 14, 2013. On December 15, 2013, the rule expired and reverted to its previous status. Repeal filed July 29, 2015; effective October 27, 2015.

Chapter 0940-04-04 Repealed

Tenn. Comp. R. & Regs. 0940-04-04-.01 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-04-.08 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-04-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-04-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-101, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-04-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-04-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-04-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-04-04-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, and 33-3-219 through 33-3-221.
Administrative History: Original rule filed March 29, 2005; effective June 12, 2005. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-01 Definitions

Tenn. Comp. R. & Regs. 0940-05-01-.01 DEFINITION OF GENERAL TERMS USED IN ALL RULES

As used in Chapters 0940-05-01 through 0940-05-47 of these rules, unless the context indicates otherwise, terms have the following meaning:

(1) “Alcohol and Drug Treatment Services” includes evaluation, treatment, residential personal care, habilitation, rehabilitation, counseling, or supervision of service recipients who abuse or are dependent upon alcohol or drugs; or services designed to prevent alcohol and/or drug abuse or dependence.

(2) “Ambulatory Service Recipient” means a service recipient who is physically and mentally capable under emergency conditions of finding a way to safety without physical assistance from another person. An ambulatory service recipient may use a cane, wheelchair or other supportive device and may require verbal prompting.

(3) “Applicant or Licensee Applicant” means the proprietorship, partnership, association, governmental agency, or corporation which makes, or is required to make, application for the licensure of a facility determined to be under the licensure jurisdiction of the Department.

(4) “Assessment” means a documented evaluation of a service recipient for the purpose of determining prevention, treatment and/or rehabilitation needs. An assessment may, but does not necessarily, include examinations and tests determined to be necessary by the service staff based on the presenting problems and symptoms of the individual service recipient.

(5) “Capable of Self-Preservation” means that a service recipient is capable of responding to an approved emergency signal, including prompting by voice, by following a pre-taught evacuation procedure within a reasonable time limitation whether or not the service recipient is fully aware of the reasons for the action. A service recipient is capable of self-preservation if the service recipient is able to transfer unassisted from the bed or another fixed position to an individualized means of mobility, which is continuously available, and able to demonstrate the ability to transverse a pre-defined means of egress from the facility within a reasonable time limitation. Service recipients who have imposed upon them security measures beyond their control, which prevent their egress from the facility, are not capable of self-preservation.

(6) “Caregiver” means a temporary care-giving adult person with power of attorney for care of minor child as defined by T.C.A. § 34-6-302.

(7) “Chief Executive Officer or Director” means the person appointed, designated, or hired by the governing body to be responsible for the day-to-day operation of the facility or facilities operated by the licensee.

(8) “Civil Rights” means the rights of personal liberty guaranteed to citizens by the Constitutions of the United States and the State of Tennessee, and by federal and state statutes.

(9) “Community Living Skills” means the array of skills which enables a service recipient to live independently in the community. These include, but are not limited to, skills in the following areas: independent living, educational/vocational, inter-personal, social, problem solving, financial, leisure time, mobility in the community and use of community resources.

(10) “Conservator” means a person or persons appointed by the court to provide partial or full supervision, protection and assistance of the person or property, or both, of a disabled person as defined in T.C.A. § 34-1-101.

(11) “Corporal Punishment” means the application of painful stimuli to the body in an attempt to terminate behavior or as a penalty for behavior, but does not mean aversive stimuli.

(12) “Declaration for Mental Health Treatment” means a document that allows an individual sixteen (16) years of age or older or an emancipated minor with the capacity to make informed mental health treatment decisions to say how the individual wants to be treated when the individual is unable to make an informed mental health treatment decision.

(13) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(14) “DSM” means the current version of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, a handbook for mental health professionals listing different categories of mental disorders and the criteria for diagnosing them.

(15) “Emotional Abuse” means any threatening behavior or statement directed toward a service recipient that causes emotional trauma or fear including, but not limited to, ridicule, gestures which subject the service recipient to humiliation or degradation, or threatening motions or noises intended to startle or frighten the service recipient.

(16) “Exploitation” means any act intended to exploit, extort or defraud a service recipient including, but not limited to, misuse of authority over a service recipient, forcing or compelling a service recipient to do anything illegal or immoral, attempting to extort money from a service recipient through devious means, or stealing a service recipient’s personal possessions.

(17) “Facility” means an institution, treatment resource, group residence, boarding home, sheltered workshop, activity center, rehabilitation center, hospital, community mental health center, DUI school, counseling center, clinic, halfway house, or other entity by these or other names, providing mental health, mental retardation, and/or alcohol and drug treatment services.

(18) “Governing Body” means the person or persons with primary legal authority and responsibility for the overall operation of the facility and to whom a director/chief executive officer is responsible. Depending upon the organizational structure, this body may be an owner or owners; a board of directors or other governing members of the licensee; or state, city, or county officials appointed by the licensee, etc.

(19) “Grievance Procedure” means a procedure for responding to an expression of a cause of distress believed by a service recipient, or by another acting on behalf of a service recipient, to constitute a reason for complaint.

(20) “Guardian” means a person or persons appointed by the court to provide partial or full supervision, protection and assistance of the person or property, or both, of a minor as defined by T.C.A. § 34-1-101.

(21) “Habilitation or Habilitative Services” means the structured process by which the service provider assists a service recipient to acquire and maintain those life skills which enables the service recipient to cope more effectively with the demands of the service recipient’s own person and environment and to raise the service recipient’s physical, mental, and social functioning. This process includes programs of formal, structured education and training referred to as “individualized program planning.”

(22) “ICD” means the current version of the International Statistical Classification of Diseases and Related Health Problems, published by the World Health Organization. The ICD provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease.

(23) “Independent Living Skills” means the complete continuum of skills involved in increasing independence. These include, but are not limited to the following areas: grooming/personal hygiene, selection/care of clothing, responsible self-medication, personal safety, housekeeping, nutritional/meal preparation, eating/table manners, use of telephone and money/budgeting concepts.

(24) “Individualized Program Plan” means a document developed by the treatment staff/team and the service recipient, which identifies the service recipient’s problems and specifies goals to be addressed in treatment and the interventions used to accomplish these goals.

(25) “Isolation” means the confinement of a service recipient alone in a room or an area where the service recipient is prevented from leaving. This definition is not limited to instances in which a service recipient is confined by a locked or a closed door. Isolation does not include:

(a) The segregation of a service recipient for the purpose of managing biological contagion consistent with the Centers for Disease Control Guidelines;

(b) Confinement to a locked unit or ward where other service recipients are present.

Time-out may involve the voluntary separation of an individual service recipient from others.

(26) “Legend Drugs” mean any item that federal law prohibits dispensing without a prescription as defined in T.C.A. § 53-10-101.

(27) “Licensed Clinical Psychologist” means a psychologist licensed to practice psychology in Tennessee with the certified competency in clinical psychology determined by the State Licensing Board for the Healing Arts and the Board of Examiners in Psychology.

(28) “Licensed Practitioner” means an individual who is licensed by the Tennessee Health Related Boards as a:

(a) Physician (medical doctor or doctor of osteopathy);

(b) Certified nurse practitioner;

(d) Nurse with a master’s degree in nursing who functions as a psychiatric nurse;

(e) Psychologist with health service provider designation;

(f) Licensed professional counselor;

(g) Senior psychological examiner;

(h) Licensed marriage and family therapist;

(i) Licensed clinical social worker;

(j) Licensed psychological examiner; or (k) Licensed alcohol and drug abuse counselor.

(29) “Licensee” means the proprietorship, partnership, association, governmental agency, or corporation which operates a facility under the licensure jurisdiction of the Department.

(30) “Medication” means drug, either prescribed or available over the counter, intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease or condition.

(31) “Medication Assistance” means loosening the cap on a pill bottle for oral medication or opening medication packaging and placing the medication within reach of the service recipient, but does not allow the caregiver to give the medication to the individual. Assistance includes medication reminders, and is limited to holding a service recipient’s hand steady to help them with drinking liquid medication, guiding their hand when the individual is applying eye/ear/nose drops and wiping the excess liquid, helping with a nasal cannula or mask for oxygen, or plugging the machine in and turning it on.

(32) “Mental Health Services” means all services pertaining to and incidental to the prevention, diagnosis, evaluation, treatment, domiciliary care, training, habilitation, counseling, or supervision of service recipients who are mentally ill or service recipients with alcohol and/or drug abuse or dependency disorders.

(33) “Mental Retardation Services” means all services pertaining to and incidental to the prevention, diagnosis, evaluation, treatment, domiciliary care, training, habilitation, counseling, or supervision of mental retardation or service recipients who have mental retardation.

(34) “Mentally Ill Service Recipient” means a service recipient who has a psychiatric disorder, alcohol dependence or drug dependence, but does not mean an individual whose only disability is mental retardation or a developmental disability.

(35) “Mobile Non-Ambulatory Individual” means an individual who is able, without other assistance, to transfer to and move about only with the aid of a wheelchair, walker, crutch, wheeled platform, or similar device.

(36) “On-Duty and On-Site” means a staff person who is on the facility’s premises and has the obligation to carry out any job responsibilities designated in his/her job description.

(37) “On-Site” means a staff person who is on the facility’s premises but is only required to be on duty during an emergency.

(38) “Personal Care” means services provided to a service recipient who does not require chronic or convalescent medical or nursing care. Personal care is the safekeeping and supervision of the service recipient’s self-administration of prescription medication along with any of the following services: (1) responsibility for the safety of the service recipient, (2) a daily awareness by the management and staff of the service recipient’s functioning, (3) knowledge of his or her whereabouts, (4) reminding a service recipient of appointments, (5) the ability and readiness to intervene if a crisis arises for a service recipient, and/or (6) supervision in the following areas for the service recipient’s major life activities, self-care, self-direction; capacity for independent living or economic self-sufficiency.

(39) “Physical Abuse” means harmful or painful physical contact including, but not limited to, the intentional striking, shoving, or pushing of a service recipient by anyone, including another service recipient. Also included is the use of excessive force when restraining a service recipient (e.g., using methods to restrain a service recipient which are not outlined in staff training) and acts which constituted sexual activity.

(40) “Physician” means a graduate of an accredited medical school authorized to confer upon graduates the degree of Doctor of Medicine (M.D.) who is duly licensed in Tennessee or an osteopathic physician who is a graduate of a recognized osteopathic college authorized to confer the degree of Doctor of Osteopathy (D.O.) and who is licensed to practice osteopathic medicine in Tennessee.

(41) “Physician Assistant” means an individual who renders services, whether diagnostic or therapeutic, which are acts constituting the practice of medicine and, but for the provisions of T.C.A. § 63-6-204, could only be performed by a licensed physician.

(42) “Policies and Procedures Manual” means a document that describes the philosophy, services, organization, policies, and procedures for implementing services to the service recipients of a facility.

(43) “PRN” means an order which is written to allow a medication or a treatment to be given on an as-needed basis.

(44) “Psychiatrist” means a physician who specializes in the assessment and treatment of individuals having psychiatric disorders; is certified by the American Board of Psychiatry and Neurology or has the documented equivalent in education, training and/or experience; and who is fully licensed to practice medicine in the State of Tennessee.

(45) “Psychoactive Drug” means a psychotropic medication. For a more complete definition see the definition for “psychotropic medication.”

(46) “Psychotropic Medication” means a drug which exercises a direct effect upon the central nervous system and which is capable of influencing and modifying behavior. Drugs covered by these rules include but are not limited to:

(a) Anti-depressants, (b) Anti-psychotics, (c) Agents for control of mania and depression, (d) Anti-anxiety agents, (e) Psychomotor stimulants, and (f) Hypnotics.

(47) “Qualified Dietician” means a person licensed as a dietician/nutritionist by the Tennessee Board of Dietician/Nutritionist Examiners.

(48) “Qualified Food Service Manager” means a qualified dietician, a graduate of a dietetic technician or assistant training program approved by the American Dietetic Association or a graduate of a state-approved course that provides ninety (90) or more hours of classroom instruction in food service supervision who has experience as a supervisor in a health care institution with consultation from a qualified dietician.

(49) “Qualified Medical Records Practitioner” means a record technician (ART) currently accredited by the American Medical Records Association, or a registered record administrator (RRA) currently registered by the American Medical Record Association or others qualified by work experience.

(50) “Qualified Prescribers” means individuals authorized to prescribe medications by the State of Tennessee Board of Medical Examiners or the Tennessee Board of Nursing.

(51) “Quality Assurance” means a systematic procedure for the review and evaluation of the agency’s functions, quality of services and the utilization of resources in the provision of services.

(52) “Recovery” means the process in which service recipients diagnosed with mental illness and/or alcohol and/or drug abuse or dependency disorders live, work, learn, and participate fully in their communities. Recovery services help service recipients live a full or productive life with a disability and may result in the reduction or complete remission of problems or abstinence from addictive behaviors. Recovery services include: basic education about mental illness or addictive disorders, case management, drug testing, employment support, family support, pastoral support/spiritual support, social activities, relapse prevention, housing, transportation, and consumer/peer support.

(53) “Reputable and Responsible Character” means having a personal and/or business history which suggests that the licensee can be trusted with responsibility for individuals particularly vulnerable to neglect and financial and sexual exploitation. Personal and/or business histories involving operation of substandard facilities and an arrest record resulting in a conviction for offense relating to theft, larceny, embezzlement, rape, assault, homicide, drugs, and pornography, are inherently inconsistent with “reputable and responsible character.”

(54) “Restraint” means measures taken to restrict service recipients’ freedom of movement including:

(a) “Chemical Restraint” means a medication that is prescribed to restrict the service recipient’s freedom of movement for the control of extreme violent physical behavior.

Chemical restraints are medications used in addition to, or in replacement of, the service recipient’s regular drug regimen to control extreme violent behavior. The medications that comprise the service recipient’s regular medical regimen (including PRN medications) are not considered chemical restraints, even if their purpose is to control ongoing behavior;

(b) “Mechanical Restraint” means the application of a mechanical device, material, or equipment attached or adjacent to the service recipient’s body, including ambulatory restraints, which the service recipient cannot easily remove and that restricts freedom of movement or normal access to the service recipient’s body. Mechanical restraint does not include the use of:

Restrictive devices or manual methods employed by a law enforcement agent or other public safety officer to maintain custody, detention, or public safety during the transport of an individual under the jurisdiction of the criminal justice system or juveniles with charges in the juvenile justice system; or 2. Restraints for medical immobilization, adaptive support, or medical protection; or 3. Restrictive devices administratively authorized to ensure the safety of the service recipient or others when an involuntary committed service recipient must be transported.

(c) “Physical Holding” means the use of staff body contact with a service recipient in order to restrict freedom of movement or normal access to one’s body to prevent the service recipient’s behavior from becoming dangerous to himself, others or property. Physical holding does not include the use of:

Physical touch associated with prompting, comforting or assisting that does not prevent the individual service recipient’s freedom of movement or normal access to his or her body;
Physical escort which means the temporary touching or holding of the hand, wrist, arm, shoulder or back for the purpose of inducing the individual to walk to a safe location; or 3. Physical intervention for the temporary holding of the hand(s), wrist(s), arm(s), shoulders(s), or leg(s) which does not otherwise restrict freedom of movement or access to one’s body, for the purpose of terminating unsafe behavior.

(55) “Restrictive Procedure” means a treatment procedure that limits the rights of the service recipient for the purpose of modifying problem behavior, including but not limited to time-out and restraint.

(56) “Schedule II Drugs” means drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, defined in T.C.A. § 39-17-407 or listed in T.C.A. § 39-17-408.

(57) “Self Administration of Medication” means the ability of a service recipient to take prescribed or over-the-counter medications without assistance from another person.

(58) “Service Recipient” means a person who is receiving services, has applied for services, or for whom someone has applied for or proposed services because the person has mental illness, serious emotional disturbance, or a developmental disability.

(59) “Shall or Must” means a mandatory provision.

(60) “Should or May” means a suggestion or recommendation.

(61) “Standard Precautions” means an approach to infection control based on the principle that broken skin and mucus membranes as well as all blood, body fluids, and secretions (except sweat) may contain transmissible infectious agents. Standard precautions apply to all service recipients regardless of suspected or confirmed infection status, in any setting where care is provided. Current guidelines for Standard Precautions are published by the Centers for Disease Control and Prevention (CDC).

(62) “Time-Out” means a behavior management procedure in which the opportunity for positive reinforcement is withheld, contingent upon the demonstration of undesired behavior. Timeout may involve the voluntary separation of an individual service recipient from others.

(63) “Treatment Review Committee” means a committee to make decisions for a service recipient who lacks capacity as defined by T.C.A. § 33-3-218. The composition, duties and responsibilities of Treatment Review Committees are defined by T.C.A. § 33-6-107.

(64) “Treatment” means a therapeutic process to reduce or eliminate the symptoms and side effects of mental illness, alcohol and/or drug abuse, or dependency disorders through direct observation, assessment, examination, and therapeutic intervention. Treatment services are screening; clinical assessment; diagnostic evaluation; treatment planning; therapeutic interventions including individual, family and group therapy; medication prescription and monitoring; and discharge planning and referral.

(65) “Verbal Abuse” means insulting or coarse language directed toward a service recipient which subjects the service recipient to humiliation or degradation, including, but not limited to, swearing at a service recipient, name calling, taunting, and other inappropriate verbal behavior.

(66) “Vocational Services” means the services provided to service recipients involving remunerative work experiences within the licensed facility and the provision of vocational activities of an industrial or productive vocational nature such as assembling, packaging, painting, stripping, wood or metal working, or manufacturing within the licensed facility.

(67) “Volunteer” means a person who is not paid by the licensee and whose varied skills are used by the licensee to support and supplement the efforts of the paid facility staff.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404, and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed August 29, 2003; effective December 29, 2003. Repeal and new rule filed June 29, 2004; effective September 12, 2004. Amendment filed May 6, 2008; effective September 26, 2008. Repeal and new rule filed August 27, 2008; effective December 29, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-01-.02 DEFINITION OF TERMS USED IN MENTAL HEALTH RULES

As used in Chapters 0940-05-14 through 0940-05-19 and 0940-05-29 through 0940-05-37 of these rules, unless the context indicates otherwise, terms have the following meaning:

(1) “Activity Therapy Staff” means persons with degrees and/or clinical training and/or certification registration in a recognized activity therapy field which includes, but is not limited to, therapeutic recreation, music therapy, occupational therapy, art therapy, or dance therapy, or a person who is directly supervised by one of the above professionals.

(2) “Licensed Clinical Psychologist” means a psychologist licensed to practice psychology in Tennessee with the certified competency in clinical psychology determined by the State Licensing Board for the Healing Arts and the Board of Examiners in Psychology.

(3) “Licensed Mental Health Professional” means a licensed mental health professional is an individual who meets the requirements in the definition of Licensed Independent Practitioner or who is licensed by the Tennessee Health Related Boards as a registered nurse, licensed practical nurse, psychological examiner, or substance abuse counselor.

(4) “Mental Health Personnel” means a staff member who operates under the direct supervision of a mental health professional.

(5) “Mental Health Professional” means a board eligible or a board certified psychiatrist or a person with at least a Master’s degree and/or clinical training in an accepted mental health field which includes, but is not limited to, counseling, nursing, occupational therapy, psychology, social work, vocational rehabilitation, or activity therapy.

(6) “Qualified Mental Health Professional” means a person who is licensed in the state, if required for the profession, and who is a psychiatrist; physician with expertise in psychiatry as determined by training, education, or experience; psychologist with health service provider designation; psychological examiner or senior psychological examiner; social worker who is certified with two (2) years of mental health experience or is licensed; marital and family therapist; nurse with a master’s degree in nursing who functions as a psychiatric nurse; professional counselor; or if the person is providing service to service recipients who are children, any of the above educational credentials plus mental health experience with children.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal filed September 4, 2003; effective January 28, 2004. New rule filed June 29, 2004; effective September 12, 2004. Repeal and new rule filed August 27, 2008; effective December 29, 2008.

Tenn. Comp. R. & Regs. 0940-05-01-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed November 6, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed June 29, 2004; effective September 12, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-01-.04 DEFINITION OF DISTINCT CATEGORIES OF MENTAL HEALTH FACILITIES

(1) Crisis Stabilization Unit - A crisis stabilization unit (CSU) is specifically designed for service recipients eighteen (18) years of age and older in need of short-term stabilization (up to 96 hours), who do not meet the criteria for other treatment resources, other less restrictive treatment resources are not available, or the service recipient is agreeable to receive services voluntarily at the CSU and meet admission criteria. If necessary, in order to assure that the adequate arrangements are in place to allow for the safe discharge of the service recipient, the length of stay may be extended by up to 24 hours.

(2) Mental Health Day Program Facility - A non-residential facility that provides a treatment and/or rehabilitation program of at least three (3) hours duration per program day for persons with mental disorders. The program may be provided during the day, evening, or weekend hours. The program may be structured and offer community living skills training, vocational training, assistance with interpersonal relationships and be geared toward moving the person on to a more independent and normal life style. The program might also be unstructured and provide socialization and maintenance to persons who might not move on to more independence.

(3) Mental Health Hospital Facility - An inpatient facility that is held out to the public as a hospital and, in connection with the services of a physician, offers diagnosis, treatment, and care to mentally ill individuals on a comprehensive inpatient basis.

(4) Mental Health Outpatient Facility - A non-residential, clinic facility that provides services designed to provide mental health care for non-hospitalized individuals experiencing acute or ongoing psychiatric distress. Periodic contacts are of short duration. Services include, but are not limited to, diagnostic assessments, collateral services, individual therapy, crisis intervention, medication, and follow up.

(5) Mental Health Residential Treatment Facility - A community-based facility that offers twentyfour (24) hour residential care as well as a treatment and rehabilitation component. The focus of the program may be on short-term crisis stabilization or on long-term rehabilitation that includes training in community living skills, vocational skills, and/or socialization. The staff includes direct-care staff as well as treatment staff. Treatment staff may be present full time or only during times when program activities or interventions are occurring. Access to medical services, social services, and mental health services are insured and are usually provided off site.

(6) Mental Health Supportive Living Facility - A residential facility which provides room, board, and personal care services to two (2) or more individuals unrelated to the owner or operator of the facility who have been diagnosed with a mental illness by a mental health professional using the current Diagnostic and Statistical Manual (DSM) criteria.

(7) Psychosocial Rehabilitation Program Facility - A non-residential facility which provides a program of rehabilitation and recreation for persons with mental disorders. The program may be provided during the day, evening, or weekend hours. The focus of the program is on mental health, strengths and abilities, rather than mental illness, symptoms and problems.

Service recipients are typically members and not patients and frequently are responsible for most of the content and format of the program. The degree of structure may vary but will generally offer interpersonal skill training, daily living skills training, educational development, recreational/social activities, self-help groups, and family involvement. However, a major focus of the program is on vocational rehabilitation. Members may participate in the program with varying intensity for an indefinite period of time.

(8) Mental Health Intensive Day Treatment Program for Children and Adolescent Facility - A program equal in length to a school day or after school program which includes a variety of treatment activities including, but not limited to, individual, family, and/or group therapy, vocational training, social skills training, etc.; and an educational component.

(9) Therapeutic Nursery Program Facility - A non-residential facility program lasting a minimum of (3) hours per day designed specifically for pre-school children who are experiencing serious emotional disturbance which is a result of severe environmental trauma, especially child abuse or neglect. A variety of treatment activities are provided which may include individual therapy, therapeutic group instruction and socialization, and a variety of activities to address developmental deficits resulting from environmental trauma.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed December 8, 1980; effective January 22, 1981. Repeal and new rule filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed June 29, 2004; effective September 12, 2004. Amendment filed May 6, 2008; effective September 26, 2008. Amendment filed August 27, 2008; effective December 29, 2008.

Tenn. Comp. R. & Regs. 0940-05-01-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed November 30, 1983; effective December 30, 1983. Rule renumbered as 0940-05-02-.18. New rule filed May 26, 1988; effective July 11, 1988. Repeal filed September 4, 2003; effective January 28, 2004. New rule filed June 29, 2004; effective September 12, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-01-.14 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed December 8, 1980; effective January 22, 1981. Amendment filed November 30, 1983; effective December 30, 1983. Repeal filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-01-.15 DEFINITIONS FOR THE DISTINCT CATEGORY OF PERSONAL SUPPORT

SERVICES AGENCIES.

(1) “Agency” means a sole proprietorship, partnership, corporation, limited liability company or limited liability partnership providing personal support services as defined below. Agency includes all entities that employ or subcontract with individuals who provide personal support services to service recipients.

(2) “Chronic Condition” means a mental and/or physical impairment that is expected to last indefinitely.

(3) “Service Recipient” means an individual who, because of a chronic condition, has substantial limitations in two or more major life activities, and who is receiving services in either a regular or temporary residence.

(4) “Education Services” means consultation provided by a licensed nurse to the service recipient or primary family caregiver concerning a chronic condition.

(5) “Personal Support Services” means one or more of the following services provided to a service recipient in the individual’s regular or temporary residence to assist with activities of daily living. Personal support services include but are not limited to:

(a) Self-care assistance with tasks such as eating, dressing, toileting, bathing, mobility, transfer assistance and other services and supports to maintain health and wellness;

(b) Household assistance with tasks such as housekeeping, laundry, meal planning, meal preparation, shopping, bill paying, and use of telecommunication devices;

(c) Personal assistance to access community activities such as transportation, social, recreational or other personal activities; and (d) Education services.

(6) “Major Life Activities” means (a) Self-care;

(b) Receptive and expressive language;

(d) Mobility;

(e) Self-direction;

(f) Capacity for independent living; or (g) Economic self-sufficiency.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed August 29, 2003; effective December 29, 2003.

Tenn. Comp. R. & Regs. 0940-05-01-.16 DEFINITIONS OF TERMS USED IN ALCOHOL AND DRUG RULES

As used in Chapters 0940-05-39 through 0940-05-47 of these rules, unless the context indicates otherwise, terms have the following meaning:

(1) “Aftercare Plan/Aftercare Services” means services provided to the service recipient following successful completion of a treatment program to ensure sustained achievement of goals post-treatment including sobriety and successful transition to a recovery-oriented lifestyle in the community. Services are provided on an outpatient basis and may include individual counseling, group counseling, self-help group participation, and/or recovery support services.

Services may be provided by the treatment program or through referral to another service provider. The services must be documented in an aftercare plan developed by a treatment staff person and the service recipient, and specifying the type of services, planned frequency of contact, number of contacts, referrals for services, and staff responsible for the plan.

(2) “Alcohol and/or Drug Abuse or Dependency” means disorders characterized by the continuous or episodic use of alcohol and/or other drugs resulting in maladaptive patterns of use as defined in currently accepted diagnostic nomenclature for abuse or dependency.

(3) “ASAM PPC” means the most current version of the American Society of Addiction Medicine Patient Placement Criteria for matching service recipients to appropriate levels of care.

(4) “ASAM PPC Case Review” means documentation of the reasoning for admission, continued stay, step up/step down or discharge for a specific service recipient using the ASAM PPC.

(5) “ASI” means Addiction Severity Index, a standardized multi-focused screening/assessment tool used to collect information regarding the nature and severity of problems of substance abusers.

(6) “Detoxification” means a process of withdrawing a service recipient from a specific psychoactive substance in a safe and effective manner.

(7) “Qualified Alcohol and Drug Abuse Treatment Personnel” means persons who meet the criteria described in subparagraphs (a), (b) and (c) as follows:

(a) Currently meet one (1) of the following conditions:

Licensed or certified by the State of Tennessee as a physician, registered nurse, practical nurse, psychologist, psychological examiner, social worker, substance abuse counselor, teacher, professional counselor, associate counselor or marital and family therapist, or if there is no applicable licensure or certification by the State, has a bachelor’s degree or above in a behavioral science or human development related area; or 2. Actively engaged in a recognized course of study or other formal process for meeting criteria of part 1. of subparagraph (a) above, and directly supervised by a staff person who meets criteria in part 1. of subparagraph (a) above, who is trained and qualified as described in subparagraph (b) and (c) below, and who has a minimum of two (2) years experience in his/her area of practice; and (b) Are qualified by education and/or experience for the specific duties of their position; and (c) Are trained in alcohol, tobacco and/or other drug abuse specific information or skills.

(Examples of types of training include, but are not limited to, alcohol or other drug abuse specific in-services, workshops, substance abuse schools, academic coursework and internships, field placement or residences).

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404, and Executive Order 44 (February 23, 2007).
Administrative History: New rule filed August 27, 2008; effective December 29, 2008.

Tenn. Comp. R. & Regs. 0940-05-01-.17 DEFINITIONS OF DISTINCT CATEGORIES OF ALCOHOL AND DRUG SERVICES

(1) “Alcohol and Drug D.U.I. School Services” means an intervention program providing assessment, education and, if indicated, appropriate treatment referral, for offenders of driving under the influence of alcohol and other drugs (i.e., convicted of violation of T.C.A. § 55-10-401).

(2) “Alcohol and Drug Halfway House Treatment Facility” means a transitional residential program providing services to service recipients with alcohol and/or drug abuse or dependency disorders with the primary purpose of establishing vocational stability and counseling focused on re-entering the community. Service recipients are expected to be capable of self-administering medication, working, seeking work, or attending vocational/educational activities away from the residence for part of the day. Services include counseling contacts, lectures, seminars, and other services necessary to meet the service recipient’s assessed needs.

(3) “Alcohol and Drug Non-Residential Treatment Facility” means an outpatient facility which offers treatment services to service recipients with alcohol and/or drug abuse or dependency disorders that can include but not be limited to assessment, referral, counseling, and education.

(4) “Alcohol and Drug Residential Treatment Facilities for Children and Youth” means a residential program which offers twenty-four (24) hour treatment to service recipients under eighteen (18) years of age with the primary purpose of restoring service recipients with alcohol and/or drug abuse or dependency disorders to abstinence and levels of positive functioning appropriate to the service recipient. An important goal of these services is to move the service recipient into less intensive levels of care and/or reintegration into the community. The program must provide, or arrange for an education component in compliance with the Rules, Regulations, and Minimum Standards of the Tennessee State Board of Education.

(5) “Alcohol and Drug Residential Treatment Facility for Adults” means a residential program for service recipients at least eighteen (18) years of age, which offers highly structured services to service recipients with the primary purpose of restoring service recipients with alcohol and/or drug abuse or dependency disorders to levels of positive functioning and abstinence appropriate to the service recipient. A primary goal of these services is to move service recipients into less intensive levels of care and/or reintegration into the community as appropriate. Services include counseling contacts, lectures/seminars, and other services necessary to meet the service recipients assessed needs.

(6) “Non-Residential Opioid Treatment Facility” means a non-residential opioid treatment facility for treating the opiate-dependent service recipient with the goal of the service recipient becoming free from any drug which is not medically indicated.

(7) “Alcohol and Drug Residential Detoxification Services” means intensive twenty-four (24) hour residential services for service recipients at least eighteen (18) years of age meeting the criteria of the American Society of Addiction Medicine Placement Criteria (ASAM PPC) for clinically managed detoxification (Level III.2-D) or medically monitored detoxification (Level III.7-D) to systematically reduce or eliminate the amount of a toxic agent in the body until the signs and symptoms of withdrawal are resolved. Clinically managed residential detoxification emphasizes social and peer support and relies on established clinical protocols to determine whether service recipients need a higher level of care to manage withdrawal. Medically monitored residential detoxification services use medical and nursing professionals to manage withdrawal signs and symptoms without the full resources of an acute care or psychiatric hospital. Residential detoxification services can be offered in a community setting or a specialty unit within a hospital.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404, and Executive Order 44 (February 23, 2007).
Administrative History: New rule filed August 27, 2008; effective December 29, 2008.

Tenn. Comp. R. & Regs. 0940-05-01-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed July 20, 1993; effective October 3, 1993. Amendment filed January 11, 1996; effective March 26, 1996. Repeal filed August 27, 2008; effective December 29, 2008.

Tenn. Comp. R. & Regs. 0940-05-01-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 33-2-504.
Administrative History: Original rule filed December 8, 1980; effective January 22, 1981. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-01-.08 THROUGH 0940-05-01-.12 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed December 8, 1980; effective January 22, 1981. Amendment filed November 30, 1983; effective December 30, 1983. Repeal filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-01-.13 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed December 8, 1980; effective January 22, 1981. Repeal filed May 26, 1988; effective July 11, 1988.

Chapter 0940-05-02 Licensure Administration and Procedures

Tenn. Comp. R. & Regs. 0940-05-02-.01 STATEMENT OF AUTHORITY

(1) The Tennessee Department of Mental Health and Substance Abuse Services is authorized to license facilities and services operated for the provision of mental health, substance abuse, and personal support services in the State of Tennessee by T.C.A. Title 33, Chapter 2, Part 4.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-405, and 33-2-407.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed December 8, 1980; effective January 22, 1981. Amendment filed November 30, 1983; effective December 30, 1983. Amendment filed March 11, 1987; effective April, 25, 1987. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-02-.02 TYPES AND CONDITIONS OF LICENSES

(1) Initial License. An initial license is issued to a facility or service to give the licensee an opportunity to implement minimum program requirements and to give the Department an opportunity to evaluate the facility’s or service’s compliance with licensure laws, ordinances, rules, and regulations. Initial licenses will not exceed 12 months.

(2) Full License. A full license is valid for up to 12 months from the date of issuance and is issued to a facility or service when the licensee demonstrates compliance with all applicable licensure laws, ordinances, rules, and regulations as determined by the Department.

(3) Provisional License. A provisional license may be issued to a facility or service when it does not meet all of the requirements for a full license. The Department may grant a provisional license if all of the conditions below are satisfied:

(a) The facility or service is making a diligent effort to comply with all licensure laws, ordinances, rules, and regulations. A “diligent effort to comply” is determined by past performances of the facility or service in meeting licensure laws, ordinances, rules and regulations and correcting deficiencies and by the facility’s or service’s commitments to correct existing deficiencies within time frames agreed to by the Department;

(b) The continued operation of the facility or service will not endanger the health or safety of individuals being served;

(c) The facility or service has submitted an acceptable compliance plan specifying how and when deficiencies will be corrected. The Department will consider the seriousness of the deficiencies and the past performances of the facility or service in determining whether the compliance plan is acceptable; and (d) The facility or service has substantially met the commitments made in the preceding year’s compliance plan, if any.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, 33-2-405, and 33-2-415.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed December 8, 1980; effective January 22, 1981. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendment filed October 14, 1986; effective November 28, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.03 UNLAWFUL OPERATION

(1) No person, partnership, association or corporation may begin delivering services until the Department issues a license. Providing mental health, substance abuse, developmental disability, intellectual disability, or personal support services without a license is unlawful and may result in civil and/or criminal sanctions pursuant to T.C.A. §§ 33-2-404, 33-2-407, 33-2- 408, 33-2-409, 33-2-412, and 33-2-417.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-405, 33-2-407, 33-2-408, 33-2-409, 33-2-412, and 33-2-417.
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.04 APPLICATION FORMS

(1) The application for a license is to be made on forms prepared and supplied to the applicant by the Department.

(2) Each application for a license must be submitted in writing, legible, with all the information requested on the application. The information gathered by the Department on the application is needed pursuant to T.C.A. § 33-2-406 to determine the applicant's responsible and reputable character and the applicant's ability to meet the minimum standards for the operation of a facility or service.

(3) The information to be supplied to the Department is as follows:

(a) The name, address, and other background and identifying information of the applicant;

(b) A description of the location, design, and type of facility or service to be licensed;

(c) The name, address, and other background and identifying information of the person or persons responsible for the operation of the facility or service to be licensed including Social Security number and date of birth, place of residence during the past five years and place of birth, proof of citizenship or evidence of legal immigration status, and criminal background check;

(d) Personal character references;

(e) The signature of the licensee applicant or of the person charged by the licensee applicant for certifying the correctness and completeness of the application and for ensuring compliance with the licensure rules; and (f) Any such other information as the Department may require.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, 33-2-405, 33-2-406, and 33-2-407.
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment February 12, 1992; effective March 28, 1992. Amendment filed March 19, 1992; effective May 3, 1992. Amendment filed October 3, 2002; effective December 17, 2002. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.05 FEES

(1) The applicant must submit fees for the processing of the application prior to the Department’s making a determination to grant or to deny licensure. Each initial and renewal application for licensure must be submitted with the appropriate fees. All fees submitted are non-refundable.

The fee rate is based on the number of distinct categories of service or facility, as applicable, to be operated at each site. For a residential site, the fee rate is based on the number of beds to be licensed. A fee must be submitted for each facility and/or service for which licensure is being sought under the following schedule:

Non-residential Facility Fees Per Site:

One Distinct Category of Service or Facility $ 810.00 Two Distinct Categories of Services or Facility $ 1,010.00 Three Distinct Categories of Service or Facility $ 1,220.00 Four Distinct Categories of Service or Facility $ 1,420.00 More than Four Distinct Categories of Services or Facilities $ 1,620.00 Nonresidential Office-based Opiate Treatment Facility $ 1,500.00 Nonresidential Office-based Opiate Treatment Facility With Dispensing Authorization $ 1,500.00 Residential Facilities Fees Per Site:

Mental Health Hospital Facilities (per bed) $ 175.00 All Other Residential Facilities:

Number of Beds 2 – 3 $ 200.00 4 – 10 $ 280.00 11 – 15 $ 410.00 16 – 50 $ 810.00 More than 50 beds $ 1,220.00

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, 33-2-405, 33-2-406, 33-2-407, 33-2-409, and 33-2-413 and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rule filed December 8, 1980; effective January 22, 1981. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014. Amendments filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-02-.06 APPLICATION PROCESS FOR INITIAL LICENSE

(1) The applicant must submit application forms.

(2) The applicant must submit the required fees for application processing.

(3) The applicant is responsible for any fees charged by other regulatory agencies whose inspection of the facility or service is necessary for the issuance of licenses.

(4) Upon receipt of the completed application and the required fees, the Department will arrange for needed inspections of the proposed site or sites, when applicable.

(5) The Department will review the application, make any necessary investigations, review the results of the inspections of the proposed site or sites, when applicable, and take one of the following actions:

(a) If the review indicates compliance with all requirements for an init ial license, the initial license will be issued;

(b) If the review indicates deficiencies, the applicant will be notified and must correct deficiencies before a license is issued; or (c) If the review indicates that a license should not be granted, the applicant will be so notified. Within fifteen (15) calendar days of such notification of denial, the applicant may file a written request for a hearing before the Licensure Review Panel on the denial.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-405, 33-2-406, and 33-2-407.
Administrative History: Original rule filed December 8, 1980; effective January 22, 1981. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.07 APPLICATION PROCESS FOR LICENSE RENEWAL

(1) Prior to the expiration of an initial, full or provisional license, the Department will notify the licensee of the need to submit an application for license renewal. The Department will advise the licensee of the information, fees (by invoice), and the documents needed to process the renewal application.

(2) The applicant must submit the renewal application, fee invoice and other information required by licensure. All payments must be accompanied by a copy of the fee invoice before the fee will be credited to the appropriate agency or service.

(3) The applicant is responsibl e for any fees charged by other regulatory agencies whose inspection of the facility or service is necessary for the issuance of licenses.

(4) The Department, when applicable, will conduct or arrange for inspections of the facility's or service's current life safety and environmental conditions, and review the facility's or service's program performance history. Dates for unannounced inspections will be random varying from year to year.

(5) Upon receipt of the application material and the required fees, the Department will review the application material, the current life safety and environmental conditions, when applicable, and the performance history of the facility or service and take one of the following actions:

(a) If the Department determines that all facilities or services operated by the licensee are in compliance with the applicable licensure laws, ordinances, rules, and regulations, then a full license will be issued;

(b) If the Department determines that all facilities or services operated by the licensee do not comply with the applicable licensure laws, ordinances, rules, and regulations, a provisional license may be issued covering the facility or service not in full compliance; or (c) If the Department determines that a license should not be issued to one or more facilities or services operated by the licensee, the licensee shall be notified of the denial. Within fifteen (15) calendar days of such notification of denial, the licensee may file a written request for a hearing before the Licensure Review Panel on the denial.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302 and T.C.A., Title 33, Chapter 2, Part 4.
Administrative History: Original rule filed March 11, 1987; effective April 25, 1987. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.08 DISTINCT CATEGORIES OF FACILITIES AND SERVICES

The licensure rules identify and define distinct categories of facilities or services. These facilities and services must meet applicable life safety, environmental and minimum program rules based on the type of program services and the needs of the persons served.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-3-403, 33-2-404, 33-2-405, and 33-2-407.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.09 NUMBER OF LICENSES REQUIRED

Each licensee will be issued one license for each site at which the licensee is operating a facility or service. The license for each site will indicate what category or categories of facility and/or service is authorized to be operated at that site. However, when a licensee operates more than one category at a single site, two licenses may be issued if one or more of the categories at the site require an initial or a provisional license, and one or more are eligible for a full license.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-4-405, 33-2-406, and 33-2-407.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.10 CHANGE OF OWNERSHIP OR LOCATION

Licenses are not assignable or transferable except as provided by law. A new application must be made and a new license issued before services are provided when there is a change in the ownership of a facility/service or a change of location.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-4-405, and 33-2-406.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.11 TIME LIMITS

Upon inspection of any facility or service making application for or holding a license, the Department may allow a reasonable time period for facility or service to correct deficiencies found by inspection.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-4-405, and 33-2-406.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.12 DEEMED COMPLIANCE

(1) A facility or service which is accredited or certified by any of the following may be deemed by the Department to be in compliance (“deemed compliance status”) with applicable licensure program requirements:

(a) Joint Commission on Accreditation of Health Care Organizations;

(b) Council on Accreditation of Rehabilitation Facilities (CARF);

(c) Social Security Act, Title XIX, Public Law 89-98, as amended (Medicaid) for Intermediate Care Facilities for the Mentally Retarded (ICF/MR) only;

(d) The Accreditation Council on Services for People with Disabilities; or (e) Council on Accreditation for Children and Family Services.

(2) To be considered for a deemed compliance status determination under this section, the licensee must submit written and official evidence of certification for accreditation to the Department including any cited deficiencies with plan of correction.

(3) Facilities or services receiving deemed compliance status must also demonstrate compliance with the life safety and environmental rules. Deemed compliance status of the services offered by a facility or service does not alter the operator's obligation to correct any deficiencies cited during the unannounced inspections required by T.C.A. § 33-2-413 or to cooperate with investigations conducted by the Department of reports of abuse, dereliction, or deficiency in the operation of the facility or service. Notwithstanding the deemed compliance of a facility's services, such a facility is subject to the suspension or revocation of its license under the terms and procedures established in T.C.A. § 33-2-407 and the rules of this chapter.

(4) Pursuant to T.C.A. § 33-2-403(c), a facility or service which can demonstrate compliance with regulations and standards by a previously acquired license from another state agency is considered in compliance with rules promulgated by the Department to the extent that duplicate inspection and enforcement is necessary.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-405, 33-2-406, 33-2-407, 33-2-409, 33-2-411, 33-2-412, 33-2-413, and 33-2-414.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.13 ACCESS TO PREMISES AND INFORMATION

With or without giving notice, representatives of the Department shall have the right to enter upon or into the premises of any facility or any part thereof, or service providing mental health, developmental disabilities substance abuse, or personal support services in order to make inspections deemed necessary to determine compliance with licensure laws, ordinances, regulations and rules. The facility or service shall comply with all reasonable requests of the Department and allow it to obtain information from third parties, including, but not limited to, individuals being served by the facility or service, and/or to review and obtain copies of all records of the facility or service sufficient to determine compliance with licensure laws, ordinances, regulations and rules.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-407, 33-2-413, and 33-2-420.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.14 GROUNDS FOR DENIAL, REVOCATION, OR SUSPENSION

(1) The maintenance and renewal of a license is contingent upon evidence of continued compliance with licensure laws, ordinances, rules and regulations. Grounds for denying, suspending or revoking a license may include, but not be limited to, the following:

(a) Violation of licensure law or rules;

(b) Permitting, aiding or abetting the commission of any illegal act in a licensed facility or service;

(d) The submission of false information to the Department; or (e) The use of subterfuge (for instance, filing through a second party after an individual has been denied a license).

(2) Unless the Department finds that summary suspension of a license is necessary, all license revocations, suspensions and denials shall be conducted in accordance with the applicable sections of the Uniform Administrative Procedures Act, Tennessee Code Annotated, Title 4,

Part 5. Summary suspension may only occur when the Department determines that continued operation of a licensed facility or service presents an immediate threat to the health, safety, and welfare of individuals being served. When a summary suspension occurs, proceedings for revocation or other action against the licensee shall be promptly instituted and determined in accordance with the Uniform Administrative Procedures Act.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-4-405, 33-2-406, 33-2-407, and 33-2-408.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.15 EXPIRATION OF LICENSES

The expiration date of all licenses issued by the Department will be indicated on the face of the license.

However, when a licensee has made timely and sufficient application for a new license (including payment of the required fees), the existing license does not expire until the status of the application has been determined by the Department. When the application is denied or the terms of the new license limited, the existing license does not expire until the last day for seeking review of the order or a later date fixed by order of the reviewing court.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-407, 33-2-409, 33-2-411, 33-2-412, 33-2-413, 3-2-414, 3-2-416, and 33-2-417.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.16 POSTING OF THE LICENSE

The license certificate shall be posted for public viewing in a conspicuous place at the facility or service.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.17 SURRENDER REQUIREMENTS

The license certificate must be surrendered to the Department upon revocation or suspension of the license, upon transfer of ownership of the facility or service, or when the facility or service otherwise ceases to operate.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-407, and 33-2-408.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.18 EXCLUSIONS FROM LICENSURE

The following facilities or services are excluded from the licensure jurisdiction of the Department:

(1) A facility that is appropriately licensed by the Department of Health, and whose primary

purpose is not the provision of mental health, developmental disability, or substance abuse services.

(2) A satellite hospital, as defined by rules of the Department of Health, whose primary purpose may be the provision of mental health, developmental disability or substance abuse services, and other facilities appropriately licensed by the Department of Health pursuant to T.C.A. § 68-11-201.

(3) A facility which is operated by county, municipal or state department of education, the Department of Correction, the Department of Human Services, or the Department of Children's Services and that affirmatively states that its primary purpose is not the provision of mental health, developmental disability, substance abuse, or personal support services.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404.
Administrative History: (Formerly numbered as 0940-05-01-.05. For history prior to July, 1988 see pages 1.001 through 1.003). Amendment filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.19 WAIVER AUTHORITY

The Department may waive any rule determined to be irrelevant or to pose a hardship. A hardship waiver may be granted only when strict enforcement of a particular requirement would not be in the best interest of service recipients. All waivers granted will be made in writing and entered in the official record of the licensed service or facility. This written document shall include the justification for the waiver. All waivers will be reviewed by the Department and the Licensure Review Panel.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.20 INVESTIGATION OF ABUSE, DERELICTION, OR DEFICIENCY IN OPERATION OF

A FACILITY OR SERVICE.

(1) The Department will investigate reports or suspicion of abuse, dereliction, or deficiency in the operation of a licensed service or facility in accordance with T.C.A. § 33-2-416.

(2) The licensee shall post a sign in the facility or service displaying the Department's regional toll-free telephone number which informs service recipients, families, and the public that they may file a complaint with the Department. Any exemptions to posting signs will be determined by the Department.

(3) The licensee must report to the Department any serious allegations or suspicion of abuse, dereliction, or deficiency in the operation of the facility or service.

(4) The licensee must report to the Department any significant occurrences involving the facility/service or service recipient and staffires, loss of heat/air conditioning, and/or other structural problems with the facility building(s).

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, and 33-2-416.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.21 NOTICE OF NON-COMPLIANCE AND PLAN OF COMPLIANCE

(1) The Department will give a Department-prepared Notice of Non-Compliance to the licensee on a form provided by the Department when an inspection or investigation of a facility/service reveals non-compliance with licensure law or rules.

(2) The licensee must submit, by the date specified on the Notice of Non-Compliance, a written Plan of Compliance in response to the Notice of Non-Compliance.

(3) The licensee's written Plan of Compliance shall include a description of the action taken or to be taken in correcting deficiencies, and the date by which each corrective action is completed or to be completed.

(4) The Department will notify the licensee in writing whether the Plan of Compliance is acceptable and the basis for the decision. When the Plan of Compliance is not acceptable, the Department and licensee may continue to seek agreement. If agreement cannot be reached in a reasonable time, as determined by the Department, the Department may institute sanctions against the licensee.

(5) The licensee shall maintain copies of the most recent compliance plans in a central location.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.22 UNANNOUNCED INSPECTION

The Department shall make at least one (1) unannounced inspection of each licensed facility/service yearly.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, and 33-2-413.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.23 INSPECTION FEES

(1) Pursuant to T.C.A. § 33-2-413(c), the Department is granted the authority to charge a fee in an amount not to exceed fifty dollars ($50) for an onsite inspection of any facility or service, not including an onsite initial or annual inspection which shall be charged at the rate applicable under Rule 0940-05-02-.05 for all categories of service.

(2) The Department shall invoice the applicant or licensee for each applicable inspection. The applicant or licensee shall pay the inspection fee within thirty (30) days after receipt of the invoice, unless the current license expires before the end of the 30-day period. If the current license expires before the end of the 30-day period, the licensee shall pay the inspection fee before the expiration of the current license.

(3) The Department may withhold the issuance of a license or suspend or expire an existing license pending the payment of fees required under Rule 0940-05-02-.05 or Rule 0940-05- 02-.23.

(4) Pursuant to T.C.A. § 33-2-406(h)(2)(b), the Department shall apply a reinspection fee of five hundred dollars ($500) to a nonresidential office-based opiate treatment facility or to a nonresidential office-based opiate treatment facility with dispensing authorization that the Department found to be non-compliant in a prior inspection.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, and 33-2-413 and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 10, 2008; effective June 24, 2008. Repeal and new rule filed February 3, 2014; effective May 4, 2014. Amendments filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-02-.24 ASSISTANCE TO SERVICE RECIPIENTS WHEN A LICENSE IS DENIED,

SUSPENDED OR REVOKED.

When a license is to be denied, suspended, or revoked, the Department will notify the appropriate state and local agencies which may be able to provide assistance to service recipients by coordinating placement.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, and 33-2-414.
Administrative History: Original rule filed February 3, 2014; effective May 4, 2014.

Tenn. Comp. R. & Regs. 0940-05-02-.25 CIVIL PENALTIES FOR LICENSEES

(1) The Department may, in addition to or in lieu of any other lawful disciplinary action, assess a civil penalty for each separate violation of a licensure law or rule.

(2) The procedure for imposing a civil penalty shall be as follows:

(a) Department staff shall verbally notify a licensee that a civil penalty may be imposed due to the licensee violation of a licensure law or rule;

(b) Within six (6) business days of the verbal notification, the licensee shall be notified in writing of the basis for the civil penalty and the amount imposed.

(d) The Department may impose a penalty for each day a licensee remains in violation of a licensure rule, regulation, ordinance or law. Each licensure law, rule, regulation or ordinance violated shall constitute a separate offense.

(3) In determining the amount of the daily penalty, the commissioner may consider the following:

(a) The severity of the violation and the harm or risk of harm to the service recipient;

(b) The willfulness of the violation;

(d) Any extraordinary enforcement cost incurred by the Department;

(e) The interest of the public; and (f) Whether the civil penalty imposed will be an economic deterrent to the non-compliant activity.

(4) The Department may impose a civil penalty in accordance with the following schedule:

(a) First Offense i. Priority 1/Critical Offenses $ 500 ii. All other offenses $ 250 (b) Second or subsequent offense of same type within 12-month period:

i. Priority 1/Critical Offense $ 2500 to $ 5000 ii. All other offenses $ 500 to $ 2500 (5) The Department may continue to work with a licensee to seek compliance with any licensure law or rule. The Department may waive any penalty determined by the Department to impose a hardship. A hardship waiver of a civil penalty may be granted only when strict enforcement of a particular requirement would not be in the best interest of service recipients.

(6) A “Priority 1 offense” for the purposes of these rules is defined as a substantiated investigation involving the death of a service recipient; neglect physical or sexual abuse of the service recipient by the licensee or staff; and/or a serious injury to a service recipient. A “critical offense”, for purposes of these rules, is defined as those Department-designated administrative rules whose violation could result in serious harm to the service recipient.

History

Authority: §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, 33-2-404, 33-2-407, 33-2-409, 33-2-412, 33-2-414, 33-2-416, and 33-2-417.
Administrative History: Original rule filed February 3, 2014; effective May 4, 2014.

Chapter 0940-05-03 Application of Rules For Distinct Services Category

Tenn. Comp. R. & Regs. 0940-05-03-.01 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202(a)(3), 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 28, 1986; effective July 1, 1986. Amendment filed October 17, 1986; effective December 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal filed September 4, 2003; effective January 28, 2004.

Tenn. Comp. R. & Regs. 0940-05-03-.08 APPLICATION OF RULES FOR MENTAL HEALTH OUTPATIENT FACILITIES

(1) The governing body of a mental health outpatient facility must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.04(2) Life Safety Business Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-14 Minimum Program Requirements for Mental Health Outpatient Facilities; and (e) If services are to be provided to one (1) or more mobile non-ambulatory person, rule 0940-05-04-.09(2) Mobile Non-Ambulatory Rule.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-03-.09 APPLICATION OF RULES FOR MENTAL HEALTH DAY PROGRAM FACILITIES

(1) The governing body of a day treatment facility must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.03(2) Life Safety Educational Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-15 Minimum Program Requirements for Mental Health Day Program Facilities.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-03-.10 APPLICATION OF RULES FOR MENTAL HEALTH HOSPITAL FACILITIES

(1) The governing body of a mental health hospital facility must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.02(2) Life Safety Health Care Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-16 Minimum Program Requirements for Mental Health Hospital Facilities.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-03-.11 APPLICATION OF RULES FOR MENTAL HEALTH RESIDENTIAL TREATMENT

FACILITIES.

(1) The governing body of a mental health residential treatment facility which provides services for four (4) or more persons who are not capable of self-preservation must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.02(2) Life Safety Health Care Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-17 Minimum Program Requirements for Mental Health Residential Treatment Facilities.

(2) The governing body of a mental health residential treatment facility providing services to two (2) or three (3) clients must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-01-.07(2) One and Two-Family Dwellings Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(d) Chapter 0940-05-17 Minimum Program Requirements for Mental Health Residential Treatment Facilities; and (e) If services are to be provided to one (1) or more mobile non-ambulatory person, rule 0940-05-04-.09(2) Mobile Non-Ambulatory Rule.

(3) The governing body of a mental health residential treatment facility providing services to four (4) or more clients must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.06(2) Life Safety Board and Care Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

History

Authority: T.C.A. §§ 4-5-209, 33-1-205, and 33-2-504.
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed March 19, 1996; effective June 2, 1996.

Tenn. Comp. R. & Regs. 0940-05-03-.12 APPLICATION OF RULES FOR MENTAL HEALTH CRISIS STABILIZATION UNIT

FACILITIES.

(1) The governing body of a mental health crisis stabilization unit which provides services for four (4) or more persons who are not capable of self-preservation must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.02(2) Life Safety Health Care Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-18 Minimum Program Requirements for Mental Health Crisis Stabilization Unit Facilities.

(2) The governing body of a mental health crisis stabilization unit facility providing services to two (2) or three (3) clients must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.07(2) One and Two-Family Dwellings Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(d) Chapter 0940-05-18 Minimum Program Requirements for Mental Health Crisis Stabilization Unit Facilities; and (e) If services are to be provided to one (1) or more mobile non-ambulatory person, rule 0940-05-04-.07(2) Mobile Non-Ambulatory Rule.

(3) The governing body of a mental health crisis stabilization unit facility providing services to four (4) or more clients must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.06(2) Life Safety Board and Care Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

History

Authority: T.C.A. §§ 4-5-209, 33-1-205, and 33-2-504.
Administrative History: Original rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed March 19, 1996; effective June 2, 1996.

Tenn. Comp. R. & Regs. 0940-05-03-.13 APPLICATION OF RULES FOR MENTAL HEALTH SUPPORTIVE LIVING

FACILITIES.

(1) The governing body of a mental health supportive living facility which provides services for four (4) or more persons who are not capable of self-preservation must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.02(2) Life Safety Health Care Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-19 Minimum Program Requirements for Mental Health Supportive Living Facilities.

(2) The governing body of a mental health supportive living facility pro-siding services to two (2) or three (3) clients must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.07(2) One and Two-Family Dwellings Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(d) Chapter 0940-05-19 Minimum Program Requirements for Mental Health Supportive Living Facilities; and (e) If services are to be provided to one (1) or more mobile non-ambulatory person, rule 0940-05-04-.09(2) Mobile Non-Ambulatory Rule.

(3) The governing body of a mental health supportive living facility providing services to four (4) or more clients must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.06(2) Life Safety Board and Care Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

History

Authority: T.C.A. §§ 4-5-209, 33-1-205, and 33-2-504.
Administrative History: Original rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed March 19, 1996; effective June 2, 1996.

Tenn. Comp. R. & Regs. 0940-05-03-.14 REPEALED

History

Authority: T.C.A. §§ 4-5-209, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed March 19, 1996; effective June 2, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.23 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.24 APPLICATION OF RULES FOR MENTAL HEALTH INTENSIVE DAY TREATMENT

PROGRAM FOR CHILDREN AND ADOLESCENTS FACILITIES.

(1) The governing body of a mental health intensive day treatment program for children and adolescents facility must provide services and facilities which comply with the following rules:

(a) Rule 0940-05-04-.03(2) - Life Safety Educational Occupancies rule;

(b) Chapter 0940-05-05 - Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 - Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-30 - Minimum Program Requirements for Mental Health Intensive Day Treatment Programs for Children and Adolescents Facilities.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-03-.25 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.26 APPLICATION OF RULES FOR PERSONAL SUPPORT SERVICES AGENCIES

(1) The licensee providing personal support services must comply with and provide services that comply with the following rules:

(a) Chapter 0940-05-06 Minimum Program Requirements for All Facilities;

(b) Chapter 0940-05-36 Minimum Program Requirements for Personal Support Services Agencies; and (c) Regardless of whether a licensee is a sole proprietorship, partnership, corporation, limited liability company or limited liability partnership, it must meet all requirements of chapters 0940-05-06, and 0940-05-36.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed August 29, 2003; effective December 29, 2003.

Tenn. Comp. R. & Regs. 0940-05-03-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202(a)(3), 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendment filed October 14, 1986; effective November 28, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal filed September 4, 2003; effective January 28, 2004.

Tenn. Comp. R. & Regs. 0940-05-03-.03 THROUGH 0940-05-03-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202(a)(3), 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Amendment filed March 19, 1996; effective June 2, 1996. Repeal filed September 4, 2003; effective January 28, 2004.

Tenn. Comp. R. & Regs. 0940-05-03-.06 AND 0940-05-03-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202(a)(3), 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302
Administrative History: Original rule filed May 22, 1979; effective July 10, 1979. Repeal and new rule (Rules 0940-05-03-.06 and 0940-05-03-.07, continued) filed May 28, 1986; effective July 1, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988. Repeal filed September 4, 2003; effective January 28, 2004.

Tenn. Comp. R. & Regs. 0940-05-03-.15 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.16 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.17 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.18 REPEALED

History

Authority: T.C.A. §§ 4-5-209, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed March 19, 1996; effective June 2, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.19 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.20 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.21 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-03-.22 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-04 Life Safety Licensure Rules

Tenn. Comp. R. & Regs. 0940-05-04-.01 LIFE SAFETY REQUIREMENTS

For purposes of life safety, facilities licensed by the Tennessee Department of Mental Health and Substance Abuse Services are required to meet adopted Code standards currently in use by the Office of the State Fire Marshal as set forth in Chapter 0780-02-02 of the rules of the Department of Commerce and Insurance. The Office of Licensure will give adequate notice of any proposed changes in Rule 0780- 02-02-.01 to all licensees and applicants.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.02 HEALTH CARE OCCUPANCIES

(1) Definition. Health Care Occupancies are those used for purposes such as medical or other treatment or care of persons suffering from physical or mental illness, disease, or infirmity; and for the care of infants, convalescents, or infirm aged persons. Health Care Occupancies provide sleeping facilities for the occupants or are occupied by persons who are mostly incapable of self-preservation because of age, physical or mental disability, or because of security measures not under the occupants’ control. Examples of facilities required to meet health care occupancy standards are the following:

(a) Mental Health Hospital Facility (b) Crisis Stabilization Facility (c) Any residential facility serving four (4) or more persons who are not capable of selfpreservation and any non-residential facility serving four (4) or more persons six (6) years of age or older who are not capable of self-preservation (as defined at 0940-05- 04-.10). For the purposes of occupancy rating, minor individuals residing with parents shall not count towards persons who are not capable of self-preservation.

(2) Criteria. For the purpose of life safety, facilities required to meet Health Care Occupancies must comply with the applicable standards of the Life Safety Code of the National Fire Protection Association, 1985 Edition, Health Care Occupancies, Chapter 12 (new) or Chapter 13 (existing) or equivalent standards hereafter adopted by the Office of the State Fire Marshal.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed February 1, 1979; effective March 17, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendment filed October 14, 1986; effective November 28, 1986. Amendment filed March 19, 1996; effective June 2, 1996. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.03 EDUCATIONAL OCCUPANCIES

(1) Any and all references to Chapter 0940-05 that pertain to Section 0940-05-04-.03, Educational Occupancies, shall be construed to refer to Section 0940-05-04-.04, Business Occupancies.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.04 BUSINESS OCCUPANCIES

(1) Definition. Business Occupancies are those used for the transaction of business (other than that covered under Mercantile), for the keeping of accounts and records, and similar purpose.

Examples of facilities required to meet business occupancy standards are the following:

(a) Mental Health Outpatient Facility (b) Alcohol and Drug Abuse Non-Residential Facility (c) Methadone Non-Residential Facility (d) Alcohol and Drug Outpatient Detoxification Facility (e) Psychosocial Facility (f) Day Treatment Facility (2) Criteria. For the purpose of life safety, facilities required to meet Business Occupancies must comply with the applicable standards of the Life Safety Code of the National Fire Protection Association, 1985 Edition, Business Occupancies, Chapter 26 (new) or Chapter 27 (existing) or equivalent standards hereafter adopted by the Office of the State Fire Marshal.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed February 1, 1979; effective March 17, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-04-.06 RESIDENTIAL OCCUPANCIES - BOARD AND CARE

(1) Definition. Board and Care facilities include a building or part thereof that is used for the lodging and boarding of four (4) or more residents, not related by blood or marriage to the owner or operator, to provide care services. Examples of facilities required to meet board and care occupancy standards are the following:

(a) Mental Health Residential Facility (b) Alcohol and Drug Residential Facility (2) Criteria. For the purpose of life safety, facilities required to meet Board and Care occupancy must comply with the following:

(a) Applicable standards of the Life Safety Code of the National Fire Protection Association, 1985 Edition, Residential Board and Care Occupancies, Chapter 21, or equivalent standards hereafter adopted by the Office of the State Fire Marshal, and 1. Provide at least two hundred (200) square feet, gross, of occupiable space per service recipient, (i) A minor residing with their parent or guardian at the facility does not meet the definition of a service recipient.

Provide at least:

(i) Eighty (80) square feet per service recipient bedroom space for single occupancy, or (I) A minor residing with their parent or guardian at the facility does not meet the definition of a service recipient.

(ii) Sixty (60) square feet per service recipient bedroom space for multiple occupancy, 3. Not allow multiple occupancy which exceeds four (4) service recipients per bedroom, and (i) A minor residing with their parent or guardian at the facility does not meet the definition of a service recipient.

Equip any stairways with emergency lighting, 5. Provide emergency lighting in any corridors as means of egress, 6. Not use unvented gas heaters, 7. Use portable electric space heaters only in emergency situations, and as appropriate under fire code standards, 8. Allow the use of fireplaces only under the following conditions:

(i) For recreation or therapy only, (ii) Not used as a primary source of heat, (iii) Used in activity or living rooms, (iv) Under proper supervision and in accordance with specific written fire safety procedures, and (v) Fireplaces may be installed and used only in areas other than service recipient sleeping areas, provided the fireplace is equipped with a heattempered glass fireplace enclosure guaranteed against breakage up to a temperature of 650 degrees Fahrenheit.

Allow the use of portable cooking devices in the kitchen only, 10. Document fire safety drills which shall be conducted:

(i) Monthly at unexpected times and under varying conditions, and (ii) Under direct staff supervision;

Provide a functioning UL rated battery-operated smoke detector in each bedroom occupied by the resident and document that all smoke-detection devices are tested monthly and that batteries are changed when no longer operating, but at least yearly;
Provide operable 2A-10B, C multi-purpose fire extinguishers in a fixed location and readily accessible for use in the facility, and document that all fire extinguishers are properly maintained and serviced. The facility shall consult with the fire authority of jurisdiction on the number of fire extinguishers required in a particular facility and document the recommendation.
Document instructions to staff upon employment and service recipients upon enrollment in fire evacuation procedures;
Adopt and post a policy on smoking in specified areas, except that no smoking shall be allowed within residential bedrooms;
Suspended unit electric heaters may be used, except in means of egress and service recipient sleeping areas, provided such heaters are located high enough to be out of the reach of persons using the area and provided the heaters are equipped with appropriate safety devices and as acceptable by fire code.
Use extension cords only on a limited basis and under the conditions acceptable to the Office of Licensure of the department.
In facilities where minors are residing with parents or guardians, only the parent or guardian shall be assigned to the room where the minor resides. Facilities shall request licensure approval via waiver request for multiple occupancy if they believe their arrangement justifies such a scenario.

(b) Serve only persons who require no greater level of care than personal care (as defined at 0940-05-04-.08).

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendment filed October 14, 1986; effective November 28, 1986. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.07 RESIDENTIAL OCCUPANCIES - ONE- AND TWO-FAMILY DWELLINGS (TWO OR

THREE SERVICE RECIPIENTS).

(1) Definitions. One- and Two-Family Dwellings (Two or Three Service Recipients) includes buildings in which each living unit is occupied by members of a single family or facility staff with no more than three outsiders. Examples of facilities required to meet one- and two-family dwelling occupancy standards are the following:

(a) Mental Health Residential Facility (b) Alcohol and Drug Residential Facility (2) Criteria. For the purpose of life safety, facilities required to meet one- and two-family dwelling occupancy must comply with the following:

(a) Applicable standards of the Life Safety Code of the National Fire Protection Association, 1985 Edition, One and Two-Family Dwellings, Chapter 22, or equivalent standards hereafter adopted by the Office of the State Fire Marshal, and 1. Provide at least two hundred (200) square feet, gross, of occupiable space per service recipient, (i) A minor residing with their parent or guardian at the facility does not meet the definition of a service recipient.

Provide at least:

Equip any stairways with emergency lighting, 5. Provide emergency lighting in any corridors as means of egress, 6. Not use unvented gas heaters, 7. Use portable electric space heaters only in emergency situations with advance special permission and under conditions specified by the Office of Licensure.
Allow the use of fireplaces only under the following conditions:

(i) For recreation or therapy only, (ii) Not used as a primary source of heat, (iii) Used in activity or living rooms, (iv) Under proper supervision and in accordance with specific written fire safety procedures; and (v) Fireplaces may be installed and used only in areas other than service recipient sleeping areas, provided the fireplace is equipped with a heattempered glass fireplace enclosure guaranteed against breakage up to a temperature of 650 degrees Fahrenheit.

Allow the use of portable cooking devices in the kitchen only, 10. Document fire safety drills which shall be conducted:

(i) Monthly at unexpected times and under varying conditions, and (ii) Under direct staff supervision;

Provide a functioning UL rated battery-operated smoke detector in each bedroom occupied by the resident and document that all smoke-detection devices are tested monthly and that batteries are changed when no longer operating, but at least yearly;
Provide operable 2A-10B, C multi-purpose fire extinguishers in a fixed location and readily accessible for use in the facility, and document that all fire extinguishers are properly maintained and serviced. The Office of Licensure will determine the number of fire extinguishers required in a particular facility.
Document instructions to staff upon employment and service recipients upon enrollment in fire evacuation procedures;
Adopt and post a policy on smoking in specified areas, except that no smoking shall be allowed within residential bedrooms;
Suspended unit electric heaters may be used, except in means of egress and service recipients sleeping areas, provided such heaters are located high enough to be out of the reach of persons using the area and provided the heaters are equipped with appropriate safety devices and are approved for use by the Office of Licensure of the department.
Use extension cords only on a limited basis and under the conditions acceptable to the Office of Licensure of the department.
In facilities where minors reside with parents or guardians, only the parent or guardian shall be assigned to the room where the minor resides. Facilities shall request licensure approval via waiver request for multiple occupancy if they believe their arrangement justifies such a scenario.

(b) Serve only persons who require no greater level of care than personal care (as defined at 0940-05-04-.08).

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendment filed October 14, 1986; effective November 28, 1986. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.08 PERSONAL CARE DEFINED

Personal care means services provided to a service recipient who does not require chronic or convalescent medical or nursing care. Personal care is the safekeeping and supervision of the service recipient’s self-administration of prescription medication along with any of the following services: (1) responsibility for the safety of the service recipient, (2) a daily awareness by the management and staff of the service recipient’s functioning, (3) knowledge of his or her whereabouts, (4) reminding a service recipient of appointments, (5) the ability and readiness to intervene if a crisis arises for a service recipient, and/or (6) supervision in the following areas for the service recipient’s major life activities, self-care, selfdirection, capacity for independent living or economic self-sufficiency.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22, 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.09 MOBILE NON-AMBULATORY RULE

(1) Definition. Mobile non-ambulatory individual means an individual who is able, without other assistance, to transfer to and to move about only with the aid of a wheelchair, crutch, wheeled platform, or similar device.

(2) Criteria. For the purpose of life safety, facilities required to meet the Mobile Non-Ambulatory

Rule must comply with the following:

(a) Provide that non-ambulatory individuals only be located on the level of exit discharge;

(b) Provide ramps of appropriate steepness;

(c) Provide corridors of at least three (3) unobstructed feet in width with passing intervals reasonably spaced that are at least sixty (60) inches minimum;

(d) Provide doors that open ninety (90) degrees minimum and which measure at least thirty-two (32) inches in clear opening; and (e) Provide bathrooms adequately spaced and equipped for the accessibility of nonambulatory individuals.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 16, 1978; effective January 1, 1979. Amendment filed May 22. 1979; effective July 10, 1979. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendment filed October 14, 1986; effective November 28, 1986. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.10 CAPABLE OF SELF-PRESERVATION RULE

(1) Definition. Capable of self-preservation means that a service recipient is capable of responding to an approved emergency signal, including prompting by voice, by following a pre-taught evacuation procedure within a reasonable time limitation regardless of whether the service recipient is fully aware of the reasons for the action. A service recipient is capable of self-preservation if the service recipient is able to transfer unassisted from the bed or another fixed position to an individualized means of mobility, which is continuously available, and able to demonstrate the ability to transverse a pre-defined means of egress from the facility within a reasonable time limitation. Service recipients who have imposed upon them security measures beyond their control, which prevent their egress from the facility, are not capable of self-preservation.

(2) Limitation. All residential facilities serving four (4) or more service recipients who are not capable of self-preservation and all non-residential facilities serving four (4) or more service recipients six (6) years of age or older who are not capable of self-preservation are required to meet the criteria for Health Care Occupancies.

(3) For the purposes of occupancy rating, minor individuals residing with parents or guardians shall not count towards persons who are not capable of self-preservation.

(4) Any facility permitting any persons who are not capable of self-preservation into the facility, shall assign an employee to be responsible for those individuals not capable of selfpreservation.

(5) Any service recipient who is unable to respond to an approved emergency signal, including voice prompt, and evacuate the facility without physical assistance, in three (3) minutes or less, is to be considered not capable of self-preservation.

(6) The facility shall fill out the Department’s Risk Assessment/Evaluation of Capability for each person it deems incapable of self-preservation.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Amendment filed October 14, 1986; effective November 28, 1986. Amendment filed March 19, 1996; effective June 2, 1996. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-04-.11 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, and 33-1-305.
Administrative History: Original rule filed March 1, 2002; effective May 15, 2002. Repeal filed February 24, 2026; effective May 25, 2026.

Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services

Tenn. Comp. R. & Regs. 0940-05-05-.01 STANDARD FOR NEW CONSTRUCTION

The licensee or licensee applicant must ensure that new construction for facilities subject to the licensure jurisdiction of the Department meets the appropriate standards of the edition of the Standard Building Code currently in effect as adopted by the Office of the State Fire Marshall in rule 0780-02-02-.01 of the promulgated rules of the Department of Commerce and Insurance.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed November 25, 1981; effective January 20, 1982. Repeal and new rule filed October 27, 1986; effective December 11, 1986. Amendment filed February 5, 1987; effective May 27, 1987. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.02 GENERAL ENVIRONMENTAL REQUIREMENTS FOR ALL FACILITIES

(1) The facility must be maintained in a safe manner and a continuing effort made to eliminate potential hazards.

(2) The facility must be maintained in a sanitary and clean condition, free from all accumulation of dirt and rubbish, well-ventilated, and free from foul, stale or musty odors.

(3) The facility must be kept free of mice, rats and other rodents.

(4) Housekeeping practices and standards must be maintained which will ensure the eradication of files, roaches, and other vermin.

(5) All interior and exterior stairs and steps must be equipped with securely and safely installed handrails.

(6) All interior and exterior stairways, halls, porches, walkways and all other means of egress and areas of exit discharge must be maintained free of any obstacles, including furniture or other stored items (7) A heating system must be provided which is capable of maintaining a minimum temperature of sixty-five (65) degrees Fahrenheit and a comfortable humidity level at all times within the facility.

(8) A cooling, natural ventilation or air conditioning system must be provided which is capable of maintaining a maximum temperature of eighty-five (85) degrees Fahrenheit and a comfortable humidity level at all times within the facility.

(9) Operable windows for ventilation must be provided unless the requirement for operable windows is otherwise exempted by the facility’s licensure life safety occupancy classification and the facility is equipped with an air conditioning system.

(10) All operable windows used for ventilation must be equipped with screens which do not render the window unusable if the windows also is required for escape or emergency rescue purposes.

(11) A telephone system must be provided with is capable of ensuring prompt notification in cases of emergencies and which is capable of meeting the needs of the clients served by the facility.

(12) Emergency telephone numbers must be posted for the most local available agencies for fire protection, police or sheriff, ambulance, or medical intervention, and poison control.

(13) An adequate first aid kit must be provided as recommended by the local chapter of the American Red Cross or the facility’s medical staff, as applicable.

(14) Drinking water must be provided from a source approved by the Tennessee Department of Health.

(15) A system for the disposal of sewage must be provided which is connected to a public sewage system or which is connected to a private sewage system (septic tank and field system) which has the approval of the local public health agency having jurisdiction.

(16) Natural or artificial lighting must be provided which is adequate for the needs of the clients using the facility.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed November 25, 1981; effective January 20, 1982. Amendment filed November 30, 1983; effective December 30, 1983. Repeal and new rule filed June 30, 1986; effective July 30, 1986. Repeal and new rule filed October 14, 1986; effective November 28, 1986. Amendment filed October 27, 1986; effective December 11, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.03 ENVIRONMENTAL REQUIREMENTS FOR RESIDENTIAL FACILITIES

(1) The governing body must ensure that each client is provided with the following:

(a) A separate bed of proper size and height for the client’s convenience and comfort;

(b) A mattress and springs, or a mattress foundation, both of which are clean, comfortable, and in good repair;

(c) Clean linens consisting of both a top and bottom sheet, which are clean, in good repair, and are changed as often as needed, but at least weekly;

(d) Bedding, such as blankets, which are clean, in good repair, and appropriate to the weather;

(e) A clean and comfortable pillow unless contra-indicated by the client’s choice or for health reasons;

(f) Space in a dresser or chest of drawers which is adequate for the storage of the client’s clothing;

(g) Closet or wardrobe space which is adequate for the hanging storage of the client’s clothing; and (h) Access to a mirror at an appropriate height.

(2) Unless the facility is required to meet Health Care Occupancy standards, or unless the room has a door which leads directly to the outside, then each client bedroom must be provided with a window which meets the following:

(a) Is operable from the inside without the use of special keys, tools, or knowledge;

(b) Provides a clear opening of not less than twenty (20) inches in width, twenty-four (24) inches in height, and five and seven-tenths (5.7) square feet in area; and (c) The bottom of the opening is not more than forty-four (44) inches from the floor.

(3) Each bedroom must be decorated in an appropriate manner including bedspreads, window coverings, and wall hangings.

(4) Bathrooms must be provided within the facility which are equipped as follows:

(a) One (1) private toilet for each six (6) persons, including staff, who reside in the facility;

(b) One (1) lavatory with hot water for each six (6) persons, including staff, who reside in the facility;

(c) One (1) private tub or shower with hot water for each eight (8) persons, including staff, who reside in the facility;

(d) Tub and shower floor surfaces equipped to be slip-resistant;

(e) Adequate and sanitary soap and towels provided at each lavatory; and (f) Adequate and sanitary toilet paper provided at each toilet.

(5) A dining area and dining furniture must be provided which are sufficient, appropriate, and in good repair for meeting the needs of the clients.

(6) A combined living and activity area and furnishings must be provided which are sufficient in size, in good repair, and appropriate for meeting the needs of the clients residing in the facility. The area must contain one (1) seating area such as chairs or sofas for each client and other residential furniture such as tables, lamps, wall hangings, a television, and a clock.

(7) An outdoor area must be provided which is neat, free of potential hazards, and is appropriate to meeting the needs of the clients.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed November 25, 1981; effective January 20, 1982. Repeal and new rule filed October 27, 1986; effective December 11, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.04 ENVIRONMENTAL REQUIREMENTS FOR NON-RESIDENTIAL FACILITIES

(1) If clients are regularly scheduled to be in the facility for extended periods of time which encompass recognized mealtimes, then the facility must provide a dining area with tables and chairs sufficient to take their meals whether meals are provided by the facility, the client, or other source.

(2) Provide one (1) lavatory and one (1) private toilet for each fifteen (15) persons served in the facility.

(3) Equip each lavatory with adequate and sanitary hand soap and hand towels.

(4) Equip each toilet with adequate toilet paper.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed November 25, 1981; effective January 20, 1982. Repeal and new rule filed October 27, 1986; effective December 11, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.05 REQUIREMENTS FOR FACILITIES PROVIDING FOOD SERVICES AND

NUTRITION. (All residential facilities required to meet this chapter of rules must comply with the requirements of this rule. Any non-residential facility required to meet this chapter of rules which provides food and nutrition on a regular basis to its clients must comply with the requirements of this rule.)

(1) Food and nutrition must be provided in as normal a fashion as possible.

(2) Records must be maintained which document the content of all meals served for at least the previous thirty (30) days.

(3) Food must be served in appropriate quantity, at appropriate temperatures, and in a form consistent with normal situations.

(4) Clients, including those individuals with physical handicaps, must be allowed to eat meals at a table in a dining area unless temporarily contra-indicated for medical reasons.

(5) Provisions must be made for following special diets for clients when such diets are prescribed for medical or health reasons, and encouragement given the client to follow such special diets.

(6) In residential facilities, provisions must be made for three (3) well-balanced meals at recognized mealtimes with no more than fourteen (14) hours elapsing between the evening supper meal and the following morning breakfast meal.

(7) In residential facilities, a forty-eight (48) hour supply of food must be maintained within the facility which is sufficient for meeting the needs of the clients served in the facility.

(8) Appropriate equipment and utensils for cooking food and serving meals must be provided in sufficient quantity to serve all clients and such equipment and utensils must be in good repair, washed and sanitized after each use.

(9) Kitchens must be equipped with appliances and fixtures which are sufficient and appropriate for cooking meals, refrigerating food, washing utensils and dishes, and the sanitary disposal of waste.

(10) Foods requiring cold storage must be maintained at a temperature of forty-five (45) degrees Fahrenheit or below.

(11) Foods requiring frozen storage must be maintained at a temperature of ten (10) degrees Fahrenheit or below.

(12) All dry foods and goods must be stored in a manner to prevent possible contamination and must be stored a minimum of six (6) inches above the floor.

(13) Garbage (food waste) must be stored in secure containers with tight-fitting lids and liners or discharged from the facility through a properly installed food waste disposal system.

(14) Garbage (food waste) containers must be emptied daily from the facility into secure containers located outside of the facility.

(15) Provisions must be made for the regular removal or disposal of garbage (food waste) from the facility premises.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed March 16, 1983; effective April 18, 1983. Repeal and new rule filed October 27, 1986; effective December 11, 1986. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.06 REQUIREMENTS FOR FACILITIES PROVIDING CLIENT TRANSPORTATION

SERVICES. If the facility or employees of the facility provide transportation to clients in vehicles owned either by the facility or by the employee, then the governing body must ensure that the following requirements are met:

(a) All vehicles must be maintained and operated in a safe manner;

(b) All staff providing transportation must possess an appropriate driver’s license from the Tennessee Department of Safety, and documentation of such license must be maintained in the facility’s records;

(c) All facility-owned and staff-owned vehicles for client transportation must be adequately covered by vehicular liability insurance for personal injury to occupants of the vehicle, and documentation of such insurance must be maintained in the facility’s records; and (d) Appropriate safety restraints must be used as required by state and federal law.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed October 27, 1986; effective December 11, 1986. Amendment filed February 5, 1987; effective May 27, 1987. Repeal and new rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.07 SPECIAL REQUIREMENTS FOR FACILITIES SERVING CHILDREN

(Any facility required to meet this chapter of rules which provides services to children six (6) years of age or younger must comply with these requirements.)

(1) Non-toxic, lead-free paint must be used on all painted surfaces.

(2) Electrical wall outlets which are accessible to children must be protected with covers.

(3) Poisonous and toxic materials must be identified, stored, and used only in such manner and under such conditions as not to pose any threat of poisoning to the clients or contamination of food.

(4) All sources of heat must be protected by screens or other protective barriers to prevent burns or injury to children.

(5) Furnishings and other equipment used in the facility must be free of sharp or projecting objects or surfaces and not pose any potential harm or injury to children.

(6) Steps or stairs which pose a fall hazard to children must be protected by barriers.

(7) Outside play areas must be fenced or otherwise situated to protect children from hazards such as open drainage ditches, adjacent streets, and traffic.

(8) Outside play areas must provide fifty (50) square feet of play area for each child present.

(9) Grass, bark, sand, rubber mats, or other resilient surfaces must be used under play equipment used for climbing or swinging.

(10) Furniture, equipment, and bathroom fixtures must be sized or adapted for meeting the needs of the children served by the facility.

(11) Equipment must be provided that is sufficient and appropriate for active and quiet play needs and for implementing program activities for each child.

(12) Non-residential facilities must provide nap facilities if the children are scheduled to remain in the facility for as long as six (6) hours.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.08 SPECIAL REQUIREMENTS FOR FACILITIES PROVIDING VOCATIONAL

SERVICES.

(1) Activities of an industrial or productive vocational nature such as assembling, packaging, painting, stripping, wood or metal working, or manufacturing must be conducted in a designated area or room which is separated by fire-rated construction, as required by the applicable life safety rules under Chapter 0940-05-04 of these rules, from any other part of the facility not used for vocational purposes such as classrooms, residential areas, offices, or storage rooms.

(2) Permanent aisles and passageways which provide the most direct route of egress to exits must be clearly identified within open work areas, and such aisles and passageways must be maintained free of obstacles and in good repair.

(3) All floor surfaces, platforms, and other walking surfaces must be maintained in a clean manner and free of holes or projections which constitute hazards.

(4) All materials must be stored in tiers which are stacked, racked, blocked, interblocked, or otherwise secured to prevent sliding, collapsing, or falling.

(5) All powered equipment, machinery, and powered hand tools must be equipped and maintained with the safety guards, shields, and other devices necessary to protect health and safety of the operators and others in the work area.

(6) All exposed rotating parts, motor shafts, drive belts, chains, cables, gears, cutting blades, wheels, and other moving parts of machinery must be adequately guarded.

(7) Personal protective equipment and clothing must be provided to clients and employees, when appropriate, when handling dangerous materials or working at hazardous operations.

(8) All interior floor and wall openings, open-sized mezzanine areas or platforms, which are six (6) feet or more above the adjacent ground level, must be guarded by standard railing.

(9) Natural or adequately-powered ventilation which conforms to ventilation rates of the stateadopted building codes must be provided for all working areas.

(10) Equipment, conductors, controls, and signaling devices which are necessary to provide a complete electrical system must be provided. All specifications and materials must meet state-adopted standards of the building codes, and of the Underwriters’ Laboratories, Inc. (or similarly established standards).

History

Authority: T.C.A. § 33-2-504. Amendment History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.09 SPECIAL REQUIREMENTS FOR FACILITIES SERVING PERSONS WITH VISION

LOSS. The governing body of any residential or non-residential facility, which is required to admit only persons who are capable of self-preservation and which also provides services to one or more persons who have a vision loss, must ensure compliance with the following requirements:

(a) The client must be able to demonstrate independent familiarity with the physical design and layout of the facility and be able to initiate and complete evacuation of the facility without physical assistance;

(b) The facility design and placement of furnishings are consistent, free of special hazards, and made known to the client especially when changes occur in the facility design or placement of furnishings; and (c) Prior notice of the admission of such persons must be given to the Department’s Office of Licensure.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.10 SPECIAL REQUIREMENTS FOR RESIDENTIAL FACILITIES SERVING PERSONS

WITH HEARING LOSS. The governing body of any residential facility, which is required to admit only persons who are capable of self-preservation and which also admits one or more clients who have a loss of hearing, must ensure than when the sounding of the standard fire alarm is not sufficient in notifying a sleeping client who has a hearing loss of the need to evacuate, must then provide a means of such notification which:

(a) Is independent of personal, physical contact or notification by staff or other persons during sleep;

(b) Provides some mechanical means of sensory notification during sleep;

(c) Is consistent in notifying the resident of the need to evacuate; and (d) Has the prior approval of the Department’s Office of Licensure.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-05-.11 SPECIAL REQUIREMENTS FOR NON-RESIDENTIAL FACILITIES SERVING

PERSONS WITH HEARING LOSS. Non-residential facilities which serve a client with a hearing loss must ensure that the means of notifying the client, which may include personal contact by staff, is consistent, is always available, and has the approval of the Department’s Office of Licensure.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Chapter 0940-05-06 Minimum Program Requirements for All Services and Facilities

Tenn. Comp. R. & Regs. 0940-05-06-.01 GOVERNANCE REQUIREMENTS FOR ALL SERVICES AND FACILITIES

(1) The governing body must ensure that the facility complies with all applicable federal, state, and local laws, ordinances, rules, and regulations.

(2) The governing body must ensure that the facility is administered and operated in accordance with written policies and procedures.

(3) The governing body must exercise general direction over the facility and establish policies governing the operation of the facility and the welfare of the individuals served.

(4) The governing body must designate an individual responsible for the operation of the facility.

(5) The governing body must ensure that the licensed facility serves only persons whose placement will not cause the facility to violate its licensed status and capacity based on the facility’s distinct licensure category, the facility’s life safety occupancy classification, and the required staffing ratios, if any.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rules filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.02 POLICIES AND PROCEDURES FOR ALL SERVICES AND FACILITIES

(1) The governing body must ensure that a written policies and procedures manual is maintained. The manual must include the following elements:

(a) A description of each facility service provided by the licensee. The description must include the hours of operation and admission and discharge criteria and rules for service recipients, if any;

(b) An organizational chart or a statement which clearly shows or describes the lines of

authority between the governing body, the chief executive officer, and the staff;

(c) Policies and procedures which ensure that someone is delegated the authority to act in the absence of the individual responsible for the operation of the facility;

(d) A schedule of fees currently charged to the service recipient, if any, for all services provided by the licensee, including a refund policy. The schedule shall include:

The fee or fees for each service, including any additional charges for services not covered by the basic service fee;
The process by which licensee will apply any governmental or other funds or donations to the fee or fees for services. This may include, but not be limited to, use of a service recipient’s food stamps as payment for his or her meals; use of federal, state or other funds or donations to finance all or part of the service recipient’s cost for services; or payments made to the agency for a service recipient’s participation in an employment or rehabilitation program to finance the cost of services provided; and, 3. The total cost of services to the service recipient;

(e) A statement of service recipient rights and the grievance procedures to be followed when a suspected violation of service recipient rights has been reported. This statement shall, at a minimum, include those service recipient rights found in Rule

Tenn. Comp. R. & Regs. 0940-05-06-.03 FINANCIAL MANAGEMENT OF ALL SERVICES AND FACILITIES

(1) The licensee holding or receiving funds or property for the service recipient as trustee or representative payee will adhere to all laws, state and federal, that govern his fiduciary position and relation to the service recipient. A licensee may not retaliate against an employee, volunteer or other individual who reports a violation of the licensee’s fiduciary obligation to the service recipient.

(2) The licensee shall prohibit staff, volunteers and proprietors from soliciting or borrowing money or property from service recipients.

(3) The licensee shall ensure that all money received, held and/or disbursed on behalf of the service recipient is for the strict, personal benefit of the service recipient.

(4) The licensee shall not mix funds with those of the service recipient. The licensee shall maintain a separate account in a federally insured financial institution for the deposit and/or disbursement of service recipient funds.

(5) The licensee shall not take funds or property of the service recipient for the licensee’s personal or organizational use or gain.

(6) The licensee shall maintain a written account of all monies received or disbursed on behalf of the service recipient. No less than annually, the licensee shall provide the service recipient or the service recipient’s legal representative a report of all funds held and disbursed on behalf of the service recipient.

(7) The licensee shall identify the source of each service recipient’s funding in the applicable service recipient’s chart. This identification shall specifically list whether the funding is public and, if so, identify the exact funding source(s) (e.g. Social Security Disability, Supplemental Nutrition Assistance Program (SNAP), Wellpoint, BlueCare, UnitedHealthcare Community Plan, TennCare Select, etc.).

(8) The licensee shall obtain and maintain liability insurance in the name of the organization sufficient to cover reasonably foreseeable liabilities of the agency.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.04 PERSONNEL REQUIREMENTS FOR ALL SERVICES AND FACILITIES

(1) A job description must be maintained which includes the employment requirements and the job responsibilities for each facility staff position. This description shall include whether this employee will be designated as an employee who can be assigned as an employee to assist individuals not capable of self-preservation.

(2) A personnel record must be maintained which verifies that each employee meets their respective employment requirements for the staff position held. Included in the employee’s personnel records shall be evidence of a criminal background check as specified in T.C.A. § 33-2-1202; the employee’s status on the Tennessee Elderly and Vulnerable Abuse Registry (Abuse Registry) maintained by the Health Facilities Commission; and the employee’s status on the Sexual Offender Registry (Sexual Offender Registry); the employee’s date of birth; social security number; and records of any disciplinary action. An employee on either the Abuse Registry or Sexual Offender Registry is ineligible to remain employed by or work as a volunteer or independent contractor with the licensee in any capacity.

(3) Annual training and development activities that assist the staff in meeting the needs of the service recipients. All direct care staff shall receive training in fire evacuation procedures. The agency shall document all training and development activities in which an employee participated in the employee’s personnel records.

(4) Training and development activities which are appropriate in assisting volunteers (if used by the facility) in implementing their assigned duties must be provided for each volunteer. The provision of such activities must be evidenced by documentation in the facility’s records.

(5) Direct-services staff members must be competent persons aged eighteen (18) years of age or older.

(6) An employee’s professional license or certification, including, but not limited to, certification as a peer or family support specialist, as required by the job description or state law.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.05 INDIVIDUAL SERVICE RECIPIENT RECORD REQUIREMENTS FOR ALL SERVICES

AND FACILITIES.

The governing body must ensure that an individual record is maintained, in electronic or hard copy format, for each client being served and which minimally includes the following information:

(1) The name and social security number of the service recipient;

(2) The address of the service recipient or, for residential treatment programs, a permanent or previous address;

(3) The telephone number of the service recipient;

(4) The sex of the service recipient;

(5) The date of the service recipient’s birth;

(6) The date of the service recipient’s admission to the facility;

(7) The source of the service recipient’s referral to the facility;

(8) If applicable, legal documents affirming that the service recipient has a court-appointed legal representative and the name, address and telephone number of the legal representative;

(9) The name, address, and telephone number of a family representative and/or an emergency contact person;

(10) If the facility charges fees for its services, a fee schedule, as described in Rule 0940-05-06- .02(1)(d), shall be dated, completed and signed by the service recipient (or the service recipient’s legal representative) prior to provision of any services other than emergency services. The licensee should complete a new fee schedule when there is a change in the amount of fees, the services provided, or additional charges for which the service recipient is responsible are incurred;

(11) When appropriate, informed, signed and dated consent and authorization forms for the release or obtaining of information from the service recipient. These forms shall be in compliance with state and federal confidentiality laws and include at least the following information:

(a) Name and title of the person or organization to or from whom disclosure is to be made;

(b) The signature of the service recipient or the service recipient’s legal representative;

(d) The extent and nature of information to be disclosed;

(e) A statement that the content is subject to revocation at any time except to the extent that action has already been taken in reliance thereon and a specified date, event or condition upon which the consent will expire without express revocation; and, (f) The date on which the consent is signed;

(12) Documentation that the service recipient or someone legally acting on behalf of the service recipient has been informed of the service recipient’s rights and responsibilities and of the facility’s general rules affecting the service recipient;

(13) A written account of all monies received or disbursed on behalf of the service recipient and a copy of the annual report on the use and disbursement of service recipient funds as required by 0940-05-06-.03(6); and (14) The service recipient’s record shall include a notation of any additional behavioral health providers the service recipient may concurrently see beyond the licensee and who the assigned case manager and/or social worker of the service recipient is, if applicable.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010 Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.06 SERVICE RECIPIENT RIGHTS IN ALL SERVICES AND FACILITIES

(1) The following rights shall be afforded to all service recipients by all licensees and are not subject to modification:

(a) Service recipients have the right to be fully informed before or upon admission about their rights and responsibilities and about any limitation on these rights imposed by rules of the facility. The facility must ensure that the service recipient is given information about his or her rights that shall include at least the following:

A statement of the specific rights guaranteed the service recipient by these rules and applicable state and federal laws;
A description of the facility’s complaint and grievance procedures;
A listing of all available advocacy services;
A copy of all general facility rules and regulations for service recipients; and, 5. The information must be presented in a manner or format that promotes understanding by service recipients of their rights and an opportunity must be given to service recipients to ask questions about the information. If a service recipient who is unable to understand this information at the time of admission later becomes able to do so, the information must be presented to the service recipient at that time. If a service recipient is likely to continue indefinitely to be unable to understand this information, the facility must promptly attempt to provide the required information to a parent, guardian, or other appropriate person or agency responsible for protecting the rights of the service recipient;

(b) Service recipients have the right to voice grievances to staff of the facility, to the licensee, and to outside representatives of their choice with freedom from restraint, interference, coercion, discrimination or reprisal;

(c) Service recipients have the right to be treated with consideration, respect and full recognition of their dignity and individuality;

(d) Service recipients have the right to be protected by the licensee from neglect; from physical, verbal and emotional abuse (including corporal punishment); and from all forms of misappropriation and/or exploitation;

(e) Service recipients have the right to be assisted by the facility in the exercise of their civil rights;

(f) Service recipients have the right to be free of any requirement by the facility that they perform services which are ordinarily performed by facility staff;

(g) If residential services are provided, service recipients must be allowed to send personal mail unopened and to receive mail and packages which may be opened in the presence of staff when there is reason to believe that the contents thereof may be harmful to the service recipient or others;

(h) Service recipients have the right to privacy while receiving services;

(i) Service recipients have the right to have their personal information kept confidential in accordance with state and federal confidentiality laws;

(j) Service recipients have the right to ask the facility to correct information in their records. If the facility refuses, the service recipient may include a written statement in the records of the reasons they disagree;

(k) Service recipients have the right to be informed about their care in a language they understand; and, (l) Service recipients have the right to vote, make contracts, buy or sell real estate or personal property, or sign documents, unless the law or a court removes these rights.

(2) The following rights must be afforded to all service recipients by all licensed facilities unless modified in accordance with Rules 0940-05-06-.07 or 0940-05-06-.08:

(a) Service recipients have the right to participate in the development of the service recipient’s individual program or treatment plans and to receive sufficient information about proposed and alternative interventions and program goals to enable them to participate effectively;

(b) Service recipients have the right to participate fully, or to refuse to participate, in community activities including cultural, educational, religious, community services, vocational and recreational activities;

(c) If residential services are provided, service recipient must be allowed to have free use of common areas in the facility with due regard for privacy, personal possessions, and the rights of others;

(d) Service recipients have the right to be accorded privacy and freedom for the use of bathrooms when needed;

(e) Service recipients shall be permitted to retain and use personal clothing and appropriate possessions including books, pictures, games, toys, radios, arts and crafts materials, religious articles, toiletries, jewelry and letters;

(f) If residential services are provided and if married service recipients reside in the facility, privacy for visits by spouses must be ensured, and if both spouses are service recipients residing in the facility, they must be permitted to share a room;

(g) If residential services are provided, service recipients have the right to associate and communicate privately with persons of their choice including receiving visitors at reasonable hours; and, (h) If residential services are provided, service recipients supported have the right to be given privacy and freedom in the use of their bedroom/sleeping area.

(i) Service recipients shall have the right to make and receive phone calls during designated awake hours according to the facility’s policy.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.07 MODIFICATION OR LIMITATION OF ALL SERVICE RECIPIENTS’ RIGHTS

(1) The rights of all service recipients in a facility may only be modified or limited under the following conditions:

(a) It is demonstrated and documented that a legitimate program purpose cannot reasonably be achieved without such modification or limitation;

(b) No modification or limitation may be made solely for the convenience of facility staff or be more stringent than is necessary to achieve the demonstrated purpose;

(c) Service recipients or representatives of service recipients, as appropriate, must be fully informed of proposed facility rules, policies or procedures modifying or limiting service recipient rights, and of the reasons therefore and must be given an opportunity to object; to propose alternatives; and to consult with family, friends and/or advocacy agencies prior to their implementation;

(d) Facility rules, policies or procedures which modify or limit service recipient rights must be in writing and posted in a conspicuous place. If the service recipients receive services in their homes, they and/or their legally appointed representative shall be provided with a written copy of the proposed rules, policies or procedures; and, (e) The facility is not a Medicaid-reimbursed home and community-based service (HCBS) provider required to comply with the federal home-based and community-based setting final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014).

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.08 MODIFICATION OR LIMITATION OF AN INDIVIDUAL SERVICE RECIPIENT’S

RIGHTS.

(1) The rights of an individual service recipient in a facility may only be modified or limited under the following conditions:

(a) It is demonstrated and documented that such modification or limitation is necessary because of the individual service recipient’s physical or mental condition or inappropriate behavior;

(b) To achieve a legitimate goal in the service recipient’s individual program plan;

(c) No modification or limitation may be made solely for the convenience of staff or be more stringent than is necessary;

(d) The service recipient and/or the service recipient’s legally appointed representative, as appropriate, must be fully informed of the proposed limitation or modification and must be given an opportunity to object, to propose alternatives, and to consult with family, friends, and/or advocacy agencies prior to implementation of the modifications or limitations;

(e) Any modifications or limitations and the reasons therefore must be documented in the service recipient’s record; and, (f) The facility is not a Medicaid-reimbursed home and community-based service (HCBS) provider required to comply with the federal home-based and community-based setting final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014).

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.09 SERVICES OR FACILITIES PROVIDING HOME AND COMMUNITY-BASED

SERVICES.

A facility contracted to provide Medicaid-reimbursed home- and community-based services (HCBS) is required to comply with the federal home-based and community-based setting final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014).

(1) Medicaid-reimbursed individuals receiving HCBS services shall be afforded the rights referenced in 42 C.F.R. 441.301(c)(4) of the HCBS Settings Rule.

(2) The service recipients of an agency contracted to provide Medicaid-reimbursed HCBS residential services have the right to associate and communicate privately with persons of their choice including receiving visitors at any time.

(3) The rights of persons supported in a facility receiving HCBS services may only be modified or limited as provided in the federal home-based and community-based setting final rule, published in the Federal Register at 79 FR 2947 (January 16, 2014).

(a) Any modifications or limitations must be documented in the service recipient’s record or service plan and must:

Identify a specific and individualized assessed need;
Document the positive interventions and supports used prior to any modifications to the person-centered service plan;
Document less intrusive methods of meeting the need that have been tried but did not work;
Include a clear description of the condition that is directly proportionate to the specific assessed need;
Include regular collection and review of data to measure the ongoing effectiveness of the modification;
Include established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;
Include the informed consent of the service recipient or legal representative; and, 8. Include an assurance that interventions and supports will cause no harm to the service recipient.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Tenn. Comp. R. & Regs. 0940-05-06-.10 MINORS RESIDING WITH PARENTS OR GUARDIANS AT A FACILITY

This section applies to facilities who are serving parents or guardians who have a minor child residing with them at the same facility. For the purposes of the Department’s regulations, a minor residing with their parent or guardian at the facility does not meet the definition of a service recipient. These specialized programs provide behavioral health treatment; therapy; parenting skills training; medication management, in settings where allowed; psychosocial services; life skills; and job readiness education.

These settings are supported by professional staff who ensure the safety of children in the environment while their parent or guardian and families work towards sobriety and recovery.

(1) Facilities must notify the Office of Licensure and receive approval in writing before allowing children to reside with their parent or guardian at the facility. The licensure chapters where this model may be in place, post-approval, are limited to the following:

(a) Mental Health Adult Residential Treatment Services;

(b) Mental Health Supportive Living Facilities;

(d) Alcohol and Drug Residential Detoxification Treatment Facilities;

(e) Alcohol and Drug Residential Rehabilitation Facilities; and (f) Adult Supportive Residential Facilities.

(2) The following policy and procedure requirements shall apply when minors are present:

(a) Policies and procedures regarding minor(s) residing with their parent or guardian at the facility which shall include a description of responsibility the facility will undertake related to the care and responsibility for the minor(s), if any.

If the facility will undertake any level of care and responsibility for minor(s) present, it shall ensure it obtains a Child Care license, should such license be required by the appropriate licensing authority.

(b) Policies and procedures addressing needs of school age children, including but not limited to, education and other basic needs.

Pregnancy, perinatal, and postpartum care;
Recognize the importance of family, social networks, and community systems in the therapeutic continuum of care;
Know and address incidents of intimate partner violence (IPV);
Working with interdisciplinary treatment teams to provide integrated care;
Ensure knowledge of maternity care providers within your surrounding communities;
Infant and child first aid, including but not limited to CPR and sleep safety; and 7. Employees assisting minor(s) residing with their parent not capable of selfpreservation during an emergency.

(d) Policies and procedures addressing parenting education for service recipients.

(e) Policies and procedures addressing the parent or guardian’s responsibility for meeting the minor’s basic needs regarding: food, clothing, hygiene, safety, discipline, supervision, and obtaining services in response to a referral made on behalf of the child.

(f) Policies and procedures to address making arrangements for the care of the child at any time when the parent or guardian is not present at the facility or while they are receiving treatment.

(g) Policies and procedures addressing parent-child interaction between staff, parent, and children services in order to provide a safe and healthy environment for service recipients and their children.

(h) Policies and procedures for when a child is present at the facility, including but not limited to the following:

Requirements for whether children must be immunized prior to the admission of the parent or guardian service recipient;
Requirements for whether children must show no signs of illness prior to parent or guardian service recipient admission; and 3. How the facility will ensure children are to continue receiving primary medical care during their stay and their parents/guardian’s admission in the facility;

(i) Facilities shall develop and implement written policies and procedures related to:

The maximum number of children permitted to reside in the facility at one (1) time; and 2. Allowed ranges of age of children permitted to reside in the facility.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, and 33-2-404.
Administrative History: Original rule filed May 28, 2010; to have been effective August 26, 2010. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on July 21, 2010; new effective date November 9, 2010. Withdrawal of amendment filed August 2, 2010. Amendment filed August 30, 2010; to have been effective January 29, 2011. Stay of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on January 29, 2011; new effective date March 7, 2011. Withdrawal of amendment filed by the Tennessee Department of Mental Health and Substance Abuse Services on February 25, 2011. Repeal and new rules filed November 30, 2016; effective February 28, 2017. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Amendments filed February 24, 2026; effective May 25, 2026.

Chapter 0940-05-07 Repealed

Tenn. Comp. R. & Regs. 0940-05-07 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH

AND SUBSTANCE ABUSE SERVICES

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.

Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Chapter 0940-05-08 Repealed

Tenn. Comp. R. & Regs. 0940-05-08-.01 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.10 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.02 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.03 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.04 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.05 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.06 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.07 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.08 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-08-.09 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Chapter 0940-05-09 Repealed

Tenn. Comp. R. & Regs. 0940-05-09-.01 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.10 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.02 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.03 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.04 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.05 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.06 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.07 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.08 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-09-.09 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Chapter 0940-05-10 Repealed

Tenn. Comp. R. & Regs. 0940-05-10-.01 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.11 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988, effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.02 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.03 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.04 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.05 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.06 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.07 REPEALED

History

Authority: T. C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.08 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.09 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-10-.10 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Chapter 0940-05-11 Repealed

Tenn. Comp. R. & Regs. 0940-05-11-.01 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.11 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.02 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.03 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.04 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.05 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.06 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.07 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.08 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.09 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-11-.10 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Chapter 0940-05-12 Repealed

Tenn. Comp. R. & Regs. 0940-05-12-.01 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-12-.03 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-12-.02 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Chapter 0940-05-13 Repealed

Tenn. Comp. R. & Regs. 0940-05-13-.01 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-13-.06 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-13-.02 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-13-.03 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-13-.04 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Tenn. Comp. R. & Regs. 0940-05-13-.05 REPEALED

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed May 19, 2003; effective August 2, 2003.

Chapter 0940-05-14 Minimum Program Requirements for Mental Health Outpatient Facilities

Tenn. Comp. R. & Regs. 0940-05-14-.01 POLICIES AND PROCEDURES FOR OUTPATIENT FACILITIES

(1) The facility must have a written policy and procedures manual which includes the following elements:

(a) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure appropriate treatment has been delivered according to acceptable clinical practice;

(b) A written program description which must be available to staff, clients and members of the public. The description must include, but need not to be limited to, the following:

Services offered by the facility, availability of staff (including medical) to provide services and hours of operation, 2. Characteristics of the person(s) to be served, 3. Referral process, 4. Admission criteria, 5. Re-admission criteria, 6. Facility rules for client, 7. Referral mechanisms for services outside the agency (both medical and nonmedical), 8. Emergency and non-emergency transportation of clients, and 9. Discharge criteria;

(d) If restrictive procedures are used to manage disruptive behaviors, written policies and procedures must govern their use and must minimally ensure the following:

Restrictive procedures will be used by the facility only after all less-restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective, 2. The client must have given written consent to any restrictive measures taken with him/her by the clinical staff, 3. The restrictive procedure(s) must be documented in the Individual Program Plan, be justifiable as part of the plan and meet all requirements that govern the development and review for the plan, 4. Only mental health professionals or mental health personnel may use restrictive procedures and must be adequately trained in their use, and 5. The adaptive or desirable behavior should be taught to the client in conjunction with the implementation of the restrictive procedures; and (e) A policy which states Physical Holding must be implemented in such a way as to minimize any physical harm to the client and may only be used when the client poses an immediate threat under the following conditions:
The client poses an immediate danger to self or others, and/or 2. To prevent the client from causing substantial property damage.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-14-.02 PERSONNEL REQUIREMENTS FOR OUTPATIENT FACILITIES

(1) Provide direct-treatment and/or rehabilitation services by mental health professionals or by mental health personnel who are under the direct clinical supervision of a mental health professional.

(2) Maintain a written agreement with or employ a physician to serve as medical consultant to the facility.

(3) If the physician is not a psychiatrist, the facility must also arrange for the regular, consultative and emergency services of a psychiatrist.

(4) In case of a medical or other type of emergency, the facility staff must have immediate access to relevant information in the client’s record.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-14-.03 CLIENT ASSESSMENT REQUIREMENTS FOR OUTPATIENT FACILITIES

(1) The facility must ensure that the following assessments are completed prior to the development of the Individual Program Plan:

(a) Assessment of current functioning according to presenting problem including a history of the presenting problem:

(b) Basic medical history and information:

(c) A six-month history of prescribed medications, frequently used over-the-counter medications and alcohol and other drugs; and (d) A history of prior mental health and alcohol and drug treatment episodes.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-14-.04 INDIVIDUAL PROGRAM PLAN REQUIREMENTS FOR OUTPATIENT FACILITIES

(1) An Individual Program Plan must be developed for each client which is based on an initial

history and ongoing assessment and which is completed within thirty (30) days of admission.

Documentation of the Individual Program Plan (IPP) must include the following:

(a) The client’s name;

(b) The date of development of the IPP;

(d) Client goals which are related to specified problems identified in the IPP and which are to be addressed by the particular service/program component;

(e) Interventions addressing goals in the IPP;

(f) The signatures of the appropriate staff;

(g) Documentation of client participation in the treatment planning process;

(h) Standardized diagnostic formulation(s), (e.g., DSM-III, ICD-9); and (i) Planned frequency of contacts.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-14-.05 INDIVIDUAL PROGRAM PLAN REVIEW IN OUTPATIENT FACILITIES

The facility must review and, if indicated, revise the IPP every six (6) months.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-14-.06 CLIENT RECORD REQUIREMENTS FOR OUTPATIENT FACILITIES

(1) An individual client record must be maintained which includes the following:

(a) Progress notes which must include written documentation of progress or changes which have occurred within the IPP and which must be developed after each service contact;

(b) Documentation of all drugs prescribed or administered by the facility which indicates date prescribed, type, dosage, frequency, amount and reason;

(c) Narrative summary review of all medications prescribed at least every six (6) months which includes specific reasons for continuation of each medication; and (d) A discharge summary which states, if appropriate, the client’s condition at the time of discharge and signature of person preparing the summary.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Chapter 0940-05-15 Minimum Program Requirements for Mental Health Adult Day Treatment Services

Tenn. Comp. R. & Regs. 0940-05-15-.01 DEFINITION

(1) “Adult Day Treatment Services” means a non-residential program that provides a treatment and/or rehabilitation of at least (3) hours duration per program day for adult service recipients. The program may be provided during the day, evening, or weekend hours. The program may be structured and offer community living skills training, vocational training, assistance with interpersonal relationships and be geared toward moving the service recipient on to a more independent and normal life style. The program may also be unstructured and provide socialization and maintenance to service recipients who might not move on to more independence.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.02 APPLICATION OF RULES FOR MENTAL HEALTH ADULT DAY TREATMENT

SERVICES.

(1) The governing body of an adult day treatment services must comply with the following rules:

(a) Rule 0940-05-04-.03 (2) Life Safety Day Care Occupancy (b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services (c) Chapter 0940-05-06 Minimum Program Requirements for All Mental Health Services (new rules to be filed)

(d) Chapter 0940-05-15 Minimum Program Requirements for Mental Health Adult Day Treatment Services

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.07 ENVIRONMENTAL REQUIREMENTS

(1) The program must provide areas in which different therapeutic and/or educational/training activities can be conducted at the same time.

(2) Each skills-training area must contain and have readily available equipment and supplies, which are appropriate and necessary to conducting skills-training activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.08 MEDICATION ADMINISTRATION

(1) The service recipient's ability and training must be taken into consideration when supervising the administration of medication.

(2) Prescription medications are to be taken only by service recipients for whom they are prescribed, and in accordance with the directions of a physician.

(3) Drugs must be stored in a locked container that ensures proper conditions of security and sanitation and prevents accessibility to any unauthorized person.

(4) Discontinued and outdated drugs and containers with worn, illegible, or missing labels must be discarded.

(5) All medication errors, drug reactions, or suspected overmedication must be reported to the practitioner who prescribed the drug.

(6) Documentation or other tangible evidence of the current prescription of each medication taken by a service recipient must be maintained by the facility.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.03 PERSONNEL REQUIREMENTS

(1) Treatment and/or rehabilitation services must be provided by mental health professionals or by mental health service personnel.

(2) The program must provide access to general medical services either by a written agreement with a medical facility or physician or by employing a physician who is a non-psychiatrist to serve as medical consultant.

(3) The program must maintain a written agreement with a psychiatrist to serve as a psychiatric consultant.

(4) The program must provide at least one (1) staff person on-duty/on-site for each ten- (10) service recipients present. Staff persons counted in the staff-to-service recipient ratio may only be persons who are assigned to provide direct day program services as described by written job description. Support staff such as clerical, housekeeping, van and bus driver staff; students involved in an on-site practicum for academic credit, and volunteers, may not be counted in the staff-to-recipient ratio.

(5) The program must provide at least one on duty staff certified in CPR and trained in First aid and the Heimlich maneuver.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.04 INDIVIDUAL ASSESSMENT REQUIREMENTS

(1) The program must ensure that the following assessments are completed prior to the development of the service recipient Plan of Care:

(a) Assessment of current functioning in the following areas:

Community living skills;
Independent living skills;
Emotional, psychological health;
Educational level (b) Basic medical history and current health information;

(c) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol and/or other drug use; and (d) History of prior mental health and alcohol and drug treatment episodes.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.05 INDIVIDUAL PLAN OF CARE (POC) REQUIREMENTS

(1) A plan must be developed for each service recipient. The plan must be based on initial and on-going assessment of needs and strengths and must be completed within seventy-two (72) hours of admission. Documentation of the plan must be made in the individual's record and must include the following:

(a) The service recipient’s name.

(b) The date of plan development.

(c) Standardized diagnostic formulation(s) including, but not limited to, the current Diagnostic and Statistical Manual (DSM) Axes I-V and/or ICD-9.

(d) Needs and strengths of the service recipient that are to be addressed within the particular service/program component.

(e) Observable and measurable service recipient goals that are related to specific needs identified and which are to be addressed by the particular service/program component.

(f) Interventions that address specific goals and objectives, identify staff and/or service recipient responsibility for interventions, and planned frequency of contact.

(g) Signature(s) of the staff who develop the plan and the primary staff responsible for its implementation, including physician when indicated.

(h) Signature of service recipient (and/or conservator, legal custodian, or attorney in-fact).

Reasons for refusal to sign and/or inability to participate in Plan of Care development must be documented.

(i) Discharge planning that includes a projected discharge date as appropriate and anticipated post discharge needs including documentation of resources needed in the community.

(j) A review of the POC must occur within the first thirty (30) days of service and at least every six months thereafter or upon completion of the stated goal(s) and objective(s) and must include the following documentation:

Dated signature(s) of appropriate treatment staff, including physician; and 2. An assessment of progress toward each treatment goal and/or objective with revisions as indicated; and 3. A statement by the staff psychiatrist or physician of justification for the level of service(s) needed including an assessment of suitability for treatment in a less restrictive environment. Justification for continued services must be documented.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.06 INDIVIDUAL RECORD REQUIREMENTS

(1) The record for each service recipient must contain the following information:

(a) Progress notes which must include written documentation of progress and changes which have occurred within the Plan of Care and, at a minimum, must be developed after each service contact. Progress notes must be dated and minimally include the signature, with title or degree, of the person preparing the note.

(b) Results of assessments required by rule 0940-05-15-.03; and (c) Discharge summary which states, if appropriate, service recipient condition at the time of discharge and signature of staff person preparing the summary.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.09 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-15-.10 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed December 30, 2002; effective March 15, 2003.

Chapter 0940-05-16 Minimum Program Requirements for Mental Health Hospital Facilities

Tenn. Comp. R. & Regs. 0940-05-16-.01 HOSPITAL GOVERNANCE

(1) In addition to meeting rule 0940-05-06-.01 Governance Requirements for All Facilities, a written description of the governing body must be maintained which includes the following:

(a) The organization, lines of authority and responsibilities of the governing body;

(b) The names and addresses of all owners, controlling parties, officers, directors and/or responsible authorities; and (c) The procedures for hiring a Director/Chief Executive Officer who is delegated authority to implement overall policy and day-to-day operations of the facility.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.02 HOSPITAL POLICIES AND PROCEDURES

(1) The governing body must ensure that a written policies and procedures manual is maintained. In addition to meeting the requirements of rule 0940-05-06-.02 Policies and Procedures for all facilities, the manual must include the following elements:

(a) A quality assurance procedure for the assessment of the quality of care. This procedure must ensure appropriate treatment has been delivered according to acceptable clinical practice;

(b) A written program description which must be available to staff, patients and members of the public. The description must include, but need not be limited to, the following:

Characteristics of the persons to be served, 2. Referral process, 3. Program rules for patients, and 4. Referral mechanisms for services outside the facility (both medical and nonmedical); and (c) Procedures to ensure how the patient’s parents, guardian, members of the immediate family or other responsible adult are to be notified in the case of any unusual occurrence including serious illness, accidents or death.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.03 HOSPITAL PERSONNEL REQUIREMENTS

(1) The governing body must ensure the following requirements are met:

(a) Maintain personnel records on all employees which contain, but are not limited to: job title, job application, job qualifications, verification of credentials, performance evaluations, evidence of employee’s professional certification or licensure, and/or appropriate academic degrees when required by the job requirements and date of separation from employment with the facility;

(b) Provide a mechanism for staff development and training which must include, but is not limited to, the following:

Patient rights, 2. Privacy rights and justification for searches and inspections of patients’ person and property, and, 3. Medications and their side effects; and (c) Assure that volunteers, if utilized, are in a supportive capacity under the supervision of an appropriate designated staff member.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.04 HOSPITAL MEDICAL ORDERS

(1) All orders for diagnostic procedures, treatments, medications and transfer or disposition must be recorded legibly in ink or typewritten, dated and signed by the physician, dentist or podiatrist. All telephone orders and oral orders may be taken by licensed nurses. Telephone orders and oral orders may also be taken by allied health specialists who are qualified by training and experience and categorically approved by the medical staff of the facility.

Telephone orders and oral orders must be countersigned by the physician, dentist or podiatrist at the time of the next visit.

(2) Distinction must be made as to whether medication orders are received “orally” or “by telephone”, and the person recording must sign their name and title. No patient must be given medication, special diet, or treatment except upon a physician, dentist or podiatrist’s order taken by either a licensed nurse or an allied health specialist qualified by training and experience and categorically approved by the medical staff of the facility.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.05 HOSPITAL MEDICATION ADMINISTRATION

(1) Medications must be administered only when ordered by a duly licensed physician, dentist, podiatrist, nurses authorized by law, or other professionally educated practitioners functioning under medical protocol and with the approval of the hospital medical staff by laws and governing board of the hospital and in accordance to state law. When medications are administered, the medication and dosage must be checked against the orders. Each dose must be properly recorded in the clinical record.

(2) Written policies must be established to control the administration of toxic or dangerous drugs with specific reference to the duration of the order and dosage.

(3) All medications must be administered by licensed medical or licensed nursing personnel or by other qualified personnel. (Qualified personnel under these rules means a certified or registered respiratory therapist, a radiological technologist, a nuclear medicine technologist, or a certified physician assistant practicing pursuant to a protocol approved by the medical staff of the hospital.) Such qualified personnel may only administer medication within the scope of an established protocol.

(4) Legend drugs must be dispensed only by a licensed pharmacist.

(5) The facility will report medication errors, drug reactions and suspected drug overmedication to the practitioner who prescribed the drugs or the on-call physician in the absence of the prescribing practitioner.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.06 HOSPITAL MEDICATION STORAGE

(1) All medications and other medical preparations intended for internal or external human use must be stored in medicine cabinets or drug rooms. Such cabinets or drug rooms must be kept securely locked when not in use and the key must be in the possession of the supervising nurse or other authorized person.

(2) Schedule II drugs must be stored within two (2) separately locked compartments at all times and accessible only to persons in charge of administering medication.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.07 DISPOSITION OF UNUSED MEDICATIONS IN HOSPITALS

Any unused portions of prescriptions must be either turned over to the patient only on a written authorization including directions by the physician or returned to the pharmacy for proper disposition by the pharmacist.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.08 HOSPITAL PHARMACY REQUIREMENTS

(1) All hospitals must have a licensed pharmacy. In hospitals up one hundred (100) beds the pharmacy must be under the full-time or part-time supervision of a pharmacist licensed to practice in the State of Tennessee. A pharmacy in a hospital of over one hundred (100) beds must be under the supervision of a full-time pharmacist.

(2) The full-time or part-time pharmacist is responsible for the control of all bulk drugs and maintenance of records of their receipts and expenditures. The pharmacist must supervise all dispensing of drugs from the bulk supply, properly label all bottles and make the medications available to the appropriate licensed nursing staff.

(3) The pharmacy must be operated in accordance with applicable Tennessee State Laws.

(4) The pharmacy floor space must be allocated to assure that drugs are prepared in sanitary, well-lighted and enclosed places.

(5) Pharmacy equipment and physical facilities for the proper compounding, dispensing and storage of drugs must be provided.

(6) A library must be maintained with applicable reference books.

(7) All designated areas for drug storage within the facility must be maintained in a sanitary environment, appropriate temperature and ventilation, moisture control, segregation, security and lighting. Refrigeration must be provided for thermolabile drugs in all hospital pharmacies.

(8) The pharmacy must be kept securely locked and vacant if a pharmacist is not on duty.

Arrangements must be made in written policies for provision of drugs by use of night cabinets and in emergency circumstances, by access to the Pharmacy during absence of a pharmacist according to the rules of the Pharmacy Board.

(9) Drugs may be provided by emergency kits provided that such kits meet requirements of the Pharmacy Board.

(10) No drugs must be distributed by the use of the any mechanical device unless the device has been approved by the Pharmacy Board. The approved device must be stocked with drugs only by or under the supervision of a pharmacist.

(11) Drugs which are repacked in the pharmacy for use within the facility must be labeled according to the Pharmacy Board’s requirements.

(12) The pharmacy must be responsible for the preparation, sterilization, labeling and dispensing of parental medications within the facility.

(13) A pharmacist must receive, review and initial a direct copy or an electronic transmission thereof of all medication orders before a drug is dispensed except in an emergency situation.

(14) Drugs dispensed to inpatients must be recorded on patient medication profiles in accordance with standard pharmacy practice. Such records must be maintained as part of the medical record. The institution must maintain a retrievable record of drugs dispensed for at least five (5) years.

(15) All substances and legend drugs that have a potential for abuse must be dispensed and recorded accordingly.

(16) All drugs for patients who are leaving the facility must be dispensed and labeled by a pharmacist.

(17) All discontinued, outdated, defective or deteriorated drugs; drug containers with illegible or missing labels; and recalled drugs are to be returned to the pharmacy for proper disposition.

(18) Whenever patients bring drugs into a hospital facility, such drugs must not be administered unless they can be identified and ordered to be given by a physician. If such drugs cannot be administered, they must be delivered to the pharmacy, packaged, sealed and returned to an adult member of patient’s immediate family or stored in the pharmacy and returned to the patient upon discharge.

(19) A qualified pharmacist must make documented, monthly inspections of all drugs and pharmaceutical materials kept in other areas of the hospital facility.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.09 HOSPITAL PATIENT RECORDS

In addition to meeting rule 0940-05-06-.05 Individual Client Records, the governing body must ensure that the following requirements are met:

(1) A person must be designated to be responsible for supervision of medical records. This person must be a qualified medical records practitioner or receive consultation from a qualified individual.

(2) An individual, separate and complete medical record must be maintained for each patient which includes:

(a) Documentation of any referrals made by the facility and the results of these referrals;

(b) List of the patient’s personal property valued at fifty dollars ($50.00) or more including its disposition, if no longer in use;

(d) Reports of abuse, accidents, seizures, illnesses, treatments for such abuse accidents, seizures and illnesses, immunizations and significant behavior incidents;

(e) Documentation of any instance of seclusion, restraint, or restriction with justification and authorization;

(f) Appropriate consents and authorizations for the release or obtaining of information about the patient including a standardized release of information which contains:

The name and title of the person or organization to which disclosure is to be made, 2. The name of the patient, 3. The purpose or need for the disclosure, 4. The extent and nature of information to be disclosed, 5. A statement that the consent is subject to revocation at any time except to the extent that action has alr eady been taken in reliance thereon and a specification of the date, event, or condition upon which the consent will expire without express revocation, 6. The date on which the consent is signed, and 7. The signature of the patient or the signature of a person authorized to sign in lieu of the patient;

(g) Periodic progress notes which minimally include dates; name of the patient on each page of notes; a brief descriptive statement of the patient’s progress, or lack thereof, toward treatment plan goals; and the signature of the clinician preparing the note.

Frequency of progress notes must be determined by the patient’s condition but must be at least weekly for the first month of hospitalization and monthly thereafter;

(h) A discharge summary completed and authenticated to include the provisional diagnosis, primary and secondary final diagnoses, clinical resume, condition on discharge or transfer and aftercare arrangements. The discharge summary should be recorded at the time of discharge, but no later than fifteen (15) days after discharge;

(i) Reason for admission including presenting problem and referral source;

(j) Documentation of all medication and treatment orders including date of order, type, dosage, frequency and reason. Documentation of administration of medication must also be in the patient record;

(k) Assessments, including at least the following:

Medical history, 2. Psychiatric history and/or chemical dependency assessment, 3. Physical examination (within twenty-four (24) hours of admission and at least annually thereafter), 4. Laboratory and other diagnostic test results when indicated, (l) Sources of financial support including social security, veterans benefits and insurance; and (m) Sources of coverage for medical care costs.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.10 HOSPITAL INDIVIDUALIZED TREATMENT PLANS

(1) An individualized treatment plan must be entered into each patient’s record which is based on the patient’s initial history and ongoing assessment and which is completed within ten (10) days of admission. The individualized treatment plan must include the following:

(a) Patient’s name and case number.

(b) The date of development.

(d) Specific, identified patient problems to be addressed during hospitalization.

(e) Goals addressing each targeted problem.

(f) Specific interventions addressing each goal.

(g) Signature(s) of staff who develop the plan and primary clinician(s) responsible for its implementation.

(2) A review of the individualized Treatment Plan must be completed at least every ninety (90)

days. A narrative summary must be completed which includes the progress or lack thereof toward each individual goal and an updated individualized treatment plan must be completed if indicated by the review.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11,1988

Tenn. Comp. R. & Regs. 0940-05-16-.11 HOSPITAL LABORATORY REQUIREMENTS

(1) The laboratory must be licensed in accordance with the Tennessee Medical Laboratory Act.

All technical laboratory staff must be licensed in accordance with the Tennessee Medical Laboratory Act and must be qualified by education, training and experience for the types of services rendered.

(2) A written and signed report of each laboratory test and examination must be made a part of the patient’s record. There must be a procedure established to allow for effective and immediate communication with the attending physician and other department/services regarding test results, inappropriate specimens, or other consultations.

(3) Laboratory facilities must be provided in keeping with services rendered by the hospital.

Documentation and record keeping must be maintained for tracking and performance monitoring.

(4) Where facilities for performance of post mortem examinations are not available in the hospital, arrangement are to be made with a local undertaker or another hospital where examination may be made.

(5) Provisions through contractual services with a licensed laboratory for specific laboratory services may be granted if the contract source is approved and licensed in accordance with the rules and regulations under the Tennessee Medical Laboratory Act.

(6) All laboratory personnel must have an orientation in infection control policies and employee health at the time of employment. Prior to beginning laboratory studies, the lab personnel must check the readiness, cleanliness and working condition of laboratory equipment. All single service articles will be disposed of after one use. Storage of all laboratory equipment in a clean environment is essential. All personnel involved in laboratory procedures will undergo on-the-job orientation and training with the opportunity for continuing education or they may demonstrate competence in hygiene, infection control, proper cleaning and safe operation of equipment and proper waste disposal. The laboratory must define a traffic control plan.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.12 HOSPITAL RADIOLOGY REQUIREMENTS

(1) Each hospital must provide x-ray facilities for complete diagnostic service consistent with services rendered by the hospital or must have diagnostic x-ray services available by contract (2) If x-ray facilities are provided directly by the facility, the facility must assure the following:

(a) X-ray personnel must be qualified by education, training and experience for the type of service rendered and must be certified as required by chapter 0880-5 of the Rules of the Tennessee Board of Medical Examiners;

(b) All x-ray equipment must be registered with the Tennessee Division of Radiological Health;

(d) Equipment must include radiographic and fluoroscopic equipment with adequate facilities for the developing and reading of x-ray film;

(e) X-rays must be retained for four (4) years and may be retired thereafter provided that a signed interpretation by a radiologists is maintained in the patient’s medical record under T.C.A. § 68-11-305; and (f) Patients, employees and the general public must be provided protection from radiation in accordance with “State Regulations for Protection Against Radiation.” All radiation producing machines must be registered and all radioactive material must be licensed by the Division of Radiological Health.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.13 HOSPITAL INFECTION CONTROL

(1) Infection control policies must be developed that include infection control orientation to protect the hospital employees and patients from cross contamination. The policies must ensure the following:

(a) Isolation of infectious patients from other patients or staff; and (b) Isolation techniques to include gowns, masks and gloves as needed in transporting of infectious patients to and from the Radiology service.

(2) Disinfection of use area and equipment in accordance with infection control policies must be accomplished when infectious patients have been served.

(3) It must be the duty of the Chief Executive Officer or Administrator to assure that an infection control committee including members of the medical staff, nursing staff and administrative staff develop guidelines and techniques for the prevention, surveillance, control and reporting of hospital infections in accordance with hospital rules and regulations. Duties of the committee must include the establishment of:

(a) Written infection control measures;

(b) Techniques and systems for discovering and reporting infections in the hospital;

(d) Written procedures concerning food handling, laundry practices, disposal of environmental and patient wastes, traffic control and visiting rules in high risk areas, sources of air pollution and routing culturing of autoclaves and sterilizers;

(e) A method of control used in relation to the sterilization of supplies and water and a written policy requiring sterile supplies to be reprocessed at specific time periods;

(f) Formal provisions to educate and orient all appropriate personnel in the practice of aseptic techniques, such as handwashing and scrubbing practices, proper grooming, masking and dressing care techniques, disinfecting and sterilizing techniques and the handling and storage of patient care equipment and supplies; and (g) Measures which control the indiscriminate use of preventive antibiotics in the absence of infection and the use of antibiotics in the presence of infection based on necessary cultures and sensitivity tests.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.14 HOSPITAL STAFFING REQUIREMENTS

(1) The governing body of a Mental Health Hospital Facility must provide adequate staff to provide services and activities which are adaptable to the individual needs of patients. The governing body must:

(a) Provide direct-treatment and/or rehabilitation services by qualified personnel or under the direct clinical supervision of such persons;

(b) Ensure that psychiatric services are provided by psychiatrists or by physicians in consultation with a psychiatrist;

(d) Provide a direct-care staffing level of at least two (2) direct-care staff members on duty/on site per ward per shift with at least one (1) nurse per building per shift.

Supervision by a Registered Nurse must be provided at the facility on a twenty-four (24) hours per day basis;

(e) Provide an adequate number of activity therapy staff to provide therapeutic activities on days, evenings, weekends and holidays; and (f) Assure that diagnostic services are provided by a psychiatrist, a clinical psychologist, or an addictionologist, where applicable.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.15 HOSPITAL CENTRAL STERILE SUPPLY AND CONTROL

(1) Sterilizing equipment must be under the supervision of a qualified individual. This qualification consists of a working knowledge of basic bacteriology and principles of sterilization gained through education and experience.

(2) Sterilizer function must be checked by bacterological, mechanical and chemical indicators.

(3) Autoclave functions will be monitored daily by use of mechanical and chemical indicators.

Autoclaves equipped with vacuum pumps must be monitored once daily with an appropriate test to verify proper mechanical function. Biological testing must be conducted a minimum of once weekly using a heat-resistant, spore-forming organism.

(4) Ethylene oxide sterilizers must be checked with mechanical and chemical indicators to verify proper operation of the sterilizer. In addition, each cycle of the sterilizer must be tested with a suitable bacteria.

(5) All bacteria must be cultured at the temperature recommended by the supplier.

(6) Precautions must be taken so that soiled supplies cannot contaminate sterile supplies. Sterile supplies must be packaged and stored in a manner that will protect the sterility of the contents. There must be separation between decontamination and preparation areas.

(7) Infection control policies and procedures must be developed pertaining to the control of infection by screening and treatment of sick employees and orientation of all central supply personnel in aseptic techniques and in the prevention of contamination through the handling, cleaning and sterilizing of contaminated supplies and equipment.

(8) All packages or containers must be appropriately labeled. If processed by sterilizing, the label must remain legible. In addition, the label must contain an expiration date.

(9) A written policy governing expiration dates and procedures for collecting out-of-date or recalled supplies must be formulated.

(10) Storage must be provided for keeping equipment and supplies in a clean, convenient and orderly manner.

(11) In lieu of closed storage spaces, dust covers sealed to exclude outside air may be used.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.16 HOSPITAL LAUNDRY PLAN REQUIREMENTS

(1) The laundry facility within the hospital must comply with the following:

(a) It must be provided with an area for receiving, processing, storing and distributing of clean linens;

(b) It must be located in an area that must not require transportation for storage of soiled or contaminated linen through food preparation area, food storage area, or dining area;

(c) It must be provided with a ventilation system to include adequate air intake, filtration, exchange rate and exhaust to minimize microbial dissemination into the hospital environment.

(d) Space must be provided for receipt and holding of soiled linen with a ventilation system and exhaust system that must minimize odor and microbial dissemination into the hospital environment;

(e) Space must be provided for storage of clean linen within nursing units and for bulk storage within a clean area of the hospital;

(f) The laundry must be constructed of a material that may be cleaned and disinfected routinely; and (g) Carts, bags, or other acceptable containers must be provided and appropriately marked to identify those used for soiled linen and those used for clean linen to prevent dual utilization of the equipment and cross contamination.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.17 HOSPITAL LAUNDRY MANAGEMENT

(1) The Chief Executive Officer or Administrator of the hospital must appoint a person to manage the laundry and linen service who is qualified for the position by education, training and experience.

(2) The supervisor of the laundry must be responsible for the following:

(a) Establishing a laundry service within the hospital or by a contract service that provides the hospital with sufficient, clean, sanitary linen at all times;

(b) Knowing and enforcing infection control rules and regulations for the hospital laundry service;

(c) Conducting a training or orientation course and maintaining a record of same to assure that all laundry-service employees are familiar with the appropriate infection control procedures;

(d) Assuring that collecting, packaging, transporting and storage of soiled, contaminated and clean linen is accomplished in accordance with the appropriate infection control

rule, regulation and procedure;

(e) Assuring that any contract laundry service complies with infection control rules, regulations or procedures to prevent microbial dissemination within the hospital or to the public. Periodic inspections of the contract laundry facility must be conducted by the hospital; and (f) Being a member of the infection control committee or reporting to the staff relative to unusual infection control circumstances in writing.

(3) Bacterial checks of the laundry, storage areas and clean linen must be accomplished by the hospital laboratory staff when a need is demonstrated and recorded. Reports to the infection control staff of the findings must be accomplished by the laboratory staff.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.18 HOSPITAL MAINTENANCE AND HOUSEKEEPING PLAN REQUIREMENTS

(1) The hospital must be provided with space and facilities for housekeeping equipment and supply storage in each service area of the hospital. A bulk storage area for storage of housekeeping supplies must be provided in other than patient care areas.

(2) The hospital must have a written plan for the provision of an emergency water supply.

(3) The building must be kept in good repair, clean, sanitary and safe at all times.

(4) Mechanical and electrical equipment must be maintained in good repair and operating condition at all times.

(5) The hospital must be provided with an appropriate method for disposal of waste.

Accumulation of waste material must be disposed of routinely as needed to maintain a clean and safe environment.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.19 HOSPITAL MAINTENANCE AND HOUSEKEEPING MANAGEMENT

(1) Employees must participate in an education program on infection control and employee health. This program must include appropriate methods for working in the isolated environment and documentation and understanding of the care of the contaminated tools and equipment.

(2) The Chief Executive Officer or Administrator of the hospital must appoint a person to supervise housekeeping who is qualified for the position by education, training and experience.

(3) The supervisor of housekeeping must have the following responsibilities:

(a) Organizing and coordinating the hospital’s housekeeping service to provide a safe and hygienic environment for patients and staff;

(b) Acquiring and storing sufficient supplies and equipment to maintain the hospital in a clean and sanitary condition at all times;

(c) Having knowledge of infection control rules, regulations and guidelines adopted for guidance for hospital housekeeping by departments or services; and (d) Responsibility for the cleaning and sanitary condition of the hospital. The cleaning must be accomplished in accordance with the infection control rules and regulations herein and any departmental guidelines or policies adopted by the hospital.

(4) All housekeeping staff must receive training or orientation in the infection control rules and regulations herein and guidelines and policies required in special areas established by the hospital.

(5) Policies and procedures for each department regarding infection control must be maintained and adhered to by the housekeeping department. These policies and procedures must include, but not be limited to, items such as fluid and wet vacuuming, wet mopping techniques, linen service, handling of soiled linens, handling of linen washing and drying, trash collection and incinerations of refuse and cleaning of all areas within the hospital.

Policies must be maintained in this department that would include disposal of contaminated waste products. A documentation of supplies used for cleaning and cleaning schedules must be maintained within the department. Specific policies regarding cleaning of isolation areas must be maintained within this department. All housekeeping employees must have an orientation that includes infection control policies and procedures with specific reference to their department and employee health.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.20 CHEMICAL DEPENDENCY TREATMENT UNITS IN HOSPITALS

To provide a chemical dependency treatment unit as a separate unit in a Mental Health Hospital Facility, the service must be devoted exclusively to the care and treatment of alcohol and/or drug dependency patients. The unit must be under the care of physician(s) qualified in addictionology (the diagnosis and treatment of alcoholism and drug addiction). Other professional personnel utilized in direct patient care should also be qualified in the diagnosis and treatment of chemical dependency. Facilities must be provided to offer protection for the patients and staff against any physical injury resulting from a patient becoming disturbed or violent. Adequate facilities and personnel must be provided for safe, medical detoxification and a procedure available so that a patient can be transferred to an intensive care unit should such care become necessary.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.21 USE OF SECLUSION OR RESTRAINTS IN HOSPITALS

(1) Seclusion or restraint must not be imposed as punishment, as a convenience for staff, or as a substitute for habilitative or rehabilitative programs. The owner or operator must ensure that seclusion or restraint is imposed only in accordance with the following:

(a) Seclusion or restraint is only to prevent injury to self or others or to prevent serious disruption of the therapeutic environment. Only current behavior may justify use of seclusion or restraint;

(b) Seclusion or restraint must be ordered by a physician following assessment of the need for seclusion or restraint. In emergency situations, other trained clinical professionals may initiate seclusion or restraint prior to obtaining an order. Seclusion or restraint cannot be ordered on a PRN basis;

(c) Justification of the need for seclusion or restraint must be documented in the patient’s record and must reflect that less-restrictive measures were deemed inadequate;

(d) Seclusion or restraint must be discontinued when other less-restrictive interventions will achieve the same results or when the behavior which led to the seclusion or restraint is under control;

(e) Seclusion or restraint must not be used in a manner which causes physical discomfort, harm or pain to the patient;

(f) Regular attention must be given to patients while in seclusion or restraint in regard to meals, clothing, toileting and exercise of restrained extremities;

(g) Seclusion rooms must be clean, dry, comfortable and not contain anything with which the patient might harm self or others. Seclusion rooms must be designed so that the entire room is visible from the door window (h) Restraint must be imposed in an area as private as possible; and (i) All uses of seclusion or restraint must be reviewed regularly by the Chief Executive Officer or designee.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.22 USE OF ELECTROCONVULSIVE THERAPY

(1) Facilities which provide or arrange for electroconvulsive or other convulsive therapy must ensure the following:

(a) Written informed consent must be obtained from the patient or guardian. Consent may be withdrawn at any time. Provision of electroconvulsive therapy to minors must be in accordance with T.C.A. § 33-3-201;

(b) Clinical justification for the use of electroconvulsive or other convulsive therapy must be documented in the patient’s record and must reflect consideration of other, lessintrusive therapies; and (c) Electroconvulsive or other convulsive therapy must be ordered by a psychiatrist or in consultation with a psychiatrist if the attending physician is not a psychiatrist.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.23 USE OF PSYCHOSURGERY

(1) Facilities which perform or arrange for psychosurgery or other surgical procedures for the intervention in or alteration of a mental, emotional, or behavioral disorder must assure the following:

(a) Written, informed consent must be obtained from the patient or guardian. Consent may be withdrawn at any time. Psychosurgery or other surgical procedures may not be performed on minors;

(b) Clinical justification for the use of psychosurgery or other surgical procedures must be documented in the patient’s record and must reflect consideration of other lessintrusive treatments; and (c) The decision to perform psychosurgery or other surgical procedures must be made following consultation with a psychiatrist and a neurosurgeon.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.24 USE OF PHYSICAL HOLDING IN HOSPITALS

(1) Physical holding must be used only when less-restrictive methods have been attempted and must be implemented in such a manner so as to minimize any physical harm to the patient.

Physical holding can only be used under the following conditions:

(a) To prevent injury to self or others;

(b) To prevent substantial property damage;

(c) To prevent serious disruption of the therapeutic environment; and (d) In transporting patients to the seclusion room, restraint area, or time out area.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.25 USE OF RESTRICTIVE BEHAVIOR MANAGEMENT IN HOSPITALS

(1) The use of restrictive behavioral interventions to treat maladaptive behaviors must follow the following guidelines:

(a) The facility must have clearly defined, written rules for patients that set limits of behavior. Patients must be given copies of these rules upon admission;

(b) The use of restrictive contingencies must be under the supervision of a clinical professional and must be included as part of the patient’s treatment plan. If, as part of the treatment philosophy, the patient group is involved in setting consequences, this must be subject to the approval of the treatment team;

(c) Patients must not be denied food, treatment activities, religious activities, mail, or contact with family as consequences of behavior;

(d) Positive and/or non-restrictive procedures must be attempted prior to implementing a restrictive contingency;

(e) Contributing environmental factors that may promote maladaptive behaviors must be identified and a program to eliminate or minimize these effects must be implemented.

(f) As the intrusiveness of the procedure increases, so should the frequency and intensity of review increase;

(g) Positive or desirable behavior must be taught to the patient in conjunction with the implementation of the restrictive procedure;

(h) Staff must be adequately trained in the implementation of the procedure; and (i) Behavior-modification procedures which use painful stimuli must be implemented only with the written, informed consent of the patient or guardian. The patient’s record must reflect the clinical justification of such procedures and the consideration of lessaversive interventions.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.26 HOSPITAL EMERGENCY SERVICES REQUIREMENTS

(1) All direct-care staff must be provided training to handle emergency medical and mental health situations.

(2) Emergency policies and procedures must be reviewed at least annually by all staff.

(3) Personnel must be available during all shifts in all phases of the facility who are trained in administering first aid, the Heimlich maneuver and cardiopulmonary resuscitation.

(4) First aid kits must be available to facility staff at all times. Contents of the kits must be selected by nursing staff or medical staff and must include items designed to meet the needs of the facility.

(5) If patients are transferred to another facility for emergency medical care, the Mental Health Hospital Facility must arrange for the patient to continue to receive treatment for his/her mental health problem.

(6) Names and phone numbers of all staff to be contacted in emergency situations must be clearly posted in all patient care areas.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.27 CONTRACTED FOOD SERVICE REQUIREMENTS FOR HOSPITALS

When food service is provided on a contract basis by an outside food management company, the company must comply with all applicable licensing rules and regulations and provide for constant liaison with the hospital medical staff for recommendations on dietetic policies affecting patient treatment.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.28 HOSPITAL FOOD SERVICE PERSONNEL REQUIREMENTS

(1) When food service is provided by the facility, it must be under the direction of a qualified food service manager. The food service nutritional aspect must be the responsibility of a qualified dietitian employed by the facility on either a full-time, part-time, or consultative basis.

(2) The facility must employ an adequate number of food service staff to perform effectively all defined functions. This includes cooks, bakers, dishwashers, clerks and supervisors appropriate in number to meet the needs of the facility and provide coverage for all hours of food service operation.

(3) No person while known to be infected with any disease in a communicable form; or while known to be a carrier of such disease; or while known to be afflicted with boils, wounds, sores, or an acute respiratory infection must work in any area of the food service department in any capacity which there is a likelihood of such person contaminating food or food contact surfaces with pathogenic organisms or transmitting disease to other individuals.

(4) All employees must wear clean garments, maintain a high degree of personal cleanliness and conform to hygienic practices while on duty. They must wash their hands thoroughly in a handwashing facility meeting the requirements of rule 0940-05-16-.33(2) before starting work and as often as necessary to remove soil and contamination. No employee must resume work after visiting the toilet room without first washing his/her hands.

(5) All persons engaged in the preparation of food for patients must have a current health evaluation. Food handlers’ hair must be appropriately covered.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.29 NUTRITION IN HOSPITAL PATIENT CARE

(1) A minimum of three (3) meals in each twenty-four (24) hour period must be served. A supplemental night meal must be served if more than fifteen (15) hours lapse between supper and breakfast. Additional nourishments must be provided to patients with special dietary needs.

(2) Menus must be written at least a week in advance and must meet the nutritional needs of the patient in accordance with the current recommended dietary allowances of the Food and Nutrition Board, National Research Council and in accordance with the physician’s orders.

(3) Standardized recipes must be used so that the food is properly prepared. Modified or therapeutic diets must be prescribed by written orders by the physician.

(4) A current therapeutic diet manual approved by the dietary and medical staff must be readily available to all medical, nursing and food service personnel.

(5) The dietitian must be responsible for the development of a nutritional care plan in compliance with the physician’s order to meet the needs of the patient for the maintenance of health, prevention of disease and treatment through diet modification and normal nutritional counseling.

(6) The dietitian must correlate and integrate the dietary aspect of patient care with the patient and the patient’s chart through such methods as patient instruction, recording diet histories, progress notes, nutritional care plans and participation in treatment team meetings.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.30 FOOD PROCUREMENT IN HOSPITALS

All food approved by the hospital’s food service department must be from sources approved or considered satisfactory by the food service department and must be clean, wholesome, free from spoilage, free from adulteration and misbranding and safe for human consumption. No food which has been processed in a place other than a commercial food processing establishment must be used.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.31 FOOD PROTECTION IN HOSPITALS

All food while being stored, prepared, displayed, served or sold in the food service department or during transportation must be protected from all sources of contamination. Frozen foods must be thawed under refrigeration, under running water or cooked from the frozen state. All perishable food must be stored at such temperatures as appropriate to protect it against spoilage. All potentially hazardous food must be maintained at safe temperatures except during necessary periods of preparation and service. Raw fruits and vegetables must be washed before use. Stuffed poultry and meats must be stuffed immediately before cooking. Pork products and poultry must be cooked until well done before serving. Individual portions of food, once served, must not be served to a patient again.

(1) Dry or staple food items must be stored in accordance with standard dry food storage techniques. Shelves must be at least six (6) inches off the floor to facilitate cleaning and adequate ventilation. The room provided for storage of dry or staple food items must be ventilated and must not be subject to sewage or waste water back flow. Poisonous or toxic materials must not be stored in areas with food supplies. Clothing of any kind must not be kept or stored in the kitchen areas where food is kept. Separate janitor closets are recommended for care of kitchen and dining areas. The food products must be protected from contamination caused by condensation, leakage, mopping, insects, rodents, or vermin.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.32 HOSPITAL FOOD SERVICE EQUIPMENT AND UTENSILS

(1) There must be space in the dietary department to store food separately from nonfood supplies, prepare and distribute food, maintain appropriate references for personnel, and meet compliance with federal, state and local sanitation and safety laws and regulations.

(2) All equipment and utensils must be so designed and of material and workmanship as to be smooth, easily cleaned and durable and must be in good repair; and the food contact surfaces of such equipment and utensils must, in addition, be easily accessible for cleaning, non-toxic, corrosion resistant and relatively non-absorbent.

(3) All equipment must be so installed and maintained as to facilitate the cleaning thereof and of all adjacent areas. Lighting in food service and storage areas must have proper protective shields.

(4) Single service articles, plastic ware, disposable containers and utensils must be made from non-toxic materials and must be discarded after use.

(5) Kitchen, dining, storage and serving areas must be maintained in a clean and sanitary manner. Traffic of unauthorized individuals through food preparation and service areas must be prohibited.

(6) All reusable eating and drinking utensils must be thoroughly cleaned and sanitized after usage with approved cleaning agents and equipment.

(7) All kitchenware, food cutting boards and food contact surfaces of equipment, exclusive of cooling surfaces of equipment, used in the preparation of serving of food or drink and all food storage utensils must be thoroughly cleaned after each use. Cooking surfaces of equipment must be cleaned every twenty-four (24) hours. All utensils and food contact surfaces of equipment used in the preparation, service, display, or storage must be thoroughly cleaned and sanitized prior to each use. Non-food contact surfaces of equipment must be cleaned at such intervals as to keep them in a clean and sanitary condition.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.33 HOSPITAL FOOD SERVICE PLAN REQUIREMENTS

(1) Dishwashing procedures must be well developed and carried out in compliance with state and local health codes. There must be a physical barrier separating dishwashing areas from food service areas. There must be periodic checks at established intervals to:

(a) Detergent dispenser operation;

(b) Washing, rinsing and sanitizing temperatures and cleanliness of machines and jets; and (c) Thermostatic controls, temperatures checked daily and a log maintained.

(2) A handwashing lavatory with knee or foot controls or wrist blades must be located in the kitchen and an approved sanitary disposable towel vendor near the lavatory must be provided. No mirror must be provided at this location. Bacteriostatic or approved soap detergent must be provided.

(3) The food service departments must be provided with an adequate, conveniently located toilet and lavatory facilities for its employees. They must be kept in clean condition and good repair. Toilet doors must have an automatic door close and must not open into the kitchen area.

(4) All garbage and rubbish containing food wastes must, prior to disposal, be kept in leakproof, nonabsorbent containers which must be kept covered with fitting lids when filled, stored, or not in continuous use. All other rubbish must be stored in a closed container. All garbage and rubbish must be disposed of with sufficient frequency and in such a manner as to prevent an unsanitary condition or a nuisance.

(5) Effective measures must be taken to protect the food service department and facility against the entrance into or presence of vermin or rodents.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-16-.34 HOSPITAL PATIENT RIGHTS

(1) The governing body must support, protect and enhance the constitutional and statutory rights of all recipients of services. The governing body must have provisions to ensure the protection of patient rights.

(2) A written description of the patient’s rights must be provided to all individuals receiving services. This must include their right to:

(a) Grievance and appeal procedures;

(b) Respectful, professional attention to any problem which falls within the scope of services provided by the facility;

(d) Confidentiality of communications by the patient to staff and all information in the case record;

(e) Access to any information about the patient kept by the agency, unless it is documented that it is therapeutically a disadvantage to the patient;

(f) Participate in the development and review of an individual treatment plan;

(g) Be informed about the course of treatment; and (h) Give informed consent to treatment.

(3) Each patient, within twenty-four (24) hours of admission to a facility, must be provided an orientation which includes minimally the following:

(a) Explaining the facility’s services, activities, performance expectations, rules and regulations including providing to the patient the program description (if applicable);

(b) Familiarizing the patient with the facility’s premises;

(c) Introducing the patient to the direct-care and professional staff responsible for his/her care; and (d) Explaining patient rights and grievance procedures.

(4) Facilities must not require patients to perform services for the facility which are ordinarily performed by the staff except under the following conditions:

(a) The work is part of the individual treatment plan;

(b) The work is performed voluntarily;

(c) The patient receives wages commensurate with the economic value of the work; and (d) The work project complies with federal, state and local laws and regulations.

Routine self-care and domicailiary activities that the patient would be expected to perform at this own home are not considered as work.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Chapter 0940-05-17 Minimum Program Requirements for Mental Health Adult Residential Treatment Services

Tenn. Comp. R. & Regs. 0940-05-17-.01 DEFINITION

(1) “Adult Residential Treatment Program” means a mental health treatment program that offers 24 hour intensive, coordinated, and structured services for adult service recipients within a non-permanent therapeutic milieu that focuses on enabling a service recipient to move to a less restrictive setting.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.02 APPLICATION OF RULES FOR MENTAL HEALTH ADULT RESIDENTIAL

TREATMENT PROGRAM.

(1) The governing body of an adult residential treatment program must comply with the following rules:

(a) Rule 0940-05-04-.02 (2) Life Safety Board and Care Occupancy (b) Chapter 0940-05-05 Adequacy of Program Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Mental Health Services (new rules to be filed), (d) Chapter 0940-05-17 Minimum Program Requirements for Mental Health Adult Residential Treatment Program

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.03 PERSONNEL AND STAFFING REQUIREMENTS

(1) Treatment and rehabilitation services must be provided by mental health professionals or mental health personnel and under the direct clinical supervision of a licensed mental health professional.

(2) The program must provide access to medical services via a written agreement or employment of a licensed physician.

(3) If the physician is not a psychiatrist, the program must arrange for the regular, consultative, and emergency services of a licensed psychiatrist;

(4) During normal waking hours, all programs must provide a least one (1) on-duty/on-site staff person for every ten (10) service recipients present in the program. Staff persons counted in the staff-to-service recipient ratio may only be persons who are assigned to provide direct program services as described by written job description. Support staff such as clerical, housekeeping, van and bus driver staff; students involved in an on-site practicum for academic credit; and volunteers may not be counted in the staff-to-recipient ratio. During normal sleeping hours, all programs must provide one (1) on-duty/on-site staff in each building where service recipients are housed; and in any building housing more than ten (10) service recipients, programs must provide one (1) additional on-duty/on-site staff for each additional ten (10) service recipients.

(5) The program must provide a ratio of one (1) on-site, on-duty direct-treatment staff member to ten (10) service recipients for not less than three (3) hours of treatment/rehabilitation services on site per week day.

(6) The program must provide at all times at least one (1) on-duty staff member certified in cardiopulmonary resuscitation (CPR) and trained in First aid, and the Heimlich maneuver.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.04 OTHER SERVICES

(1) The program must arrange access to qualified dental, medical, nursing, and pharmaceutical care for service recipients of the program on a twenty-four (24) hours per day and seven (7) days a week basis. Service recipients or their families may choose a personal professional for non-emergency services.

(2) The program must insure that each service recipient has had a physical examination within the six (6) months prior to admission or within thirty (30) days after admission. Such examinations should include routine screenings (such as vision and hearing) and laboratory examinations (such as Pap smear and blood work), as determined necessary by the physician, and special studies where the index of suspicion is high and thereafter as often as indicated by the service recipient’s physician.

(3) In consultation with the service recipient/guardian/conservator, the program must arrange access for each service recipient for ongoing mental health services not provided by the program and assist the service recipient in keeping appointments and participating in such treatment programs. Documentation of such referrals must be kept in the service recipient’s record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.05 EMERGENCY SERVICES

(1) Program must arrange care for emergency services on a twenty-four (24) hours per day and seven (7) days a week basis.

(2) The program must provide direct or telephone access to at least one (1) Tennessee licensed mental health professional twenty-four (24) hours a day seven (7) days a week. If the professional is not a psychiatrist, the program must also arrange for the regular, consultative, and emergency services of a psychiatrist.

(3) The program must provide back-up coverage by staff trained to handle acute psychiatric problems on a twenty-four (24) hours per day and seven (7) days per week on-call basis.

(4) The program must secure emergency services for service recipients who pose an imminent physical danger to themselves or others.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.06 INDIVIDUAL RECORD REQUIREMENTS

(1) The record maintained for each service recipient must include the following information:

(a) Progress which must include written documentation of progress and changes which have occurred within the Plan of Care and, at a minimum, must be recorded daily.

Progress notes must be dated and minimally include the signature, with title or degree, of the person preparing the note;

(b) A list of each service recipient’s personal property valued at one hundred ($100.00) or more, including its disposition if no longer in use;

(c) Narrative summary review of all medications prescribed at least every six (6) months, which includes specific reasons for continuation of each medication.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.07 ASSESSMENT REQUIREMENTS

(1) The facility must ensure that the following assessments are completed prior to the development of the service recipient's Plan of Care:

(a) Current assessment of functioning according to presenting problem(s), including a

history of the presenting problem, and assessments in the following areas:

Community living skills, 2. Educational level;
Independent living skills, and 4. Emotional psychological health;

(b) Current diagnosis and DSM axis (I-V);

(c) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol and other drug use.

(d) History of prior mental health and alcohol and drug treatment episodes.

(e) Basic medical history and information.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.08 PLAN OF CARE REQUIREMENTS

(a) The service recipient’s name.

(b) The date of plan of care development.

(c) Standardized diagnostic formulation(s) including, but not limited to, the current Diagnostic and Statistical Manual (DSM) Axes I-V and/or ICD-9.

(d) Needs and strengths of the recipient that are to be addressed within the particular service/program component.

(e) Observable and measurable individual goals that are related to specific needs identified and which are to be addressed by the particular service/program component.

(f) Interventions that address specific goals and objectives, identify staff responsible for interventions, and planned frequency of contact.

(g) Signatures(s) of treatment staff who develop the plan and the primary staff responsible for its implementation, including physician when appropriate.

(h) Signature of service recipient (and/or conservator legal custodian, or attorney in-fact).

Reasons for refusal to sign and/or inability to participate in Plan of Care development must be documented.

(i) Discharge planning that includes a projected discharge date and anticipated post discharge needs including documentation of resources needed in the community.

(j) A review of the Plan of Care must occur at least every thirty days after development of the Plan of Care and every thirty days thereafter and must include the following documentation:

Dated signature(s) of appropriate treatment staff, including physician; and 2. An assessment of progress toward each treatment goal and/or objective with revisions as indicated; and 3. A statement by the staff psychiatrist or physician of justification for the level of services(s) needed; and 4. An assessment of suitability for treatment in a less restrictive environment must be part of the review process.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.09 MANAGEMENT OF DISRUPTIVE BEHAVIOR

(1) Policies addressing the methods for managing service recipients’ disruptive behavior must include the following:

(a) Post incident debriefing for staff and service recipient.

(b) Service recipient Program Plan modification as indicated.

(c) Teaching the adaptive or desirable behavior to the service recipient in conjunction with the implementation of the procedures.

(d) Physical holding must be implemented in such a way as to minimize any physical harm to the service recipient and may only be used when the service recipient poses an immediate danger to self or others. Physical holding may be used only until the service recipient is calm.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.10 SERVICE RECIPIENT RIGHTS

(1) Service recipients must be allowed to use their personal funds directly or allow the service recipient’s representative payee or other legally authorized person acting on behalf of the service recipient to purchase incidentals and special needs items.

(2) Each service recipient must be allowed to possess and use his/her own money unless otherwise indicated by the service recipient's Plan of Care.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.11 MEDICATION ADMINISTRATION

(1) The service recipient’s ability and training must be taken into consideration when supervising the self-administration of medication.

(2) Prescription medications are to be taken only by service recipients for whom they are prescribed, and in accordance with the directions of a physician.

(3) Medications must be stored in a locked container which ensures proper conditions of security and sanitation and prevents accessibility to any unauthorized persons.

(4) Discontinued and outdated medications and containers with worn, illegible, or missing labels must be disposed.

(5) It must be documented and reported to practitioners who prescribed the medication, all medication errors, drug reactions, or suspected overmedication.

(6) Evidence of the current prescription of each medication taken by a service recipient must be maintained by the program.

(7) All direct-service staff must be trained about medications used by service recipients. This training must include information about the purpose and function of the medications, their major side effects and contraindications, and ways to recognize signs that medication is not being taken or is ineffective.

(8) Staff must have access to medications at all times.

(9) All medications must be administered by licensed medical or licensed nursing personnel or by other qualified personnel. (Qualified personnel under these rules means a certified or registered respiratory therapist, a radiological technologist, a nuclear medicine technologist, or a certified physician assistant practicing pursuant to a protocol approved by the medical staff.) Such qualified service personnel may only administer medication within the scope of an established protocol.

(10) Schedule II drugs must be stored within two (2) separately locked compartments at all times and be accessible only to staff in charge of administering medication.

(11) All medications and other medical preparations intended for internal or external human use must be stored in medicine cabinets or drug rooms. Such cabinets or drug rooms must be kept securely locked when not in use and the key must be in the possession of the supervising nurse or other authorized staff. Locks in doors to medicine cabinets and drug rooms must be such that they require an action on the part of staff to lock and unlock.

(12) Staff must document each time a service recipient self-administers medication or refuses a medication. This documentation must include the date, time, medication name, dosage as well as over the counter medication. This documentation must be made on the medication log sheet in the service recipient's chart.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.12 RECREATIONAL ACTIVITIES

(1) The program must ensure that opportunities are provided for recreational activities which are appropriate to and adapted to the needs, interests, and ages of the service recipients being served.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-17-.13 HEALTH, HYGIENE, AND GROOMING

(1) The program must assist service recipients in the independent exercise of health, hygiene, and grooming practices.

(2) The program must assist each service recipient in securing an adequate allowance of personally-owned, individualized, clean, and seasonal clothes that are the correct size.

(3) The program must assist and encourage service recipients in the use of dental, physical prosthetic appliances and visual aids.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed December 30, 2002; effective March 15, 2003.

Chapter 0940-05-18 Minimum Program Requirements for Mental Health Crisis Stabilization Unit Facilities

Tenn. Comp. R. & Regs. 0940-05-18-.01 DEFINITION

(1) “Crisis Stabilization Unit” (CSU) means services specifically designed for service recipients eighteen (18) years and older in need of short-term stabilization, up to ninety-six (96) hours, who do not meet the criteria for other treatment resources, other less restrictive treatment resources are not available, or the service recipient is agreeable to receive services voluntarily at the CSU and meet admission criteria. If necessary, in order to assure that adequate arrangements are in place to allow for the safe discharge of the service recipient, the length of stay may be extended by up to twenty-four (24) hours.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-18-.02 APPLICATION OF RULES FOR MENTAL HEALTH CRISIS STABILIZATION UNIT

FACILITIES.

(1) Applicable occupancy rules found in 0940-05-04: Life Safety Health Care Occupancies for facilities providing services for four (4) or more service recipients who are not capable of selfpreservation; Life Safety Board and Care Occupancies for facilities providing services to four (4) or more service recipients; or Life Safety One- and Two-Family Dwellings Occupancies for facilities providing services to two (2) or three (3) service recipients;

(2) If services are to be provided in a facility meeting the requirements for Board and Care or One- and Two-Family Dwelling Occupancy and services are provided to one (1) or more mobile non-ambulatory service recipients, then Rule 0940-05-04-.09(2) Mobile Non- Ambulatory rule;

(3) Applicable rules for Adequacy of Facility Environment and Ancillary Services found in 0940- 05-05;

(4) Applicable Minimum Program Requirements for all Facilities found in 0940-05-06;

(5) Minimum Program Requirements for Mental Health Crisis Stabilization Unit Facilities found in 0940-05-18; and (6) Requirements for the Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities found in 0940-03-09.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-18-.03 POLICIES AND PROCEDURES FOR CRISIS STABILIZATION UNIT FACILITIES

(1) The program must maintain written policies and procedures in accordance with Chapter 0940-05-06. In addition, policies and procedures must include:

(a) Policies which address the procedure for the prescription and administration of psychotropic medications, including policies and procedures for determining lack of capacity to consent to treatment.

(b) Policies and procedures for referral to services outside the program.

(d) Policies and procedures for procuring medical treatment or monitoring primary physician medications of service recipients while in the crisis stabilization program.

(e) Policies and procedures related to Treatment Review Committee responsibilities under TCA 33-6-107.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003.

Tenn. Comp. R. & Regs. 0940-05-18-.04 PERSONNEL AND STAFFING REQUIREMENTS IN CRISIS STABILIZATION UNIT

FACILITIES.

(1) The program must have a designated director or administrator who is responsible for the management and operation of the facility.

(2) A qualified prescriber, who is authorized to prescribe medications by the Tennessee Board of Medical Examiners or the Tennessee Board of Nursing, must provide general medical services, prescription of medications and treatment. If the qualified prescriber is not a psychiatrist, the qualified prescriber must have psychiatric expertise, as defined by training, education or experience with consultation available from a psychiatrist. The qualified prescriber must be on call twenty-four (24) hours per day and must make daily rounds.

(3) At least one registered nurse, nurse practitioner or physician assistant must be on duty and in program twenty-four (24) hours per day, 7 days per week.

(4) The on-site and in program ratio of mental health personnel must not be less than one (1) full time equivalent (FTE) staff for every five (5) service recipients present. At no point shall there be fewer than two (2) staff present, one (1) of whom must be staff as identified in (3) above.

(5) Mental health services must be provided by mental health personnel with expertise appropriate to the service recipient’s needs.

(6) At least one (1) on-duty and on-site staff member must be certified in cardiopulmonary resuscitation (CPR) and trained in first aid, the abdominal thrust maneuver and standard precautions for infection control.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003. Amendments filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-18-.05 INDIVIDUAL PLAN OF CARE (IPC) REQUIREMENTS FOR CRISIS STABILIZATION

UNIT FACILITIES.

(1) A plan must be developed for each service recipient. The plan must be based on initial and on-going assessment of need, designed to resolve the immediate psychiatric crisis, and be completed within six (6) hours of admission. The IPC must be documented in the service recipient’s record and must include the following:

(a) The service recipient’s name.

(b) The date of plan development.

(c) Standardized diagnostic formulation(s) including, but not limited to the current Diagnostic and Statistical Manual (DSM) and/or current International Statistical Classification of Diseases and Related Health Problems (ICD);

(d) Problems and strengths of the service recipient that are to be addressed.

(e) Observable and measurable individual objectives that relate to the specific problems identified.

(f) Interventions that address specific objectives, identify staff responsible for interventions, and planned frequency.

(g) Signatures of treatment staff responsible for developing plan, including qualified prescriber;

(h) Signature of service recipient (and/or parent/guardian, conservator, legal custodian or attorney-in-fact). Reasons for refusal to sign and/or inability to participate in IPC development must be documented.

(i) A projected discharge date and anticipated post discharge needs including documentation of resources needed in the community.

(j) A review of the IPC must occur at least daily or upon completion of the stated goal(s) and objective(s) and must include the following documentation:

Dated signature(s) of appropriate treatment staff, including qualified prescriber.
Progress toward each treatment objective, with revisions as indicated;
Status of discharge plans, including availability of resources needed in the community, with revisions as indicated; and 4. A statement by the staff psychiatrist or physician of justification for the level of service(s) needed including an assessment of suitability for treatment in a less restrictive environment.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302 and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003. Amendments filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-18-.06 INDIVIDUAL RECORD REQUIREMENTS FOR CRISIS STABILIZATION UNIT

FACILITIES.

(1) The individual record for each service recipient must contain the following information:

(a) Intake interview and initial physical assessment.

(b) A signed and dated original consent for treatment including documentation of informed consent for the administration of medication, if applicable.

(d) Daily progress notes by the qualified prescriber, nurses and other mental health professionals, as applicable;

(e) Laboratory and radiology results, if applicable.

(f) Documentation of all contacts with external medical and other services.

(g) Original documentation of all crisis stabilization service physician medication orders.

(h) A discharge summary with prognosis justified by explanation.

(i) List of personal property, including its disposition if no longer with the service recipient.

(j) Documentation of significant behavioral events and actions taken by staff.

(k) Documentation of discharge disposition, including aftercare arrangements, if applicable.

History

Authority: T.C.A. §§4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302 and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003. Amendment filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-18-.07 MEDICATION ADMINISTRATION IN CRISIS STABILIZATION UNIT FACILITIES

(1) Medications must be ordered by qualified prescribers.

(2) All medication must be administered by Tennessee licensed medical or nursing personnel or by other qualified personnel as allowed by Tennessee law and in accordance with the medical protocol of the facility/program.

(3) “Oral” or “Telephone” orders may be issued by the qualified prescriber. These orders must be taken by a licensed nurse or physician assistant, qualified by training and experience, and categorically approved by the medical staff of the facility/program. Upon hearing the order, the receiver shall record the order in the service recipient’s record, and then shall read back the written order to the issuing professional to assure that the order is understood clearly.

“Oral” and “Telephone” orders must be documented as such and staff recording must sign their name and title. “Oral” and “Telephone” orders must be countersigned by the qualified prescriber no later than seventy-two (72) hours.

(4) Legend drugs must be dispensed only by a licensed pharmacist.

(5) All medication errors, drug reactions and suspected drug overmedication must be documented and reported to the practitioner who prescribed the drugs.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302 and 33-2-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003. Amendments filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-18-.08 STORAGE OF MEDICATIONS AND POISONS

(1) Prescription medication must be legally dispensed and labeled according to State law.

(2) All medications, poisons and other preparations intended for internal or external human use must be stored in medicine cabinets or drug rooms. When preservation of the medication, poison, or other preparations depends upon refrigeration, the facility must provide a means of securely refrigerating these items. Such cabinets or drug rooms must be kept securely locked when not in use, and the key must be in the possession of the supervising nurse or other authorized person.

(3) Schedule II drugs must be stored within two (2) separately locked compartments at all times and accessible only to persons in charge of administering medication.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003.

Tenn. Comp. R. & Regs. 0940-05-18-.09 DISPOSITION OF UNUSED MEDICATIONS

(1) Any unused portions of program-prescribed medication(s) must be either turned over to the service recipient with written authorization and directions by the qualified prescriber or returned to a pharmacy for proper disposition by the pharmacist.

(2) Whenever a service recipient brings his/her own prescribed medications into the facility, such medications must not be administered unless identified and ordered by a qualified prescriber.

If such medications cannot be administered, they must be packaged, sealed, and returned to an adult member of the service recipient’s immediate family or legal guardian/conservator, or securely stored and returned to the service recipient upon discharge. However, if previously prescribed medication(s) would prove harmful to the service recipient, they may be withheld from the service recipient and disposed of as in paragraph one (1) above. There must be documentation by the qualified prescriber in the service recipient’s clinical record citing the dangers or contraindications of the medication(s) being withheld.

History

Authority: T.C.A. §§4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302 and 33-4-404.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003. Amendments filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-18-.10 RESERVED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Amendment filed September 4, 2003; effective November 18, 2003.

Chapter 0940-05-19 Minimum Program Requirements for Mental Health Supportive Living Facilities

Tenn. Comp. R. & Regs. 0940-05-19-.01 POLICIES AND PROCEDURES FOR SUPPORTIVE LIVING FACILITIES

(1) The facility must maintain a written policies and procedures manual which contains the following elements:

(a) A policy and procedures which only allow the admittance of persons who are:

Able to perform basic self-help activities including eating and bathing, 2. Able to care for their own possessions and to maintain bedroom or living area in a reasonable state of orderliness and cleanliness.
Able to recognize danger or threat to personal safety, 4. Able to live comfortably within any limitations in the structure of the facility, and 5. Generally able to maintain appropriate behaviors tolerable to the community;

(b) A policy and procedures which address the method for managing disruptive behavior; and (c) A policy and procedures which state that Physical Holding must be implemented in such a way as to minimize any physical harm to the client and may only be used when the client poses an immediate threat under the following conditions:

The client poses an immediate danger to self or others; and/or 2. To prevent the client from causing substantial property damage.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.07 RECREATIONAL PROVISIONS FOR CLIENTS OF SUPPORTIVE LIVING

FACILITIES. The facility must provide opportunities for recreational activities appropriate to and adapted to the needs, interests and ages of the clients being served.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.02 PERSONNEL AND STAFFING REQUIREMENTS FOR SUPPORTIVE LIVING

FACILITIES.

(1) The facility must provide adequate supervision by an adult who is knowledgeable of rules, policies and procedures relevant to the facility'’ operation.

(2) During normal waking hours, all facilities must provide at least one (1) direct-care staff person on-duty/on-site for every sixteen (16) clients present in the facility. During normal sleeping hours, all facilities must provide at least one (1) direct-care staff person on-site in each building where clients are housed; and in any building housing more than sixteen (16) clients, facilities must provide one (1) additional, direct-care staff person on-duty/on-site for each additional sixteen (16) clients.

(3) Clients must not be left unattended in the facility at any time.

(4) Facility staff must be provided with annual training relevant to the operation of a supportive living facility. Such training is to be provided by the local community mental health center, the Tennessee Department of Mental Health and Substance Abuse Services, or other agencies able to provide training information relevant to the operation of the facility. The provision of training must be evidenced by documentation in the facility’s records.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-19-.03 PROFESSIONAL SERVICES FOR CLIENTS OF SUPPORTIVE LIVING FACILITIES

(1) Utilizing community resources, the facility must make arrangements for qualified dental, medical, nursing and pharmaceutical care for clients of the facility including care for emergencies on a twenty-four (24) hours per day and seven (7) days per week basis; and allow clients or their families to have the option of choosing a personal professional for routine services.

(2) The facility must provide or procure for each client a physical examination, which includes routine screening and special studies as determined by the examining physician, within thirty (30) days of admission unless the client has had a physical examination within ninety (90) days prior to admission. Subsequent physical examinations must be provided or procured as determined by the client’s examining physician. The documentation of required physical examinations must be provided in the client’s record and must include exact name of the examining physician, clinic, or hospital.

(3) In consultation with the client, the facility must refer each mentally ill client for on-going mental health services and assist the client in keeping appointments and participating in treatment programs. Documentation of such referrals must be made in the client’s record.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.04 CLIENT RECORD REQUIREMENTS FOR SUPPORTIVE FACILITIES

The individual record maintained for each client must contain the following information:

(1) Marital status;

(2) Social security number;

(3) Medicaid or Medicare number;

(4) Legal competency status if available;

(5) Source of financial support and financial arrangements for residing in the facility. This information must be updated when the client’s financial status changes;

(6) Name, address and telephone number of the physician or health agency providing medical services;

(7) A list of each individual article of the client’s personal property valued at fifty dollars ($50) or more including its disposition, if no longer in use;

(8) Written accounts of all monies received and disbursed on behalf of the client;

(9) Report of medical problems, accidents, seizures and illnesses and treatments for such accidents, seizures and illnesses;

(10) Report of significant behavior incidents; and (11) Notes made on a quarterly basis (every three [3] months) which minimally include a brief statement of the client’s progress while residing in the facility. The notes must include the date that the note was written and the signature of the person making the note.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.08 HEALTH, HYGIENE AND GROOMING PROVISIONS FOR CLIENTS OF

SUPPORTIVE LIVING FACILITIES.

(1) The facility must assist clients in the independent exercise of health, hygiene and grooming practices.

(2) The facility must encourage the use of dental appliances, eyeglasses and hearing aids if used by clients.

(3) The facility must encourage each client to maintain a well groomed and clean appearance that is age and activity appropriate and within reason of currently acceptable styles of grooming, dressing and appearance.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.09 CLOTHING PROVISIONS FOR CLIENTS OF SUPPORTIVE LIVING FACILITIES

(1) The facility must provide indirect supervision of clients in the selection and purchase of their clothes and in the selection of dressing manner and change of clothes.

(2) Any marking of clients’ clothes for identification purposes must be done in an inconspicuous manner (3) The facility must allow clients to select and purchase their clothes and to dress themselves at appropriate times.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.05 CLIENT RIGHTS IN SUPPORTIVE LIVING FACILITIES

(1) Upon admission to the facility, each client must be provided an orientation which includes minimally the following:

(a) Explanation of the facility’s services, activities, performance expectations, any rules and regulations and program descriptions;

(b) Familiarizing the client with the facility’s premises, the neighborhood and public transportation systems; and (c) Explanation of client rights and grievance procedures.

(2) Clients must not be denied adequate food, treatment/rehabilitation activities, religious activities, mail or other contacts with families as punishment.

(3) A client must not be confined to his/her room or other place of isolation as punishment.

This does not preclude requesting individuals to remove themselves from a potentially harmful situation in order to regain self-control.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.06 MEDICATION ADMINISTRATION IN SUPPORTIVE LIVING FACILITIES

(1) The client’s ability and training must be taken into consideration when supervising the administration of medication.

(2) Prescription medications are to be taken only by clients for whom they are prescribed and in accordance with the directions of a physician.

(3) Drugs must be stored in a locked container which ensures proper conditions of security and sanitation and prevents accessibility to any unauthorized person.

(4) Discontinued and outdated drugs and containers with worn, illegible, or missing labels must be disposed.

(5) All medication errors, drug reactions, or suspected overmedication must be reported to the practitioner who prescribed the drug.

(6) Evidence of the current prescription of each medication taken by a client must be maintained by the facility.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Tenn. Comp. R. & Regs. 0940-05-19-.10 DAY ACTIVITIES FOR CLIENTS OF SUPPORTIVE LIVING FACILITIES

The facility must assist clients in making use of daily activities according to the age levels, interests and abilities of the clients. Such day services may include, but are not limited to, part-time and full-time employment, attendance at a day activity center, participation in a vocational rehabilitation program, senior citizens involvement and regularly scheduled recreational activities.

History

Authority: T.C.A. § 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988.

Chapter 0940-05-20 Repealed

Tenn. Comp. R. & Regs. 0940-05-20-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.11 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1998; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule fil ed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-20-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-21 Repealed

Tenn. Comp. R. & Regs. 0940-05-21-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.11 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; eff ective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.07 REPEALED

Authority T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504. Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-21-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-22 Repealed

Tenn. Comp. R. & Regs. 0940-05-22-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-22-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-22-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-22-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-22-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-23 Repealed

Tenn. Comp. R. & Regs. 0940-05-23-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.15 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.11 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025. 0940-05-23.-12 REPEALED. Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.

Tenn. Comp. R. & Regs. 0940-05-23-.13 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-23-.14 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-24 Repealed

Tenn. Comp. R. & Regs. 0940-05-24-.01 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.14 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.08 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.09 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.10 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.11 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.12 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-24-.13 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-101, 33-1-302, 33-1-303, 33-1-305, 33-1-309, 33-2- 301, and 33-2-302.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal and new rule filed April 29, 2004; effective July 13, 2004. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-25 Repealed

Tenn. Comp. R. & Regs. 0940-05-25-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.11 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-25-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-26 Repealed

Tenn. Comp. R. & Regs. 0940-05-26-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.14 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.11 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.12 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-26-.13 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-27 Repealed

Tenn. Comp. R. & Regs. 0940-05-27-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-27-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-27-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-27-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-27-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-27-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-27-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-28 Repealed

Tenn. Comp. R. & Regs. 0940-05-28-.01 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.13 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.02 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.03 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.04 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule fil ed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.05 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.06 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.07 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.08 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.09 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.10 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.11 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-28-.12 REPEALED

History

Authority: T.C.A. §§ 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed May 26, 1988; effective July 11, 1988. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-29 Minimum Program Requirements for Mental Health Psychosocial Rehabilitation Program Facilities

Tenn. Comp. R. & Regs. 0940-05-29-.01 DEFINITION

(1) “Psychosocial rehabilitation” means a consumer-centered program of services for adult service recipients to enhance and support the process of recovery. Program focus is based on a strengths model of mental health, working with the whole service recipient to improve service recipient functioning, rather than treatment for symptoms of a mental illness. Service participants, in partnership with staff, form goals for skill development in the areas of vocational, educational, and interpersonal growth that serve to maximize opportunities for successful community integration. Service participants proceed with goal development at their own pace and may continue in the program with varying intensity for an indefinite period of time.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.02 APPLICATION OF RULES

(1) The governing body of a psychosocial program must comply with following rules:

(a) Rule 0940-05-.02(2) Life Safety Business Occupancy;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(d) Chapter 0940-05-29 Minimum Program Requirements for Psychosocial Rehabilitation Program

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.03 POLICIES AND PROCEDURES

(1) The organization should have a written program plan to guide the operation of its program and the delivery of its services. The plan should include a program description that:

(a) Reflects the philosophy of the program.

(b) Delineates the goals of the program.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.04 PROGRAM SERVICE REQUIREMENTS

(1) The program should insure core services are provided in the following areas that are organized around the needs of the service recipients served, their preferences, and their stated goals.

(a) Enhancement of the understanding of and ability of the service recipients served to manage and cope with their psychiatric disabilities.

(b) Entitlement/income budget maintenance.

(d) Socialization and use of leisure time.

(e) Vocational development.

(2) In addition to the core services and dependent on the needs and preferences of the service recipients served, the program should provide or assess need for and make referrals for:

(a) Advocacy services.

(b) Alcoholism and other drug dependency education and/or services.

(d) Family support and education.

(e) Job placement and support.

(f) Mental health services.

(g) Self-help and peer support.

(h) Safe, decent, and affordable housing.

(i) Medical services.

(3) Meetings of the service recipients served and program staff must be held on a regular basis to discuss matters of mutual concern such as program operations, problems, and the use of program resources.

(4) The program must establish procedures for outreach to link service recipients in the community who are in need of psychosocial rehabilitation with the program.

(5) The program’s follow-up procedures should provide effective means to reach out to service recipients who are not attending, who are becoming isolated in the community, or who have been re-hospitalized.

(6) When residential services are provided, there must be a written description detailing the array of residential services provided, including the type and level of staffing or other services provided.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.05 PERSONNEL REQUIREMENTS

(1) The program services must have on staff or have available on a consultative basis both a Tennessee licensed mental health professional and an individual with demonstrated skill in the vocational areas provided by the program.

(2) A facility based program must have sufficient staff persons on duty to provide adequate supervision of the scheduled activities with a minimum staff-to-service recipient ratio of 1:20.

Staff persons counted in the staff-to-service recipient ratio may only be persons who are assigned to provide direct services as described by written job description. Support staff such as clerical, housekeeping, van and bus driver staff; students involved in an on-site practicum for academic credit, and volunteers, may not be counted in the staff-to-recipient ratio.

(3) The facility must provide at least one on duty staff person trained in first aid and the Heimlich maneuver.

(4) All staff, within three (3) months of hire, must acquire knowledge and competency appropriate to groups served. Training topics must include but not be limited to the following:

(a) Principles of job development, supported employment, and psychological rehabilitation (b) Vocational and work assessment (c) Value to work 1. Employer support 2. Assuming and utilizing natural support system at a work site 3. Work culture 4. Americans with Disability Act 5. Rights of service recipients with mental illness regarding work 6. Community support systems, community based services and systems of care, community resources and linkages with these resources 7. Cultural diversity 8. Behavioral characteristics of service recipients with mental illness 9. Stress management skills for vocational workers 10. Data management and record keeping 11. Agency policies and procedures 12. Psychiatric medications and their side effects 13. Fire safety

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.06 INDIVIDUAL ASSESSMENT REQUIREMENTS

(1) The program must ensure that the following assessments are completed prior to the development of the Plan of Care and are maintained in the service recipient’s record.

(a) Living arrangements (b) Vocational/Educational (c) Social supports (d) Financial (e) Basic medical history and current health information (f) Leisure/Recreational (g) Emotional/Behavioral health (h) Transportation (i) Medications (j) History of prior mental health and alcohol and drug treatment episodes (2) Assessments must be completed in face to face session(s) with the service recipient and document how they effect the Plan of Care.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.07 INDIVIDUAL PLAN OF CARE REQUIREMENTS

(1) A Plan of Care must be developed for each service recipient. The plan must be based on initial and on-going assessment of needs and strengths and must be completed within fourteen (14) days of admission into the vocational program. Documentation of the plan must be made in the service recipient’s record and must include the following:

(a) Service recipient’s name.

(b) Date of plan of care development.

(c) Needs and strengths of the service recipient that are to be addressed within the particular service/program component.

(d) Observable and measurable service recipient long and short-term goals that are related to specific needs identified and which are to be addressed by the particular service/program component.

(e) Interventions that address specific goals and objectives, identify staff responsible for interventions, and planned frequency of contact.

(f) Signature(s) of the staff who develop the plan and the primary staff responsible for its implementation.

(g) Signature of service recipient (and/or conservator, legal guardian, or attorney in-fact).

Reasons for refusal to sign and/or inability to participate in the Plan of Care development must be documented.

(2) The Plan of Care must be reviewed by program staff and the service recipient within three months of the initial development of the Plan of Care. The second review must take place within six months after the development of the Plan of Care, and every six months thereafter.

The review must include the following documentation:

(a) Dated signature(s) of appropriate staff; and (b) An assessment of progress toward each goal and/or objective with revisions as indicated.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.08 INDIVIDUAL RECORD REQUIREMENTS

(1) The service recipient record for each service recipient must contain the following information:

(a) Record of attendance at program services;

(b) Discharge summary which states, if appropriate, service recipient condition at the time of discharge and signature of staff person preparing the summary.

(c) Progress notes which must include written documentation of progress and changes which have occurred within the Plan of Care and, at a minimum must be developed on a weekly basis. Progress notes must be dated and minimally include the signature, with title or degree, of the person preparing the note

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Amendment filed December 30, 2002; effective March 15, 2003.

Tenn. Comp. R. & Regs. 0940-05-29-.09 ADDITIONAL ENVIRONMENTAL REQUIREMENTS

(1) If different therapeutic and/or vocational/educational training activities are to be conducted at the same time, the facility must have separate areas for each activity.

(2) Each skills-training area must contain and have readily available equipment and supplies which are appropriate and necessary to conducting skills-training activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed July 20, 1993; effective October 3, 1993. Original rule filed December 30, 2002; effective March 15, 2003.

Chapter 0940-05-30 Minimum Program Requirements for Mental Health Intensive Day Treatment Program for Children and Adolescents Facilities

Tenn. Comp. R. & Regs. 0940-05-30-.01 POLICIES AND PROCEDURES FOR INTENSIVE DAY TREATMENT PROGRAM

FACILITIES. The facility must maintain a written policy and procedures manual which includes the following elements:

(1) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure appropriate treatment has been delivered according to acceptable clinical practice.

(2) A written program description which must be available to staff, clients, and members of the public. The description must include but need not be limited to the following:

(a) A comprehensive statement of the philosophy that guides the program services, structure, and practices, (b) Services offered by the facility, availability of staff (including medical) to provide services, and hours of operation, (c) Characteristics of the person(s) to be served, (d) Process of referral into the program, (e) Admission criteria, (f) Re-admission exclusion criteria, (g) Facility rules for clients (h) Referral mechanisms for services outside the facility (both medical and non-medical)

(i) Emergency and non-emergency transportation of clients, and (j) Discharge criteria.

CHILDREN AND ADOLESCENTS FACILITIES

(3) Policies and procedures which address the methods for managing disruptive behavior (4) If restrictive procedures are used to manage disruptive behaviors, written policies and procedures must govern their use and must minimally ensure all of the following:

(a) Restrictive procedures must be used by the facility only after all less-restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective.

(b) The parents or guardian must have given written consent to any restrictive measures taken by the treatment staff, unless the child is over 16 years of age and has signed him/herself into the program. In this case, the child may give such written consent.

(c) The restrictive procedure(s) must be documented in the Individual Program Plan, be justified as part of the plan, and meet all requirements that govern the development and review of the plan.

(d) Only mental health professionals or mental health personnel may use restrictive procedures and must be adequately trained in their use.

(e) The adaptive or desirable behavior should be taught to the client in conjunction with the implementation of the restrictive procedures.

(5) A policy which states physical holding must be implemented in such a way as to minimize any physical harm to the client and may only be used when the client poses an immediate threat under the following conditions:

(a) The client poses an immediate danger to self or others, and/or (b) To prevent the client from causing substantial property damage.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.02 PERSONAL REQUIREMENTS FOR INTENSIVE DAY TREATMENT PROGRAM

FACILITIES.

(1) Treatment and/or rehabilitation services must be provided by properly licensed or certified mental health professionals or by mental health personnel who are under the direct supervision of a properly licensed or certified mental health professional. Qualifications of individuals who will provide educational programs shall meet the employment standards outlined in the State Board of Education Rules, Regulations, and Minimum Standards.

(2) The facility must maintain a written agreement with or employ a licensed physician to serve as medical consultant.

(3) If the consulting physician is not a psychiatrist, the facility must arrange for the regular, consultative, and emergency services of a licensed psychiatrist.

(4) The facility must provide at least one (1) staff person on-duty/on-site fore each six (6) clients present. Staff persons counted in the staff-to-client ratio may only be persons who are assigned to provide direct day program services as described by written job description.

Support staff, such as clerical, housekeeping, van and bus driver staff, and students involved in an on-site practice for academic credit may not be counted in the staff-to-client ratio.

CHILDREN AND ADOLESCENTS FACILITIES

(5) The facility must provide at least one (1) on-duty staff member trained in First Aid, CPR, and the Heimlich maneuver.

(6) A training plan for each non—doctoral level staff person must be documented.

(7) The operator must perform background checks on all employees and volunteers. A person, whether an employee or a volunteer, who is named as a suspect in an “indicated” report of child sexual abuse, or who is currently charged with committing a crime against a child must not work as a caregiver or have any contact with the children.

(8) Children must not be in the care of or have any direct contact while in the care of the facility with a person who has been convicted of a crime involving children or of violating a law enacted to protect children.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.03 CLIENT ASSESSMENT REQUIREMENTS FOR INTENSIVE DAY TREATMENT

PROGRAM FACILITIES. The facility must ensure that the following assessments are completed prior to the development of the Individual Program Plan:

(1) Assessment of current functioning according to presenting problem including a history of the presenting problem in the following areas:

(a) Community living skills;

(b) Living skills appropriate to age;

(2) Basic medical history and information.

(3) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol or other drugs.

(4) History of prior mental health and alcohol and drug treatment episodes.

(5) Assessment of whether client meets eligibility requirements for special education services in accordance with the State Board of Education Rules, Regulations, and Minimum Standards.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.04 INDIVIDUAL PROGRAM PLAN REQUIREMENTS FOR INTENSIVE DAY

TREATMENT PROGRAM FACILITIES.

(1) An Individual Program Plan must be developed and implemented for each client. The Individual Program Plan (IPP) must be based on initial history and on-ongoing assessment of the client’s needs and must be completed within thirty (30) days of admission.

CHILDREN AND ADOLESCENTS FACILITIES

(2) Documentation of the IPP and of its implementation must be made in the individual client record and must include the following:

(a) The client’s name in the IPP;

(b) The date of development of the IPP;

(c) Client Problems specified in the IPP which are to be addressed within the particular service/program component, including treatment and educational components;

(d) Client objectives which are related to specified problems identified in the IPP and which are to be addressed by the particular service/program component;

(e) Interventions addressing goals in the IPP;

(f) Signatures of the staff providing the services;

(g) Participation of client, or parent/guardian where appropriate, in the treatment planning process;

(h) Standardized diagnostic formulation(s), [including, but not limited to, the current Diagnostic and Statistical Manual (DSM) Axes I-V and/or ICD-9] where appropriate; and assessment documentation on file which is updated as recommended by IPP team;

(i) Planned frequency of treatment contacts;

(j) A plan for family involvement in the child’s treatment.

(3) An education plan must be developed for each client that conforms to the Rules, Regulations and Minimum Standards of the State Board of Education with an Individualized Education Program (IEP) being developed by an appropriately constituted M-Team for all “qualified students with disabilities”;

(4) Documentation of the education plan must be contained in the individual client record;

(5) The education plan may include education services provided either by the facility or by the local education agency;

(6) Education and treatment components must be integrated.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.05 INDIVIDUAL PROGRAM PLAN REVIEW IN INTENSIVE DAY TREATMENT

PROGRAM FACILITIES. The facility must review and, if indicated, revise the IPP every six (6) months.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.06 CLIENT RECORD REQUIREMENTS FOR INTENSIVE DAY TREATMENT PROGRAM

FACILITIES. The individual record for each client must contain the following information:

CHILDREN AND ADOLESCENTS FACILITIES

(1) Documentation of the IPP and the IEP (if required) and of their implementation;

(2) Progress notes which must be developed after each service contact, and which must include written documentation of client progress or changes which have occurred within the IPP;

(3) Documentation of all drugs prescribed or administered by the facility which indicates date prescribed, type, dosage, frequency, amount, and reason;

(4) Narrative summary review of all medications prescribed at least every six (6) months which includes specific reasons for continuation of each medication;

(5) Results of assessments required by Rule 0940-05-30-.03; and (6) Discharge summary which states, if appropriate, client condition at the time of discharge and signature of person preparing the summary.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.07 CLIENT RIGHTS IN INTENSIVE DAY TREATMENT PROGRAM FACILITIES

Upon admission to the facility, each client, and/or their parent or guardian where appropriate, must be provided an orientation which minimally includes all of the following:

(1) Explanation of the facility’s services, activities, performance expectations, rules and regulations, and program descriptions.

(2) Familiarization of the client, or his/her parent, custodian or guardian where appropriate, with the facility’s premises and the neighborhood. Orientation to the public transportation system will be determined by the child’s individual needs.

(3) Explanation of client rights, including policies regarding restrictions on these rights, and grievance procedures.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.08 ENVIRONMENTAL REQUIREMENTS FOR INTENSIVE DAY TREATMENT

PROGRAM FACILITIES.

(1) Each skills-training area must contain and have readily available equipment and supplies which are appropriate and necessary to conducting skills-training activities.

(2) All potentially dangerous items (e.g. knives, scissors, paint, glue) should be properly inventoried and stored for maximum safety precautions

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.09 MEDICATION ADMINISTRATION IN INTENSIVE DAY TREATMENT PROGRAM

FACILITIES.

(1) The client’s ability and training must be taken into consideration when supervising the administration of medication.

CHILDREN AND ADOLESCENTS FACILITIES

(2) Prescription medications are to be taken only by clients for whom they are prescribed, and in accordance with the directions of a physician.

(3) Drugs must be stored in a locked container which ensures proper conditions of security and sanitation and prevents accessibility to any unauthorized person.

(4) Discontinued and outdated drugs and containers with worn, illegible, or missing labels must be discarded.

(5) All medication errors, drug reactions, or suspected overmedication must be reported to the practitioner who prescribed the drug.

(6) Documentation or other tangible evidence of the current prescription of each medication taken by a client must be maintained by the facility.

(7) When psychotropic or other regularly taken medications are prescribed by a physician, these medications should be reviewed by the physician at least on a quarterly basis, and more often if medically indicated.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Tenn. Comp. R. & Regs. 0940-05-30-.10 HEALTH, HYGIENE, AND GROOMING IN INTENSIVE DAY TREATMENT PROGRAM

FACILITIES.

(1) Facility staff must be given immediate access to relevant information in the client records in the event of medical or other type of emergency.

(2) The facility must assist clients in the independent exercise of health, hygiene, and grooming practices.

(3) The facility must encourage the use of dental appliances, eyeglasses, and hearing aids if used by clients.

(4) The facility must encourage each client to maintain a well-groomed and clean appearance that is age and activity appropriate and within reason of current acceptable styles of grooming, dressing and appearance for individuals of like age.

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996.

Chapter 0940-05-31 Repealed

Tenn. Comp. R. & Regs. 0940-05-31-.01 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-203(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.12 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.08 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.09 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.10 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-31-.11 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205(b)(5), 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed January 11, 1996; effective March 26, 1996. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-32 Repealed

Tenn. Comp. R. & Regs. 0940-05-32-.01 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.11 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.08 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.09 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Tenn. Comp. R. & Regs. 0940-05-32-.10 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-205, 33-1-302, 33-1-303, 33-1-305, and 33-2-504.
Administrative History: Original rule filed October 17, 1995; effective December 31, 1995. Repeal filed November 25, 2024; effective February 23, 2025.

Chapter 0940-05-33 Mental Health Partial Hospitalization Programs

Tenn. Comp. R. & Regs. 0940-05-33-.01 DEFINITION

(1) “Partial hospitalization” means a non residential medically directed treatment program that offers intensive, coordinated, and structured services for adults and/or children within a stable therapeutic milieu. Partial hospitalization embraces day, evening, night, and weekend treatment programs which employ an integrated, comprehensive and complementary schedule of recognized mental health service approaches. Partial hospitalization is designed to provide intensive treatment services for service recipients who are able to be voluntarily diverted from inpatient psychiatric hospitalization or require intensive treatment after discharge from an inpatient stay. Programs are designed to serve service recipients with significant impairment resulting from a psychiatric, emotional or behavioral disorder. Such programs are also intended to have a positive impact on the service recipient’s support system.

Partial hospitalization programs may either be free standing or integrated with a broader mental health or medical program. Partial hospitalization must be a separate, identifiable, organized program representing a significant link within the continuum of comprehensive mental health services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003.

Tenn. Comp. R. & Regs. 0940-05-33-.02 APPLICATION OF RULES FOR MENTAL HEALTH PARTIAL HOSPITALIZATION

PROGRAMS.

(1) The governing body of a partial hospitalization program must comply with the following rules:

(a) Rule 0940-05-04-.03(2) Life Safety Educational or Day Care Occupancy (b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Mental Health Services (new rules to be filed); and (d) Chapter 0940-05-15 Minimum Program Requirements for Partial Hospitalization Programs.

(e) Chapter 0940-03-06, Use of Isolation and Restraint in Inpatient Facilities

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003.

Tenn. Comp. R. & Regs. 0940-05-33-.03 PERSONNEL REQUIREMENTS

(1) The program must ensure that all staff providing service have the necessary skills, qualifications, training and supervision to provide the services specified in the individual plan of care.

(a) The program must be under the direction of a Tennessee licensed physician.

Treatment and/or rehabilitation services must be provided by mental health professionals or by mental health personnel. Treatment services, staff type and ratio must be adequately justified according to level of care provided in program.

(b) The program must provide access to medical services either by a written agreement with or employ a licensed physician.

(c) If the physician is not a psychiatrist, the program must arrange for the regular , consultative, and emergency services of a psychiatrist;

(d) The psychiatrist or physician must be available during program hours. All diagnostic services must be provided by a psychiatrist, a psychologist, or an addictionologist, as applicable.

(e) The program must have at least one (1) Tennessee licensed nurse or physician assistant, to be on duty, and on-site during operating hours. The program must additionally have at least one (1) staff person who is a assigned to provide direct program services, is on duty, on-site for each eight (8) adult service recipients present and one (1) to five (5) children/youth service recipients present. Support staff such as clerical, housekeeping, van and bus driver staff, volunteers and students involved in an on-site practicum for academic credit may not be counted in the staff-to-recipient ratio.

(f) The program must provide at least one on duty staff certified in CPR and trained in first aid and the Heimlich maneuver.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003.

Tenn. Comp. R. & Regs. 0940-05-33-.04 INDIVIDUAL ASSESSMENT REQUIREMENTS

(1) The program must ensure that the following assessments are completed prior to the development of the Plan of Care:

(a) Assessment of current functioning according to presenting problem including a history of the presenting problem in the following areas:

Community living skills, including independent living skills;
Present level of functioning and ability to self manage mental illness, and 3. Educational services.

(2) Basic medical history and information, determination of the necessity for a medical evaluation and a copy, where applicable, of the results of the medical evaluation (3) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol and/or other drug use; and (4) History of prior mental health and alcohol and drug treatment episodes.

(5) Psychiatric evaluation (6) Assessment of whether service recipient is currently eligible for special education services in accordance with the State Board of Education Rules, Regulations, and Minimum Standards

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003.

Tenn. Comp. R. & Regs. 0940-05-33-.05 INDIVIDUAL PLAN OF CARE (POC) REQUIREMENTS

(1) A Plan must be developed for each recipient. The plan must be based on initial and on-going assessment of the service recipient's needs and strengths must be completed within twentyfour (24) hours of the first day of services rendered. Documentation of the plan must be made in the individual’s record and must include the following:

(a) The service recipient’s name.

(b) The date of plan development.

(c) Standardized diagnostic formulation(s) including, but not limited to, the current Diagnostic and Statistical Manual (DSM) Axes and/or ICD-9.

(d) Needs and strengths of the service recipient which are to be addressed within the particular service/program component.

(e) Observable and measurable service recipient goals that are related to specified needs identified and which are to be addressed by the particular service/program component.

(f) Interventions that address specific goals and objectives, identify staff responsible for intervention, and planned frequency of contact.

(g) Signature(s) of treatment staff who develop the plan, the primary staff responsible for its implementation, including the physician.

(h) Signature of service recipient (and/or parent/guardian, conservator, or legal custodian).

Reasons for refusal to sign and/or inability to participate in POC development must be documented.

(i) Plan for discharge which includes projected discharge date, and (j) Anticipated post discharge needs including documentation of resources needed in the community.

(k) A review of the POC must occur every seven (7) days of service or completion of the stated goal(s) and objective(s) and must include the following documentation:

Dated signature(s) of appropriate treatment staff, including physician; and 2. An assessment of progress toward each treatment goal and/or objective with revisions as indicated; and 3. A statement by the staff psychiatrist or physician of justification for the level of service(s) needed including an assessment of suitability for treatment in a less restrictive environment. Justification for continued services must be documented.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003.

Tenn. Comp. R. & Regs. 0940-05-33-.06 RECIPIENT RECORDS REQUIREMENTS

(1) The individual record for each service recipient must also contain the following information:

(a) Progress notes which must include written documentation of progress and changes that have occurred within the plan of care and, at a minimum, are documented daily.

Progress notes must be dated and minimally include the signature, with title or degree, of the person preparing the note.

(b) A discharge summary which includes primary diagnosis, secondary diagnosis (when appropriate), clinical summary, condition at time of discharge or transfer, and aftercare arrangements and recommendations.

(c) Results of assessments required by 0940-05-33-.05 (d) Individual Plan of Care (e) Standardized diagnostic formulation(s) including, but not limited to, the current Diagnostic and Statistical Manual (DSM) and/or ICD-9.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003.

Tenn. Comp. R. & Regs. 0940-05-33-.07 ENVIRONMENTAL REQUIREMENTS

(1) The program must have areas in which different therapeutic and/or educational/training activities can be conducted at the same time.

(2) Each program area must contain, and have readily available equipment and supplies which are appropriate and necessary to conduct therapeutic and/or skills training activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, and 33-2-302.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003.

Chapter 0940-05-34 Repealed

Tenn. Comp. R. & Regs. 0940-05-34-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309; 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003. Repeal filed August 15, 2011; effective January 29, 2012.

Tenn. Comp. R. & Regs. 0940-05-34-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309; 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003. Repeal fil ed August 15, 2011; effective January 29, 2012.

Tenn. Comp. R. & Regs. 0940-05-34-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309; 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003. Repeal filed August 15, 2011; effective January 29, 2012.

Tenn. Comp. R. & Regs. 0940-05-34-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309; 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003. Repeal filed August 15, 2011; effective January 29, 2012.

Tenn. Comp. R. & Regs. 0940-05-34-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309; 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003. Repeal filed August 15, 2011; effective January 29, 2012.

Tenn. Comp. R. & Regs. 0940-05-34-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309; 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed December 18, 2002; effective March 3, 2003. Repeal filed August 15, 2011; effective January 29, 2012.

Chapter 0940-05-35 Minimum Program Requirements for Nonresidential Office-Based Opiate Treatment Facilities

Tenn. Comp. R. & Regs. 0940-05-35-.01 PURPOSE

The rules in this chapter implement the law relative to licensure and regulation of nonresidential officebased opiate treatment facilities pursuant to Chapter 912 of the Public Acts of 2016.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.02 DEFINITIONS

(1) Definitions of general terms used in these rules can be found in Rules Chapter 0940-05-01.

(2) Definitions specific to this chapter are as follows:

(a) “Nonresidential Office-Based Opiate Treatment Facility” or “Facility” or “OBOT” is a service entity that includes, but is not limited to, stand-alone clinics, treatment resources, individual physical locations occupied as the professional practice of a prescriber or prescribers licensed pursuant to Title 63, or other entities prescribing products containing buprenorphine, or products containing any other controlled substance designed to treat opioid use disorder by preventing symptoms of withdrawal to twenty-five percent (25%) or more of its patients or to one hundred fifty (150) or more patients.

“Nonresidential office-based opiate treatment facility” does not include any Facility that meets the definition of a nonresidential substitution-based treatment center for opiate addiction, otherwise referred to as a nonresidential opioid treatment program as licensed under Rule 0940-05-42.

(b) “Advanced Practice Registered Nurse” means a person qualified by the Tennessee Board of Nursing under Rules Chapter 1000-04 as an advanced practice registered nurse with a certificate of fitness and privileges to write and sign prescriptions and/or issue legend drugs. Advanced practice registered nurses may perform any and all functions allowed by current federal and state laws and regulations within this practice setting and within their scope of allowed professional licensure.

(c) “Buprenorphine” means a semi-synthetic opioid partial agonist that activates the opioid receptors but not to the same degree as full agonists such as morphine and heroin, as well as any FDA-approved pharmaceutical product that contains buprenorphine.

(d) “Case Management/Care Coordination” means a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

(e) “Controlled Substance Monitoring Database” or “CSMD” means a program administered by the Tennessee Department of Health to monitor the prescribing and dispensing of Schedule II, III, IV and V controlled substances as set forth by T.C.A.

Title 53, Chapter 10, Part 3.

(f) “Counseling” or “Counseling Session” means any face-to-face individual therapeutic counseling session lasting not less than twenty (20) minutes with a qualified counseling provider, or a group educational session of no more than twenty (20) patients and lasting not less than fifty (50) minutes facilitated by a qualified counseling provider.

Counseling shall be focused on issues related to the patient’s identified needs in their treatment plan and shall not include discussions related to administrative procedures.

Telehealth, pursuant to the Tennessee Code Annotated, may be utilized to facilitate counseling. Attendance of a 12-step program, such as Narcotics Anonymous, shall not be considered counseling. Counseling is separate and apart from any other medical and/or clinical activities of the Facility. The Facility shall document each counseling session’s topic of focus and the duration of minutes of the counseling in the patient’s medical chart.

(g) “DEA” means the United States Drug Enforcement Administration.

(h) “Detoxification” or “Detoxification Treatment” means the use of an opioid agonist treatment medication in decreasing doses to the patient to alleviate adverse physical or psychological effects incident to withdrawal from the continuous or substantial use of an opioid drug and as a method of bringing the patient to a drug-free state within that period.

(i) “Diversion Control Plan” means specific measures, including assigning responsibilities to medical and administrative staff, to reduce the possibility of diversion of controlled substances from legitimate treatment to illicit use.

(j) “Facility Director” means the person designated by the Facility’s governing body who is responsible for the operation of the Facility, for the Facility’s overall compliance with federal, state, and local laws and regulations regarding the operation of a nonresidential office-based opiate treatment facility, and for all Facility employees including practitioners, agents, or other persons providing services at the Facility. Nonphysician Facility directors shall not supervise medical staff.

(k) “FDA” means the United States Food and Drug Administration.

(l) “Governing Body” means the person or persons with primary legal authority and responsibility for the overall operation of the OBOT and to whom a director/chief executive officer is responsible. Depending upon the organizational structure, this body may be an owner or owners; a board of directors or other governing members of the licensee; or state, city, or county officials appointed by the licensee.

(m) “Inspection” means any examination by the Department or its representatives of an OBOT including, but not limited to, the premises, staff, persons in care, and documents pertinent to initial and continued licensing, so that the Department may determine whether an OBOT is operating in compliance with licensing requirements or has violated any licensing requirements. The term inspection includes any survey, monitoring visit, complaint investigation, or other inquiry conducted for the purposes of making a compliance determination with respect to licensing requirements.

(n) “Medical Director” means a physician who meets the qualifications set out in 0940-05- 35-.20(3)(b) and who has been designated by the governing body of the Facility to be responsible for the supervision of all medical staff at the Facility and the administration of all medical services offered by the Facility, including compliance with all federal, state and local laws and rules regarding medical treatment of opioid use disorder.

(o) “Medical Record” or “Medical Chart” means medical histories, records, reports, summaries, diagnoses, prognoses, records of treatment and medication ordered and given, entries, x-rays, radiology interpretations and other written electronics, or graphic data prepared, kept, made or maintained in a Facility that pertains to services rendered to patients.

(p) “Medication Assisted Treatment” means use of a medication approved by FDA, in combination with counseling and behavioral therapies, for the treatment of an opioid use disorder.

(q) “Observed Drug Screen” means a test used to determine the presence of illicit drugs in an individual’s body conducted by and in the presence of staff with documented training on procedures of observing drug screens or contracted medical or lab staff so as to ensure against the tampering with or falsification of the results.

(r) “Office of Licensure” means the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) Office of Licensure.

(s) “Opiate/Opioid” means a drug that contains opium, derivatives of opium, or any of several semi-synthetic or synthetic drugs with agonist activity at the opioid receptor.

(t) “Patient” or “Service Recipient” shall refer to an individual receiving treatment for opioid use disorder at an OBOT.

(u) “Physical Location” means real property on which is located a physical structure, whether or not that structure is attached to real property, containing one (1) or more units and includes an individual apartment, office, condominium, cooperative unit, mobile or manufactured home, or trailer, if used as a site for prescribing or dispensing products containing buprenorphine, or products containing any other controlled substance designed to treat opioid use disorder by preventing symptoms of withdrawal.

(v) “Phases of Treatment” means the induction, stabilization, and maintenance phases of treatment a patient is in at a particular point in time as described in Rule 0940-05-35- .10.

(w) “Physician Assistant” means a person licensed by the Tennessee Board of Physician Assistants, with authorization from their supervising physician to write and sign prescriptions and/or issue legend drugs. Physician assistants may perform any and all functions allowed by the current federal and state regulations within this practice setting and within their scope of allowed professional licensure.

(x) “Program Physician” means any physician, including the medical director, who provides medical services to patients at the Facility.

(y) “Program Provider” means any physician, including the medical director, physician assistant, pharmacist, or advanced practice registered nurse, who provides medical services on behalf of the Facility to provide medical services to service recipients. Any Facility program provider who is not a medical director shall work under the supervision of the Facility’s medical director.

(z) “Qualified Counseling Provider” means any individual meeting the following conditions:

Licensed by the State of Tennessee as one (1) of the following (with experience or supervision as described, where specified); or (i) Alcohol and Drug Abuse Counselor I or II (commonly referred to as LADAC I or LADAC II);

(ii) Psychologist;

(iii) Psychological examiner;

(iv) Physician with experience or training in counseling;

(v) Physician Assistant or Nurse Practitioner with experience or training in counseling;

(vi) Registered nurse with experience or training in counseling;

(vii) Social worker, meeting one of the following:

(I) Licensed as a baccalaureate social worker (LBSW) with training in counseling and direct supervision by a master’s level social worker (LCSW or LMSW);

(II) Licensed as a master social worker (LMSW); or (III) Licensed as a clinical social worker (LCSW).

(viii) Professional Counselor; or (ix) Marriage and Family Therapist.

Actively engaged in a recognized course of study or another formal process for pursuing licensure of a discipline described in (i) above. Supervision shall be in accordance with the respective laws, rules, and regulations governing the professional licensure pursued; and 3. Be qualified by education and/or experience for the specific duties of their position and only perform those duties within the scope of their applicable professional practice acts and Tennessee license.

(aa) “Referral” means a proactive effort by Facility personnel to guide a patient towards a healthcare provider or Facility for additional evaluation, treatment, or support. The Facility is responsible for documenting the referral attempt in the patient’s medical chart. To facilitate the referral, the Facility must complete a release of information with the referring Facility and the location appropriate for the referral completed on the document. The clinic personnel must document the referral outcome. If the patient declines, the Facility must keep a record of the attempted release of information indicating the patient declined to share records for continuity of care.

(bb) “Relapse” means a process in which an individual who has established abstinence or sobriety experiences a recurrence of signs and symptoms of active addiction, often including resumption of the pathological pursuit of reward and/or relief through the use of substances and other behaviors.

(cc) “S.M.A.R.T. Goals” means objective goals created using the S.M.A.R.T. goal framework that aids in creating personal and professional goals for service recipients.

These goals are intended to be utilized in a service recipient’s treatment plan or individual counseling sessions to track achievement of short- and long-term goals and progress at the Facility. S.M.A.R.T. goals shall be specific, measurable, achievable, relevant, and time-sensitive.

(dd) “Taper,” “Tapering,” and “Medically Supervised Withdrawal” are interchangeable terms for the purposes of these rules.

(ee) “TDMHSAS” or “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(ff) “Treatment” or “Substance Use Treatment” means a broad range of services intended to assess status, reduce symptoms, or mitigate the effects of substance misuse, substance use disorders, or co-occurring disorders; reduce risk of relapse and associated harm; or restore or establish well-being for individuals and families; provided, that said practice may include, but not be limited to, care coordination, case management, medical, pharmacological, psychological, psycho-educational, rehabilitative or social services and therapies. The overall goals are to eliminate the substance use as a contributing factor to physical, psychological, and social dysfunction and to arrest or reverse the progress of any associated problems.

(gg) “Treatment Program” or “Substance Use Treatment Program” means an organized system of services containing a mission, philosophy, and model of substance use disorder treatment designed to address the needs of clients.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-406, 33-2-407, and 53-11-311.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.03 APPLICATION OF THE RULES

(1) The licensee of an OBOT shall comply with the following rules:

(a) Chapter 0940-05-02 Licensure Administration and Procedures;

(b) Applicable Minimum Program Requirements for All Services and Facilities found in

Chapter 0940-05-06; and (c) Chapter 0940-05-35 Minimum Program Requirements for Nonresidential Office-Based Opiate Treatment Facilities.

(2) If any provision of these rules, or the application thereof to any person or circumstance, is held invalid, such invalidity shall not affect other provisions or applications of these rules which can be given effect without the invalid provision or application, and to that end the provisions of these rules are declared severable.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.04 LICENSING PROCEDURES

(1) An OBOT, as defined in 0940-05-35-.02(2)(a) and T.C.A. § 33-2-402, shall be licensed by the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS or Department).

(2) An OBOT shall include, as part of its ownership structure, a physician who holds an unrestricted license from the Tennessee Board of Medical Examiners or the Tennessee Board of Osteopathic Examination. “Ownership Structure” means any entity, group, or individual(s) having legal ownership of the OBOT, directing its functions and operations. This includes, but is not limited to, a sole proprietor, general partner, board member of a non-profit or for-profit corporation, or managing member of a limited liability company. Final determination as to whether ownership structure requirements for an OBOT are being met is in the sole discretion of the Department.

(3) A public benefit non-profit/charitable corporation, registered with the Tennessee Secretary of State, shall have a physician who holds an unrestricted license from the Tennessee Board of Medical Examiners or the Tennessee Board of Osteopathic Examination and is on its Board of Trustees.

(4) A corporate entity doing business as an OBOT in the State of Tennessee shall not provide, hold itself out as providing, or advertise that it provides substance use disorder treatment for opioid use disorder in the form of opioid agonist therapy, or office-based opiate treatment, unless it complies with the following requirements:

(a) Is appropriately registered with the Tennessee Secretary of State to operate in the State of Tennessee and/or is and remains current with corporate or nonprofit/charitable registration requirements of the Tennessee Secretary of State;

(b) In the case of a for-profit corporate entity, includes, as a member of its Board of Trustees, the Facility’s medical director; and (c) In the case of a multisite entity, the inclusion of a sole physician that would meet the qualifications for a medical director, pursuant to 0940-05-35-.20(2)(b), shall be on such Board.

(5) The OBOT shall make application with the Department’s Office of Licensure by providing the following information, at a minimum:

(a) Application on the Office of Licensure’s designated forms to include the:

Initial Application;
Fact Sheet; and, 3. Financial Statement;

(b) Applicable fees as defined in Tennessee Administrative Procedures Rule 0940-05-02- .05;

(c) Evidence of all prescribers contracted and/or currently employed at the Facility holding a license from the Tennessee Board of Medical Examiners or the Tennessee Board of Osteopathic Examination or the Health Related Boards for any non-physician prescribers;

(d) Comprehensive listing of all members of the organization’s ownership structure;

(e) Evidence of the Facility Director’s experience in managing individuals showing at least one (1) year of supervisory type responsibilities; and (f) Any other item the Department believes is necessary and proper for application purposes.

(6) Prior to renewal of the license, the OBOT shall be required to develop written policies and procedures that substantially comply with the provisions of this chapter, as well as with Administrative Chapter 0940-05-06.

(7) The Department may release to and/or gather information from the Tennessee Department of Health Board of Medical Examiners (BME) as is necessary for licensing and/or investigation of complaints against an OBOT.

(8) With or without notice, the Department, or its representatives, shall have the right to access electronic information of the Facility and/or enter upon or into the premises of an OBOT in order to make inspections and/or investigations deemed necessary to determine compliance with applicable law. The OBOT shall comply with all reasonable requests of the Department and allow it to obtain information from third parties as is necessary.

(9) The Department shall be given the authority to access electronic information of and/or enter upon the premises of an unlicensed Facility prescribing buprenorphine-type products to better determine that unlicensed Facility’s need for TDMHSAS oversight. The Department shall attempt to conduct inspections and investigations in the least intrusive manner needed in order to obtain necessary information. The Facility shall be required to provide reasonable amounts of information to the Department for this determination.

(a) “Reasonable amounts of information,” in this context, may be considered aggregate, non-patient identifying information to include, but not be limited to:

Patient de-identified identifiers;
Lists of medications prescribed to that de-identified patient; and 3. The total number of patients seen at the physical location in question.

(10) The governing body of an OBOT shall designate a Facility director (as defined in 0940-05-35- .02(2)(j)), who is responsible for the operation of the Facility. Non-physician Facility directors shall not supervise medical staff.

(11) Should a Facility operate in such a fashion that the physicians working at the same physical location are unassociated and/or unaffiliated to one another in some type of business arrangement, then the unassociated and/or unrelated physicians shall designate a Facility director.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.05 POLICY AND PROCEDURES

(1) The governing body of the Facility shall ensure the OBOT is administered and operated in accordance with written policies and procedures in the below listed subject areas and in accordance with these rules. Each Facility shall clearly identify the governing body, as defined in Rule 0940-05-01-.01(18) and Rule 0940-05-35-.02(2)(l), in its policies and procedures manual including the name and contact information of the governing body.

(a) Admissions and Discharges and Best Practices Utilized (0940-05-35-.06);

(b) Patient Record Requirements (0940-05-35-.07);

(d) Individualized Treatment Plan (0940-05-35-.09);

(e) Phases of Treatment (0940-05-35-.10);

(f) Special Populations (0940-05-35-.11);

(g) Counseling (0940-05-35-.12);

(h) Medication Management (0940-05-35-.13);

(i) Drug Screens (0940-05-35-.14);

(j) Medically Supervised Withdrawal (0940-05-35-.15);

(k) Diversion Control Plan (0940-05-35-.16);

(l) Reporting Requirements (0940-05-35-.17);

(m) Patient Rights (0940-05-35-.18);

(n) Community Relations (0940-05-35-.19); and (o) Personnel and Staffing Requirements (0940-05-35-.20).

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.06 ADMISSIONS AND DISCHARGES AND BEST PRACTICES UTILIZED

(1) Initial Screening. Prior to admission to the Facility, each prospective patient shall be evaluated by the medical director or program provider or staff who have been determined to be qualified by education, training, and experience to perform or coordinate the provision of such screening. The purpose of such screening shall be to determine, and document, whether the patient meets the diagnostic criteria for an opioid use disorder as defined in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and whether the Facility will be the most appropriate treatment modality for the patient. No prospective patient shall be processed for admission until it has been verified that the patient meets all applicable criteria.

(2) Initial Assessment. Within seven days of admission, the Facility shall complete an initial assessment. The initial assessment shall focus on the individual’s eligibility and need for treatment and shall provide indicators for the service recipient’s disease severity and the need for any appropriate referrals. Whenever possible and with service recipient written consent, the initial assessment shall include a family member or significant other to assist in the provision of accurate information and a full understanding and retention of instructions given to the service recipient. The initial assessment shall include, but not be limited to, the following:

(a) A physical examination that includes a review of systems, vital signs, a pain assessment, and laboratory testing, unless otherwise specifically exempt pursuant to state or federal regulation, consistent with 42 C.F.R. § 12 (2025);

(b) A past medical history;

(c) A substance use history that includes type, frequency, and amount of substances used, including illicit substances, tobacco, and alcohol;

(d) A list of currently prescribed or over-the-counter medications;

(e) A personal and family history of substance use;

(f) A confirmation of the opioid use disorder diagnosis;

(g) An initial observed drug screen to identify the current use of drugs including, but not limited to, opioids (including fentanyl, buprenorphine, and methadone), amphetamines, cocaine, barbiturates, and benzodiazepines;

(h) A screening shall be conducted for sexually transmitted infections (STIs) and tuberculosis. The medical director may screen for other communicable diseases based on their discretion. The Facility shall maintain a documented policy and procedure for screening for communicable diseases, which includes the process for screening methods used by the Facility and the process for providing referrals for patients for further communicable disease screening, testing, or treatment, as appropriate. Patientspecific factors that warrant a deviation from these rules or the Facility’s policy and procedures shall be documented in the patient’s medical record;

(i) Any additional screening tests, such as pregnancy screenings, as necessary or appropriate; and (j) A determination if the prospective service recipient needs special services, such as treatment for alcohol use disorder or psychiatric services, and determination that the Facility is capable of addressing these needs either directly or through referral. If referral to an outside provider is deemed necessary, efforts of the Facility in making the referral shall be documented in the patient’s medical chart.

(3) The Facility may utilize components of the initial assessment performed by an outside provider if conducted within 14 days preceding the admission and obtained by the Facility within 7 days of admission.

(4) Prior to receiving treatment at the Facility, the patient shall acknowledge in writing having received education on the following:

(a) Treatment options, including detoxification, and the benefits and risks associated with each treatment option;

(b) The risk of neonatal abstinence syndrome and use of voluntary long-acting reversible contraception for all female patients of child bearing age and potential;

(d) Expected therapeutic benefits and adverse effects of treatment medication;

(e) Risks for overdose, including drug interactions with CNS depressants, such as alcohol and benzodiazepines, and relapsing after periods of abstinence from opioids; and (f) Overdose prevention and reversal agents.

(5) A Facility shall only admit and retain patients whose known needs can be met by the Facility in accordance with its licensed program purpose and description and applicable federal and state statutes, laws, and regulations.

(6) Drug dependent pregnant females shall be given priority for admission and services.

(7) No Facility shall provide a bounty or other reward to a third party for referral of potential patients to the clinic.

(8) Comprehensive Assessment. Within 30 days of admission, the Facility shall have completed a comprehensive assessment. The comprehensive assessment shall include information obtained by the patient, family members, friends, peers, and other collateral sources, where appropriate and with the service recipient’s written consent. The comprehensive assessment shall include, but not be limited to, the following:

(a) A review of the information collected from the initial assessment;

(b) Follow up tests as necessary or appropriate based on initial screening (e.g., CBC, EKG, chest x-ray, hepatitis B, hepatitis C, HIV testing, pregnancy testing). The Facility is responsible for obtaining and maintaining documentation of required laboratory tests performed by an alternative provider;

(d) A social and family history;

(e) A criminal justice history, including any current criminal justice involvement; and (f) A psychosocial assessment that shall include information about the service recipient’s:

Motivation for treatment;
Personal treatment goals;
Personal strengths;
Individualized needs;
Urgent needs, including suicide risk;
Abilities and/or interests;
Presenting problems including a thorough analysis of the service recipient’s highrisk behaviors such as:

(i) Licit and illicit drugs used, including alcohol, including;

(I) Amount(s) and method(s) used;

(II) Frequency of use; and (III) Duration of use;

(ii) Symptoms of physical dependence or withdrawal;

(iii) History of treatment for addictive behaviors;

(iv) Adverse consequences of use; and (v) Inappropriate use of prescribed substances;

Previous behavioral health services, including:

(i) Diagnostic information;

(ii) Treatment information; and (iii) Efficacy of current or previously used medication;

Mental status;
Current level of functioning;
Need for, and availability of, social supports;
Adverse childhood experiences;
Adjustment to disabilities/disorders; and 14. Level of education.

(9) Discharge and Aftercare Plans. A Facility shall complete an individualized discharge and aftercare plan for patients who complete their course of treatment.

(a) All discharge and aftercare plans shall include documentation that the Facility’s qualified counseling providers and/or program providers have discussed with the patient an individualized medically supervised withdrawal plan appropriate to the patient.

(b) The patient’s discharge planning shall include the development of a menu of appropriate treatment resources available to the patient in his or her community. This menu shall be developed in consultation with the patient and shall be in writing and made available to the patient upon discharge. The Facility shall assist the patient in obtaining the appropriate referrals, as necessary.

(c) The discharge plan shall be completed at the time of the patient’s discharge by the person who has primary responsibility for coordinating or providing for the care of the service recipient. It shall include a final assessment of the patient’s status at the time of discharge and aftercare planning. If applicable, parents or guardian, or responsible persons may participate in discharge and aftercare planning. The reason for any patient not participating in discharge and aftercare planning shall be documented in the patient’s medical record.

(10) The Facility shall document when a patient discontinues services at an OBOT. Determination of the events that constitute a patient’s discontinuation of services at an OBOT shall be at the OBOT’s discretion.

(11) If a patient is observed to have experienced multiple relapses, the Facility shall consider the appropriateness for a referral of the patient to more intensive levels of care, to include but not be limited to, intensive outpatient, methadone treatment, or residential substance use disorder treatment. The Facility’s consideration for a referral shall be documented in the patient’s medical chart. Considerations for subsequent referrals should be discussed in line with ITP review frequency, as outlined in 0940-05-35-.09(5).

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.07 PATIENT RECORD REQUIREMENTS

(1) Each Facility shall have a specific policy and procedure outlining the Facility’s duties and responsibilities regarding any service recipient medical record requirements that are listed herein and in the minimum requirements of Chapter 0940-05-06.

(2) Facilities shall organize and coordinate patient medical and billing records in a manner which demonstrates that all pertinent patient information is accessible to all appropriate staff and to TDMHSAS surveyors.

(3) Should the licensee plan to close its operations, written notice shall be given to the patient or the new provider prior to the planned closure of the Facility. Patient medical records shall be transferred to the patient or to the new provider within ten (10) business days of the last scheduled visit of the patient.

(4) The Facility shall ensure that adequate billing and medical records are maintained in accordance with T.C.A. § 33-2-403(e), (f), and (g).

(5) Except as otherwise authorized by law, no person shall be admitted for treatment without written consent from the patient and, if applicable, parent, guardian, or responsible party. A documented, voluntary, written, program-specific informed consent to treatment from each patient at admission shall include:

(a) Information about all treatment procedures, services, and other policies and regulation throughout the course of treatment, including clinic charges in the form of a fee agreement signed by the patient. This fee agreement shall include an explanation of the financial aspects of treatment and the consequences of nonpayment of required fees, including the procedures for the patient (or patient’s legal representative) in the event they are unable to pay for treatment;

(b) Consent to the individualized, prescribed therapy before dosing begins, including information about potential interactions with and adverse reactions to other substances, including those reactions that might result from interactions and adverse reactions to alcohol, other prescribed or over-the-counter pharmacological agents, other medical procedures and food;

(d) Acknowledgement that the patient has been informed of the Facility’s rules regarding patient conduct and responsibilities;

(e) Acknowledgement that the patient has been informed of client rights as found in 0940- 05-35-.18, as well as 0940-05-06-.06;

(f) Information that at regular intervals, in full consultation with the patient, the program shall discuss the patient’s present level of functioning, course of treatment, and future goals; and (g) Information that the patient may choose to withdraw from or be maintained on the medication as the client desires unless medically contraindicated.

(6) The patient’s medical chart shall also include documentation of the following:

(a) Documentation that the patient’s initial screening and comprehensive assessment are completed and documented in the patient’s medical record prior to the development of the patient’s individualized treatment plan;

(b) The individualized treatment plan, including any reviews, changes or amendments to the plan;

(c) Documentation that services listed in the individualized treatment plan are available and have been provided or offered;

(d) A record of correspondence with the patient, family members, and other individuals and a record of each referral for services and its results;

(e) A discharge and aftercare plan pursuant to 0940-05-35-.06(9), including reasons for discharge and any referral. In the case of death, the reported cause of death shall be documented; and (f) Documentation of coordination of care should be present in those clinical situations which require consultations or coordination of care.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.08 PATIENT TRANSFERS

(1) If a prospective patient has previously been discharged, inside of the previous twelve (12) months, at a minimum, from treatment at another Facility or other type of treatment program, the admitting Facility, after having the patient sign a release of information, shall initiate an inquiry into the prospective patient’s prior treatment history, inquiring of the last Facility or other type of treatment program attended and the reasons for discharge from treatment.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.09 INDIVIDUALIZED TREATMENT PLAN

(1) A Facility shall develop an individualized treatment plan (ITP) for each patient within thirty (30) days of admission. The ITP shall be developed in accordance with peer reviewed medication assisted treatment guidelines, developed by nationally recognized organizations, such as SAMHSA and the American Society of Addiction Medicine or the Tennessee Nonresidential Buprenorphine Treatment Guidelines. The initial and comprehensive assessments listed in 0940-05-35-.06 shall be completed, unless extenuating prohibitive circumstances exist, prior to the finalization of an initial ITP. Any significant findings from the initial or comprehensive assessments that impact the service recipient’s success in treatment and recovery shall be documented and addressed in the ITP. The ITP, at minimum, shall contain: S.M.A.R.T. goals for identified service needs of the patient, listing of the services provided in-house (including but not limited to: office visit, counseling, case management, drug screen), external services and the frequency of those in-house and external services.

The Facility may use alternative treatment planning methods provided that the methodology is evidence-based and provides similar details to that of the S.M.A.R.T. goals as defined by these rules. The initial ITP and all reviews shall be signed, either in person, electronically, or by documented verbal acknowledgment, by the service recipient, qualified counseling provider, and program provider.

(2) Medical care, including referral for necessary medical service, and evaluation and follow-up of patient complaints, shall be compatible with current and accepted standards of medical practice. All patients shall receive a physical exam, in accordance with federal and state controlled substance prescribing laws, medical evaluation at least annually as part of the initial assessment. A physical exam shall then be offered, either by the Facility or through a referral, as clinically indicated. Subsequent physical exams shall be documented in the medical record. Any physical examination shall be consistent with 42 CFR 12 requirements.

The program provider shall record the results of the examinations and tests in the patient’s medical record. Any significant findings of the physical exam or other testing that may complicate a patient’s treatment at the Facility shall be included in the patient’s medical record.

(3) Each Facility shall take steps to ensure that a comprehensive range of rehabilitative services, including vocational, educational, legal, mental health, alcoholism, and social services, are made available to the patients who demonstrate a need for such services. The Facility can fulfill this responsibility by providing support services directly or by appropriate referral.

Support services that are recommended and/or utilized shall be documented in the patient’s medical record. Each Facility shall have policies for matching a patient’s needs to treatment.

(4) If the patient experiences a return to drug use, his or her ITP shall document evidence of intensified services provided. Such evidence may include, but is not limited to, a “move back” to more intensive phases of treatment (as detailed by 0940-05-35-.10), an increase in individual or group counseling session(s), or more frequent drug screens.

(5) A patient’s ITP shall be reviewed at least every six (6) months and a discussion shall be held with the patient regarding his or her continued desire to remain in the program for maintenance treatment. Alternatives such as medically supervised withdrawal shall be presented to the patient at the time of the discussion and documented in the patient’s medical record. The patient shall sign and date a statement on the ITP indicating that she or he wishes to remain within the program in a maintenance phase. If the patient wishes to enter medically supervised withdrawal, the ITP shall reflect that choice.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Amendments filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.10 PHASES OF TREATMENT

(1) Requirements for services according to phases of treatment:

(a) The patient’s most current phase of treatment, according to the patient’s specific documented history (e.g. patient coming to Facility following transfer from other provider and who may be already under a different phase of treatment), along with rationale for the assigned phase, shall be clearly documented in the patient’s medical record.

(b) For the purposes of this section, the following definitions apply:

“Induction or stabilization” means the phase of treatment when the patient is new to treatment or exhibits active symptoms of substance use disorder and receives more frequent treatment services. The Facility staff should more closely evaluate the patient for signs of reduced symptoms of their substance use disorder, including but not limited to: reduced or eliminated illicit drug use, reduced cravings for illicit substances, suppression of withdrawal symptoms, evaluation of medication side effects, or patient reports of treatment needs.
“Maintenance” means the phase of treatment when the patient demonstrates treatment stability and their substance use disorder is considered to be in remission. Treatment stability is determined by evaluating, but not limited to, the following: stable dosing of the treatment medication, favorable drug screens, reduced or eliminated cravings for illicit substances, regular clinic attendance, participation in counseling, and absence of illegal activity related to illicit substance use.

Have weekly program provider-interactive visits scheduled with the ability for 1on-1 therapeutic discussions between the patient and program provider;
Be scheduled to receive appropriate counseling sessions with a qualified counseling provider at least twice a month;
Be administered one (1) observed drug screen initially, and then a drug screen at least weekly, for a minimum of three (3) weeks; and 4. Be scheduled to receive case management services weekly.

(d) A patient in the maintenance phase of treatment for less than one (1) year shall:

Have a scheduled program provider-interactive visit at least every two (2) to four (4) weeks with the ability for 1-on-1 therapeutic discussions between the patient and program provider;
Be scheduled to receive counseling sessions with a qualified counseling provider at least monthly;
Be administered a random drug screen at least eight (8) times annually; and 4. Be scheduled to receive case management services at least monthly.

(e) A patient in the maintenance phase of treatment for one (1) year or more shall:

Have a scheduled program provider-interactive visit at least every two (2) months with the ability for 1-on-1 therapeutic discussions between the patient and program provider;
Scheduled to receive counseling sessions with a qualified counseling provider at least monthly;
Be administered a random drug screen at least eight (8) times annually; and 4. Be offered case management services at least every six (6) months. In addition to case management services provided, any offers for case management shall also be documented in the patient’s medical record.

(2) All drug screens, regardless of patient phase of treatment, shall be done in accordance with the procedures as detailed in 0940-05-35-.14.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: New rule filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.11 SPECIAL POPULATIONS

(1) Pregnant Women/Women of Child Bearing Age and Potential. Upon the initial screening, the Facility shall screen all women of child bearing age and potential for pregnancy. For this

purpose, a woman of child bearing age and potential is aligned with Tennessee Code Annotated § 53-11-308(h). The Facility will ensure that pregnant women and women of child bearing age and potential shall be treated using nationally recognized best practice guidelines and within all applicable federal and state rules and regulations. If the Facility does not provide prenatal care to pregnant patients, the Facility shall ensure that there is coordination of care between the Facility and the pregnant patient’s prenatal care provider.

The Facility shall document, in the patient’s medical record, that the Facility has informed all pregnant women and women of child bearing age and potential, initially and at regular intervals, of the risks and benefits of the utilization of voluntary, reversible, long-acting contraception, of the risks and benefits of medication assisted treatment and detoxification treatment with buprenorphine containing products, and of the risks associated with the continued use of opioids, including neonatal abstinence syndrome. The information provided to pregnant women and women of child bearing age and potential shall be based on current best practices and research.

(2) Pain Management. The Facility shall ensure that program providers are knowledgeable in the management of opioid use disorder in a context of chronic pain and pain management. The Facility shall ensure continuity of care and communication between treatment programs or physicians regarding patients receiving treatment in both a nonresidential office-based opiate treatment facility and a licensed pain management clinic or a pain management specialist’s office for purposes of pain management, with patient consent.

(3) Co-Occurring Disorders. The Facility shall ensure that patients with mental health needs are identified through the initial screening and comprehensive assessment processes and are referred to, or provided, appropriate treatment.

(a) The Facility shall monitor, assess, and document in the patient’s medical record the emergence of symptoms of mental illness during treatment.

(b) The Facility shall establish relationships with mental health providers in the community for referral/additional treatment services as indicated. See 0940-05-35-.09(3).

(4) Polysubstance Misuse. The Facility shall address misuse of alcohol and other non-opioid substances within the context of the medication-assisted therapy effort. Ongoing polysubstance misuse is not necessarily a reason for discharge; however, the Facility shall facilitate a referral of the patient, with documentation of the referral in the patient’s medical record, to more intensive levels of care, as indicated, to include but not be limited to, intensive outpatient or residential alcohol and drug use treatment.

(5) Criminal Justice. The Department encourages each Facility to work with local law enforcement, probation officers, and courts, including recovery (drug) courts, to act as a resource for individuals in the criminal justice system to receive the necessary treatment services including medications and counseling. The Facility shall document in their policy the extent of its work with this community.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.10 but was renumbered 0940-05- 35-.11 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.12 COUNSELING

(1) Counseling is a mandatory component of treatment and the Facility shall determine the best counseling option for each individual patient based upon the patient’s history and assessments, agreeance with the patient, and the goals of the patient’s individualized treatment plan.

(2) The Facility shall be responsible to determine and receive documentation that counseling is being received and the patient is progressing towards meeting the goals listed in the individualized treatment plan. The Facility shall review and modify the individualized treatment plan if it is determined that a patient is not following through with counseling referrals.

(3) If the Facility utilizes its own staff to provide counseling:

(a) The Facility staff shall be sufficient in number and in training to:

Allow the Facility to provide adequate:

(i) Psychosocial assessment;

(ii) Treatment planning; and (iii) Individualized counseling.

Allow for regularly scheduled counseling sessions; and 3. Allow patients access to their counselor if more frequent contact is merited by need or is requested by the patient.

(4) For Facilities referring patients for counseling, the Facility shall provide the patient, with the patient’s written consent, a list of available licensed treatment providers in the community and assist the patient in receiving these services by offering to make appointments on the patient’s behalf and by coordinating care after initiation of services at the outside provider.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.11 but was renumbered 0940-05- 35-.12 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.13 MEDICATION MANAGEMENT

(1) Opioid Drugs. Facilities shall develop and implement written policies and procedures for the prescription of opioid drugs. Any changes to these policies and procedures shall be done in consultation with the Facility’s medical director. These policies and procedures shall include the following:

(a) Prescribing.

The proper initial dose, medication type, and dosage form shall, in consultation with the patient, be based on the clinical judgment of the program provider who has examined the patient and who has considered all available relevant patientspecific information including, but not limited to, drug screens, initial screenings, and medication availability and cost.
No standardized routines or schedules of increases or decreases of medication doses may be established or used.
Facilities shall comply with requirements for prescribing higher doses of buprenorphine, pursuant to Tennessee Code Annotated § 53-11-311(d)(1). For purposes of these rules, a patient dose greater than sixteen milligrams (16mg), or its equivalent, per day, shall be considered a high dose.
A patient dose of thirty-two milligrams (32mg), or its equivalent, per day shall be considered a maximum dose. Doses greater than the maximum dose may only be used with prior written approval from the State Opioid Treatment Authority.

Documentation of this approval shall be kept in the patient’s medical chart or otherwise be readily retrievable upon request or Facility inspection.

A copy of all prescriptions for a patient at the Facility shall be documented in the patient’s medical chart.
The program provider shall demonstrate to the patient appropriate techniques for administering the particular prescribed treatment medication.

(b) Dispensing. An office-based opiate treatment facility without dispensing authorization is prohibited from dispensing buprenorphine-containing products.

The patient’s medical chart shall include documentation of rationale that it is clinically appropriate for the patient to receive a high dose of the treatment medication.
The program provider shall have a discussion with the patient and the patient shall provide written consent acknowledging that the patient will receive a high dose of the treatment medication and associated risks. The program provider shall document that this discussion included an assessment of the patient’s administration technique and that the patient is using the appropriate technique for the prescribed medication.
The program provider shall not establish or use standardized routines or schedules of increases or decreases of treatment medication doses for the patient. Decisions about dosing should be individualized with documentation of reasons for choice of dosing.

(d) Program Provider-Initiated-and-Led Tapering Discussions. Program provider shall initiate and lead a discussion with the patient regarding patient readiness to taper down or taper off treatment medications employed in the patient’s treatment with each patient at any time upon the patient’s request but no later than one (1) year after initiating treatment and then every six (6) months thereafter. Documentation of this discussion shall be placed in the patient’s medical chart.

(2) CSMD Check. The Facility shall check the CSMD upon every visit of the patient with a program provider. The patient’s medical record shall include documentation of the check of the CSMD and the date upon which it occurred.

(3) Benzodiazepine Use. Benzodiazepines should only be prescribed to a patient after careful evaluation while utilizing caution and good judgment. Benzodiazepines may be prescribed to a patient on buprenorphine or a buprenorphine and naloxone combination under the following conditions:

(a) Benzodiazepines shall not be initiated with a patient with opioid use disorder or the disease of addiction who has never been prescribed these products or has a history of misusing these products. Notwithstanding, in rare circumstances:

Patients who present with a longstanding prescription for benzodiazepines for a medical condition from another prescriber may be prescribed buprenorphine products by a program provider. Contact should be initiated with the prescriber of the benzodiazepine to coordinate care and clear documentation should be recorded in the patient’s medical record.
A program provider at an OBOT may assume management of a patient’s benzodiazepine prescribing from another physician if the patient is willing to initiate a program of tapering.
If a patient presents at an OBOT with a dual diagnosis of opioid use disorder and a clear history of benzodiazepine use disorder, the duration and extent of the misuse should be clearly documented in the medical record. A program provider at an OBOT may prescribe a long-acting benzodiazepine, such as clonazepam or its equivalent, under the following conditions:

(i) A patient may continue on benzodiazepine therapy as medically indicated as long as there is an ongoing effort to taper the patient to the lowest effective dose in order to prevent benzodiazepine withdrawal syndrome and clear documentation of this effort is made in the patient’s medical record.

(I) Prescribing more than two (2) milligrams of clonazepam or its equivalent daily is considered “high dose therapy.”

(II) Patients receiving high dose therapy should have justification for the dosing clearly documented in the patient’s medical record.

(III) Patients receiving high dose therapy should be tapered as rapidly as tolerable to two (2) milligrams or less of clonazepam, or its equivalent, daily. If the taper is unsuccessful, the reason(s) shall be clearly documented in the patient’s medical record.

(IV) Patients receiving high dose therapy for a period of longer than six (6) weeks shall be managed by a physician who is board certified in addiction medicine or who is board certified or fellowship trained in addiction psychiatry, or by a physician who has obtained a formal consult from a physician who is board certified in addiction medicine or who is board certified or fellowship trained in addiction psychiatry.

The formal consult shall be clearly documented in the patient’s medical record.

(4) The Facility shall have a policy and procedure developed for reviewing prescriptions from other providers, including:

(a) Procedures to ensure that a patient’s prescriptions from outside providers will be reported to the medical staff and reviewed by the program provider at admission and annually thereafter;

(b) Procedures describing the Facility’s response when information about prescriptions from outside providers is not reported to ensure compliance with this rule; and, (c) Documentation of the Facility’s efforts to obtain information about prescriptions from outside providers in the patient’s medical record, if a Facility is unable to acquire information about a patient’s prescriptions.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-406, 33-2-407, and 53-11-311.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Emergency rule filed December 20, 2018 to become effective January 1, 2019; effective through June 30, 2019. Rule was previously numbered 0940-05-35- .12 but was renumbered 0940-05-35-.13 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.14 DRUG SCREENS

(1) Random drug screenings shall be conducted for every patient according to their phase of treatment as described in 0940-05-35-.10. All patients, regardless of phases of treatment, shall be subject to at least one randomly observed drug screen per year.

(2) More frequent collection and analysis of drug samples during episodes of relapse or medically supervised or other types of withdrawal may occur.

(3) Collection and testing shall be done in a manner that assures that samples collected from patients are unadulterated. Such collection and testing shall include random direct observation, as may be warranted and determined at the program provider’s discretion, that is conducted professionally, ethically, and in a manner which respects service recipients’ privacy.

(4) A positive test is a test that results in the presence of any drug or substance that is illegal or for which the patient cannot provide a valid prescription or any drug or substance prohibited by the Facility. Any refusal to participate in a random drug test assigned by the Facility shall also be considered a positive result.

(5) The Facility shall document all results of toxicological tests in the patient’s medical record.

(6) Absence of medications prescribed by the Facility for the service recipient shall be considered evidence of possible medication diversion and evaluated by the program provider accordingly.

(7) Nothing contained in this rule shall preclude any Facility from administering any additional drug tests it determines necessary.

History

Authority: T.C.A. §§ 4-3-1601, 4-1-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.13 but was renumbered 0940-05- 35-.14 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.15 DETOXIFICATION AND MEDICALLY SUPERVISED WITHDRAWAL

(1) Medically supervised withdrawal occurs as a voluntary and therapeutic withdrawal agreed upon by staff and patient. In some cases, the withdrawal may be initiated against the advice of clinical staff (against medical advice).

(a) The Facility shall work with the patient to taper the patient’s dose at a rate that is well tolerated by the patient.

(b) The Facility may offer supportive treatment including increased counseling sessions or referrals to a self-help group or other counseling provider as appropriate during a medically supervised withdrawal.

(c) The Facility shall make provisions for continuing care (e.g., referral to other community resources for counseling) for each patient completing care at the Facility and for reentry to the Facility if relapse occurs or if the patient should reconsider treatment at the Facility.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.14 but was renumbered 0940-05- 35-.15 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.16 DIVERSION CONTROL PLAN

(1) Each Facility shall prepare a Diversion Control Plan that contains specific measures to reduce the possibility of diversion of controlled substances from legitimate medical treatment use and that assigns specific responsibility to the medical and administrative staff of the Facility for carrying out the diversion control functions described in the Diversion Control Plan. These measures may include patient call backs. The Diversion Control Plan shall address, at a minimum, the following scenarios that may indicate diversion:

(a) The patient has been reported to be diverting medication.

(b) The patient’s recent drug screen results show an absence of the treatment medication.

(d) Results from the patient’s CSMD check demonstrate significant variation from the patient’s treatment plan.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.15 but was renumbered 0940-05- 35-.16 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.17 REPORTING REQUIREMENTS

(1) Upon request or inspection, the Facility shall submit the following information to the Department:

(a) All reports, forms, and correspondence submitted to or received from the health-related boards of the Tennessee Department of Health, FDA, DEA, SAMHSA or any other applicable federal agencies, or accreditation organizations shall be provided to the Office of Licensure within five (5) business days of sending or receiving such documents.

(b) Such reports and information which may be required by the Department to conduct evaluations of medication assisted treatment effectiveness or monitor service delivery.

(2) The Facility shall report any significant occurrence, as defined in the TDMHSAS Office of Licensure Reportable Incident Form Instructions, to the Office of Licensure. This shall include any unexpected occurrence or accident that results in death or serious injury to a patient or any action taken against the Facility by the DEA, accrediting body, or other state (not to exclude any state related boards and/or commissions), local, or federal agency. Additional reporting requirements may be found in Chapter 0940-05-02-.20.

(3) The Facility shall be required to respond in writing following the citation of the Office of Licensure or other state entity. The Facility will be given an appropriate amount of time to respond and their response should encapsulate at least the following:

(a) The actions implemented to address current citation and to prevent the recurrence of the event;

(b) The time frames for the action(s) to be implemented;

(c) The person(s) designated to implement and monitor the action(s); and (d) The strategies for the measurements of effectiveness to be established.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.16 but was renumbered 0940-05- 35-.17 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.18 PATIENT RIGHTS

(1) Patients shall have a right to present complaints, either orally or in writing, and to have their complaints addressed and resolved as appropriate in a timely manner.

(2) All applications, certificates, records, reports, and all legal documents, petitions and records made or information received pursuant to treatment in a Facility directly or indirectly identifying a patient shall be kept confidential in accordance with T.C.A. § 33-3-103; Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations at 45 Code of Regulations (CFR) Parts 160 and 164, Subparts A and E; and Confidentiality of Alcohol and Drug Abuse Patient Records regulations at 42 CFR Part 2.

(3) Patients have the right to a humane treatment environment that affords reasonable protection from harm, exploitation, and coercion.

(4) In addition to the above Patient Rights, Facility shall follow the Patient Rights requirements that apply to nonresidential settings as detailed in 0940-05-06.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.17 but was renumbered 0940-05- 35-.18 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.19 COMMUNITY RELATIONS

(1) The Facility shall identify Facility personnel who are responsible for developing and implementing a community relations plan.

(2) A Facility shall take proactive efforts to limit disruption outside of its Facility and that may relate to patients it serves.

(3) Each Facility shall provide TDMHSAS, when requested, with a specific plan describing the efforts it will make to ensure responsiveness to community needs.

(4) Each Facility shall document community relations efforts and community contacts, including the resolution of issues identified by community members or patients.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.18 but was renumbered 0940-05- 35-.19 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Tenn. Comp. R. & Regs. 0940-05-35-.20 PERSONNEL AND STAFFING REQUIREMENTS

(1) A personnel record for each staff member of a Facility shall include an application for employment and/or resume and a record of any disciplinary action taken by the Facility. A licensee shall maintain written records for each employee and volunteer utilized by the Facility.

(2) Staffing.

(a) Facility Director. The governing body of each Facility shall designate in writing a Facility director who is responsible for the operation of the Facility and overall compliance with federal, state and local laws and regulations regarding the operation of nonresidential office-based opiate treatment programs, and for all employees at the Facility. However, non-physician Facility directors shall not supervise medical staff. Facilities shall notify the TDMHSAS Office of Licensure in writing within ten (10) calendar days whenever there is a change in Facility director.

(b) Medical Director. The governing body of each Facility shall designate in writing a medical director to be responsible for the supervision of all medical staff at the Facility and the administration of all medical services at the Facility, including compliance with all federal, state, and local laws and regulations regarding the medical treatment of opioid use disorder. The medical director shall be physically present at the Facility the equivalent of twenty-five (25) percent of the time the Facility is open to the public each week. On a monthly basis, the medical director shall review ten (10) percent of the medical charts for patients currently admitted at the Facility and document each chart review. No physician may serve as medical director of more than three (3) Facilities without the prior written approval of the TDMHSAS Office of Licensure.

(c) Program Physician. Facilities are required to provide sufficient physician services to provide the medical treatment and oversight necessary to serve patient need. A Program Physician may be the same individual as the Medical Director, should the Facility so choose and all qualification requirements for a medical director are still met.

(d) Physician Assistants and Advanced Practice Registered Nurses. Licensed physician assistants and advanced practice registered nurses with a certificate of fitness with privileges to write and sign prescriptions and/or issue legend drugs may perform any functions under federal and Tennessee laws or regulations. Any physician assistants and/or advanced practice registered nurses issuing prescriptions at the Facility shall have their supervising or collaborating physician clearly documented in their personnel file, if applicable. Physician assistants and advanced practice registered nurses shall maintain an unrestricted license with their applicable Health Related Board.

(e) Case Management/Care Coordination. Each Facility shall provide case management/care coordination services by a person who has received appropriate training and education, and:

Who has at least a Bachelor degree or equivalent education; or 2. Who is supervised by a qualified counseling provider or program provider who has received training and education to provide case management services.

(3) Staff Qualifications.

(a) Staff Training. Prior to working with patients, all staff with direct patient interaction/responsibility shall be oriented in accordance with all applicable administrative rules (as listed in 0940-05-35-.03), reporting requirements, and their individual position responsibilities. All staff shall receive ongoing training and development activities. Record of all staff training activities shall be noted in their personnel record.

(b) Medical Director. A medical director shall be licensed to practice medicine or osteopathy in Tennessee, shall maintain an unrestricted license to practice medicine or osteopathy, be designated by the OBOT’s governing body, and shall have the following experience and/or credentials:

Certification in addiction psychiatry by the American Board of Psychiatry and Neurology or exam eligible in addiction psychiatry; and two (2) years of documented experience in the treatment of persons who are addicted to alcohol or other drugs; or 2. Certification as an addiction medicine specialist by the American Board of Addiction Medicine (ABAM) or the American Board of Preventive Medicine (ABPM) or exam eligible for certification as an addiction medicine specialist and two (2) years of documented experience in the treatment of persons who are addicted to alcohol or other drugs; or 3. Meet the Tennessee Department of Health definition of addiction specialist as outlined in Rule 0880-02-.14; or 4. For an OBOT that is accredited by a national accrediting healthcare organization listed in Rule 0940-05-02-.12(1)(a) or (b) in a behavioral health or opioid treatment service category, or equivalent, the medical director shall be exempted from the requirements of 1.–3. above.

(c) Program Physician. A program physician shall be licensed to practice medicine or osteopathy in Tennessee, and shall maintain an unrestricted license to practice medicine or osteopathy.

(d) Facility Directors. All Facility directors shall have at least one (1) year of supervisory or administrative experience in the field of opioid use disorder treatment.

(e) Program Provider. A program provider shall be duly licensed, certified or registered as required by the State of Tennessee for the profession and shall only perform those duties that are within the scope of their applicable professional practice acts and Tennessee license.

(4) Direct Care Drug Screening. Facilities shall implement drug screenings for all persons providing direct services on behalf of the Facility regardless of whether persons are employed, contracted, or volunteering. Drug screens shall be completed initially, prior to any service provision, and randomly each year thereafter.

(5) In addition to the above Personnel and Staffing Requirements, the Facility shall follow the Personnel and Staffing Requirements as detailed in 0940-05-06.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, and 33-2-407.
Administrative History: Original rules filed October 14, 2016; effective January 12, 2017. Rule was previously numbered 0940-05-35-.19 but was renumbered 0940-05- 35-.20 with the introduction of a new rule 0940-05-35-.10 filed March 29, 2019; effective June 27, 2019. Amendments filed March 29, 2019; effective June 27, 2019. Amendments filed June 27, 2025; effective September 25, 2025.

Chapter 0940-05-36 Minimum Program Requirements for Nonresidential Office-Based Opiate Treatment Facilities with Dispensing Authorization

Tenn. Comp. R. & Regs. 0940-05-36-.01 PURPOSE

The rules in this chapter implement the law relative to licensure and regulation of “Nonresidential officebased opiate treatment facility with dispensing authorization” or “OBOT Plus” pursuant to Chapter 978 of the Public Acts of 2018.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, 53-11-311, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rule filed August 29, 2003; effective December 29, 2003. Repeal filed July 21, 2004; effective November 26, 2004. New rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.02 DEFINITIONS

(1) Definitions of general terms used in these rules can be found in Rule 0940-05-01.

(2) Definitions specific to this chapter are as follows:

(a) “Nonresidential office-based opiate treatment facility with dispensing authorization" or “Facility” or “OBOT Plus” is a service entity that includes, but is not limited to, standalone clinics, treatment resources, individual physical locations occupied as the professional practice of a prescriber or prescribers licensed pursuant to Title 63, or other entities prescribing and dispensing products containing buprenorphine, or products containing any other controlled substance designed to treat opioid use disorder by preventing symptoms of withdrawal to twenty-five percent (25%) or more of its patients or to one hundred fifty (150) or more patients. An association by contract, fee for service, business arrangement, or two or more unaffiliated authorized providers with a DATA 2000 waiver operating at the same physical location and who dispense products containing buprenorphine shall be considered an OBOT Plus. An OBOT Plus does not include any facility that meets the definition of a nonresidential substitutionbased treatment center for opiate addiction.

(b) “Authorized provider” means a healthcare provider authorized by the state or federal government who has authority to issue and dispense prescriptions for buprenorphine.

(c) “Authorized caregiver” means any person who is given written authorization by the patient to act on the patient’s behalf.

FACILITIES WITH DISPENSING AUTHORIZATION

(d) “Buprenorphine” means a semi-synthetic opioid partial agonist that activates the opioid receptors but not to the same degree as full agonists such as morphine and heroin, as well as any FDA-approved pharmaceutical product that contains buprenorphine.

(e) “Care Team” means the group of healthcare professionals, social workers, and counselors who help manage the patient’s detoxification and maintenance of abstinence from the patient’s drug of choice.

(f) “Central Registry” means an electronic system approved by the Department to register patients currently receiving treatment at an Opiate Treatment Program (“OTP”) or OBOT Plus.

(g) “Controlled substance(s)” means a drug, substance, or immediate precursor in Schedules I through VI as defined or listed in the Tennessee Drug Control Act, compiled in T.C.A., Title 39, Chapter 17, part 4.

(h) “DATA 2000 waiver” means the registered authority given to a qualified health care professional by the U.S. Drug Enforcement Administration to prescribe FDA-approved narcotic medication for opioid detoxification or maintenance treatment pursuant to 21 U.S.C. §823(g).

(i) “DEA” means the United States Drug Enforcement Agency.

(j) “Dispense” means preparing, packaging, compounding or labeling for delivery and actual delivery of a prescription drug, nonprescription drug or device in the course of professional practice to a patient or the patient's agent, to include a licensed health care practitioner or a health care facility providing services or treatment to the patient or patients, by or pursuant to the lawful order of a prescriber. This definition does not include administration, or supervised self-administration, as otherwise permitted by law.

(k) ''Dispenser'' means an authorized provider who dispenses buprenorphine to an ultimate user.

(l) “Dispensing area” refers to the actual physical location where dispensing occurs. It does not include any waiting or common areas.

(m) “Drug” means a substance recognized by the official United States pharmacopeia or formulary intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or, a substance intended to alter the structure or function of the human body.

(n) “Facility director” means the person designated by the Facility’s governing body who is responsible for the operation of the Facility, for the Facility’s overall compliance with federal, state and local laws and regulations regarding the operation of a nonresidential office-based opiate treatment facility with dispensing authorization, and for all Facility employees including practitioners, agents, or other persons providing services at the Facility. Non-physician facility directors shall not supervise medical staff.

(o) “FDA” means the United States Food and Drug Administration.

(p) “Licensee" means a proprietorship, partnership, association, governmental agency, or corporation, that operates a facility or a service and has obtained a license under this

part.

FACILITIES WITH DISPENSING AUTHORIZATION

(q) “Medication order” or “prescription order” means a prescription order for any prescription drug or device or related material issued by an authorized prescriber to authorized healthcare personnel in a practice site or facility.

(r) “Office of Licensure” means the Tennessee Department of Mental Health and Substance Abuse Services Office of Licensure.

(s) “Opiate” or ”opioid” means a drug that contains opium, derivatives of opium, or any of several semi-synthetic or synthetic drugs with agonist activity at the opioid receptor(s).

(t) “Patient” or “service recipient” means an individual receiving treatment for opiate use disorder at an OBOT Plus.

(u) “Patient counseling” means communication, by an authorized provider, of information to the patient or authorized caregiver in order to improve therapeutic outcomes and ensure optimal care.

(v) “Consultant Pharmacist” means a pharmacist with an active license in good standing from the Tennessee Board of Pharmacy that is employed or contracted by the OBOT Plus.

(w) “Physical location” means real property on which is located a physical structure, whether or not that structure is attached to real property, containing one (1) or more units and includes an individual apartment, office, condominium, cooperative unit, mobile or manufactured home, or trailer, if used as a site for prescribing and/or dispensing products containing buprenorphine, or products containing any other controlled substance designed to treat opiate use disorder by preventing symptoms of withdrawal.

(x) “Professional samples” means small quantities (less than a typical 30, 60, or 90-day supply) of medication provided to prescribers or authorized healthcare personnel to be administered to patients.

(y) “State Opioid Treatment Authority” or “SOTA” means any individual person designated by the commissioner to exercise the responsibility and authority for governing the treatment of opioid addiction in accordance with all applicable state and federal regulations, and serves as a liaison with the appropriate federal agencies.

(z) “TDMHSAS” or “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rule filed August 29, 2003; effective December 29, 2003. Repeal filed July 21, 2004; effective November 26, 2004. New rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.03 APPLICATION OF THE RULES

(1) The licensee of an OBOT Plus shall comply with the following rules:

(a) Chapter 0940-05-02 Licensure Administration and Procedures;

(b) Applicable Minimum Program Requirements for All Services and Facilities found in

Chapter 0940-05-06;

FACILITIES WITH DISPENSING AUTHORIZATION

(c) Chapter 0940-05-35 Minimum Program Requirements for Nonresidential Office-Based Opiate Treatment Facilities; and (d) Chapter 0940-05-36 Minimum Program Requirements for Nonresidential Office-Based Opiate Treatment Facilities with Dispensing Authorization (“OBOT Plus”).

(2) If any provision of these rules, or the application thereof, to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of these rules which can be given effect without the invalid provision or application, and to that end the provisions of these rules are declared severable.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rule filed August 29, 2003; effective December 29, 2003. Repeal filed July 21, 2004; effective November 26, 2004. New rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.04 LICENSING CRITERIA

(1) Eligibility (a) In order to be authorized to dispense buprenorphine containing products, the interested entity must be a current Full licensed Office-Based Opiate Treatment Facility in good standing with the Department that has been in licensed operation for at least one (1) calendar year.

(b) The Facility seeking dispensing authorization shall comply with Rule 0940-05-35-.04.

(2) Procedures (a) The current Full licensed Office-Based Opiate Treatment Facility shall make a request for dispensing authorization in written form and shall pay a $50 fee - as established in

Rule 0940-05-02-.23 - via invoice provided by the Office of Licensure.

(b) The Facility seeking dispensing authorization shall be subject to an on-site inspection to ensure compliance with Rule 0940-05-36-.05 Medication Storage.

(c) Each Facility seeking a license must submit to the Office of Licensure proof that every authorized provider at the facility has submitted to their respective professional licensing board notice of his or her intent to dispense buprenorphine products.

(d) Each Facility seeking a license must submit to the Office of Licensure proof that the Facility is participating in the Central Registry.

(3) Prior to renewal of the license, the OBOT Plus shall be required to develop written policies and procedures that are specific to the dispensing of buprenorphine products, and substantially comply with the provisions of this Rule, as well as with Administrative Chapters 0940-05-06 and 0940-05-35.

(4) With or without notice, the Department, or its representatives, shall have the right to enter upon or into the premises of an OBOT Plus in order to make inspections and/or investigations deemed necessary to determine compliance with applicable law. The OBOT Plus shall comply with all reasonable requests of the Department and allow it to obtain information from third parties if necessary.

FACILITIES WITH DISPENSING AUTHORIZATION

(5) The Department shall be given the authority to enter upon the premises of an unlicensed facility dispensing buprenorphine products to better determine that unlicensed facility’s need for TDMHSAS oversight. The Department shall attempt to conduct inspections and investigations in the least intrusive manner needed in order to obtain necessary information.

The facility shall be required to provide reasonable amounts of information to the Department for this determination.

(a) “Reasonable amounts of information,” in this context, may be considered aggregate, non-patient identifying information to include, but not be limited to:

Patient de-identified identifiers;
Lists of medications prescribed to that de-identified patient;
Lists of medications dispensed to that de-identified patient;
The total number of medications dispensed at the physical location in question; and 5. The total number of patients seen at the physical location in question.

(6) No provider shall dispense buprenorphine to a patient until an OBOT Plus license has been issued by the Office of Licensure.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rule filed August 29, 2003; effective December 29, 2003. Repeal filed July 21, 2004; effective November 26, 2004. New rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.05 MEDICATION STORAGE

(1) Buprenorphine products shall be stored in a secure storage area in compliance with 21 C.F.R. Part 1301.72.

(2) All prescription drugs and controlled substances, and related materials, shall be stored in an area not accessible to the public.

(3) The patient waiting area shall be physically separated from the buprenorphine storage and dispensing area.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2- 302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rule filed August 29, 2003; effective December 29, 2003. Repeal filed July 21, 2004; effective November 26, 2004. New rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.06 RECORDKEEPING

(1) Each OBOT Plus shall maintain records with the following information for each buprenorphine product dispensed:

(a) Name of product;

(b) Medication strength;

FACILITIES WITH DISPENSING AUTHORIZATION

(d) Date dispensed;

(e) Adequate identification of patient;

(f) Amount dispensed; and (g) Dispenser's initials or other identifier.

(2) OBOT Plus facilities must maintain documentation of participation in the Central Registry, pursuant to Rule 0940-05-36-.11, in order to prevent dual enrollment, diversion and to ensure patient safety.

(3) OBOT Plus facilities must report all medications dispensed to the controlled substances monitoring database, as defined in Rule 0940-05-35-.02(2)(d), to the extent permitted by 42 C.F.R. Part 2.

(4) A patient record system shall be maintained by all OBOT Plus facilities for patients for whom prescription or medical orders are dispensed. The patient record system shall provide for the immediate retrieval of information necessary to identify previously dispensed prescription or medical orders at the time a prescription or medical order is presented.

(a) In the event of a patient record system shut down, dispensing records must be maintained manually and entered into the patient records system as soon as the issue causing the shutdown is resolved.

(5) A record of compliance with Rule 0940-05-36-.09 shall be signed by the Facility Director and maintained at the OBOT Plus facility with other controlled substance records for at least two (2) years.

(6) Authorized providers shall notify their appropriate licensing board of their intent to dispense buprenorphine at an OBOT Plus facility. OBOT Plus facilities shall be required to maintain records indicating this notification for each authorized provider it employs for as long as he/she is employed and at least one (1) year thereafter.

(7) The required recordkeeping of this section will be maintained in a dispensing log at the physical location of the OBOT Plus facility.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.07 REPORTING

(1) OBOT Plus facilities must adhere to all reporting requirements of Rule 0940-05-02-.20.

(2) The Facility Director shall immediately report to the Department and appropriate licensing board(s) any robbery, embezzlement, theft, burglary, fire, or disaster resulting in a loss of prescription drugs, controlled substances, medical devices or related materials. The report shall include a list, including amounts, of such prescription drugs, controlled substances, medical devices, or related materials lost or damaged and, shall include all other requirements under Rule 1140-03-09;

FACILITIES WITH DISPENSING AUTHORIZATION

(3) Controlled substance bulk inventory lost through breakage, damage, or spillage, other than an individual patient dose, should be considered an accountable loss. Disposal of such controlled substances must be performed in accordance with DEA requirements and must be reported on DEA Form 106 Registrants Inventory of Drugs Surrendered in accordance with 21 C.F.R. 1301.76.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.08 LABELING AND PACKAGING OF BUPRENORPHINE PRODUCTS

(1) The authorized provider shall affix to the buprenorphine package a label showing at least the following information:

(a) Name, address and telephone number of the OBOT Plus;

(b) Prescription or medication order serial number;

(d) Name of the patient;

(e) Name of the prescriber;

(f) Name of the practitioner dispensing the medication;

(g) Directions for use and cautionary statements, if any;

(h) Name and expiration date of the product, if applicable;

(i) The following controlled substance warning: “CAUTION: Federal law prohibits the transfer of this drug to any person other than the patient for who it was prescribed.”; and (j) Any other appropriate advisory labels.

(2) OBOT Plus facilities must ensure that buprenorphine products are packaged in a manner that is designed to reduce the risk of accidental ingestion, including the use of child-proof containers.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.09 INVENTORY

(1) Each OBOT Plus shall be required to procure all buprenorphine containing products from a wholesaler/distributor licensed by the Tennessee Board of Pharmacy pursuant to Rule 1140- 09.

(2) Each OBOT Plus shall maintain an inventory of buprenorphine products. Each inventory shall contain a complete and accurate record of all controlled substances on hand on the FACILITIES WITH DISPENSING AUTHORIZATION date the inventory is taken, and shall be maintained in written, typewritten, or printed form at the physical location.

(a) Each licensee shall be required to take an initial inventory of all buprenorphine products, in accordance with Rule 0940-05-36-.09(3), prior to dispensing any of these products to patients.

(b) After the initial inventory is taken, the OBOT Plus facility shall be required to maintain a perpetual inventory of buprenorphine products.

(3) Each person authorized to dispense buprenorphine products shall include the following information in the inventory documentation pursuant to 21 C.F.R. Part 1304.11(1)(e)(iii) and (iv):

(a) The name and address of the OBOT Plus facility;

(b) The following information for each buprenorphine product in finished form:

The name of the substance;
Each finished form of the substance (e.g., 8/2 mg films);
The number of commercial containers of each finished form (e.g. four 30-film boxes); and 4. The exact quantity of the finished form on hand.

(4) The Facility Director or a designated clinical staff member shall immediately return or destroy all outdated, defective, or deteriorated prescription drugs and devices and related materials; except that the destruction of controlled substances listed in any schedule shall be witnessed by a second healthcare professional and documented.

(5) For each damaged or defective controlled substance awaiting disposal, the inventories shall include:

(a) The name of the substance;

(b) The total quantity of the substance to the nearest metric unit weight or the total number of units of finished form; and (c) The reason for the substance being maintained by the OBOT Plus facility.

(6) If an OBOT Plus destroys buprenorphine products they must be destroyed onsite or via a reverse distributor.

(a) For each buprenorphine product destroyed onsite, the facility shall keep a record of the following:

The name of the substance;

FACILITIES WITH DISPENSING AUTHORIZATION

The strength of the substance;
The dosage form of the substance;
The total quantity destroyed;
Method of destruction;
Date and time of the destruction;
The signature of the person destroying the substance; and 8. The signature of at least one person, other than the person destroying the substance, who witnessed the destruction of the substance.

(7) Each OBOT Plus shall maintain documentation of a current employment or contractual relationship with a consultant pharmacist.

(a) If an OBOT Plus dispenses buprenorphine to less than 100 unique patients a month, the pharmacist-in-charge shall perform a quarterly inventory review of the OBOT Plus’s invoices, perpetual inventory, and documentation of dispensed medications.

(b) If an OBOT Plus dispenses buprenorphine to 100 or more unique patients a month, the pharmacist-in-charge shall perform a monthly review of the OBOT Plus’s invoices, perpetual inventory, and documentation of dispensed medications and review the inventory for discrepancies.

If a discrepancy is found, an OBOT Plus shall report the discrepancy to the Department immediately upon discovery. The OBOT Plus shall also report to the DEA any discrepancies as appropriate.
Within 14 calendar days of discovery of a discrepancy, the OBOT Plus shall submit to the Department a root cause analysis examining the cause of the discrepancy and a plan to prevent such discrepancies in the future.
Part of the plan may include an increase in inventory review by the pharmacistin-charge.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.10 PREREQUISITES TO ISSUING PRESCRIPTIONS OR DISPENSING MEDICATIONS

(1) Prior to writing a prescription or medication order, an OBOT Plus provider shall comply with

Rule 0940-05-35 and Rule 0880-02-.14(2).

(2) Buprenorphine dispensed by an OBOT Plus may only be filled and labeled by:

(a) An authorized provider; or (b) By a designated agent of the authorized provider, if:

FACILITIES WITH DISPENSING AUTHORIZATION

The filling and labeling is done in the physical presence of the authorized provider at the OBOT plus;
The authorized provider acts as the final check in the dispensing process, and is responsible for the dispensing process in its entirety; and 3. The authorized provider documents that he or she has completed a final verification of the dispensing.

(3) Authorized providers may dispense an initial prescription only after checking the CSMD and central registry.

(4) Authorized providers must check the CSMD for every prescription dispensed.

(5) When a patient is first seen at a Facility and the patient has previously been dispensed buprenorphine, the authorized provider shall make a reasonable effort to contact the patient’s previous dispenser and obtain dosing information.

(6) Authorized providers dispensing buprenorphine pursuant to Rule 0940-05-36-.10(2) above, must comply with medication counseling requirements pursuant to Rule 1140-03-.01 and

Rule 0940-05-35.

(a) Upon the initial receipt of a prescription or medication order and following a review of the patient’s record, the authorized provider shall personally counsel the patient or authorized caregiver “face-to-face” if the patient or authorized caregiver is present. If the patient or authorized caregiver is not present, an authorized provider shall make a reasonable effort to counsel through alternative means.

(b) The authorized provider must document the counseling or document the reasonable efforts taken to provide counseling. If the patient or authorized caregiver refuses counseling, the authorized provider must document this refusal.

(c) Patient counseling shall cover matters as defined in Rule 1140-03-.01, which in the exercise of the authorized provider’s professional judgement, the authorized provider deems significant. This shall include, but is not limited to, the following:

The name and description of the medication;
The dosage form, dose, route of administration, and duration of drug therapy;
Special directions and precautions for preparation, administration, and use by the patient;
Common side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur;
Techniques for self-monitoring drug therapy;
Proper storage; and 7. Action to be taken in the event of a missed dose.

FACILITIES WITH DISPENSING AUTHORIZATION

(d) Upon a subsequent dispensing of a buprenorphine product, the authorized provider, or a person designated by the authorized provider, shall offer for the authorized provider to personally counsel the patient or caregiver about the medication.

(7) An OBOT Plus shall not require that a patient’s buprenorphine be dispensed from that OBOT Plus. An OBOT Plus shall provide patients with a list of alternative locations where buprenorphine is dispensed should the patient choose to fill his or her prescription at another location.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rules filed March 29, 2019; effective June 27, 2019.

Tenn. Comp. R. & Regs. 0940-05-36-.11 CENTRAL REGISTRY

(1) All OBOT Plus facilities shall participate in the Central Registry.

(2) Patients shall be informed of the Facility’s participation in the Central Registry. Prior to initiating a central registry inquiry, the Facility shall obtain the service recipient’s written consent.

(3) To prevent simultaneous enrollment of a service recipient in more than one OBOT Plus, the Facility shall initiate a clearance inquiry by submitting to the Central Registry the name, date of birth, or any other relevant information required for the clearance procedure or as required by the SOTA prior to dispensing buprenorphine products. No person who is reported by the Central Registry to be enrolled at another such Facility shall be admitted to an OBOT Plus, or in the event a multiple enrollment is found, the patient shall not continue to be dispensed buprenorphine until the patient enrollment status is active solely at a single OBOT Plus where the patient is currently receiving buprenorphine products.

(4) Reports received by the Central Registry shall be treated as confidential and shall not be released except to a licensed OBOT Plus facility, or its designated legal representative, or as approved by the SOTA, or as required by law. Information made available by the Central Registry to Facilities or their designated legal representatives or as approved by the SOTA shall also be treated as confidential.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-402, 33-2-403, 33-2-404, 33-2-407, and Chapter 978 of the Public Acts of 2018.
Administrative History: Original rules filed March 29, 2019; effective June 27, 2019.

Chapter 0940-05-37 Mental Health Residential Treatment Facility for Children and Youth

Tenn. Comp. R. & Regs. 0940-05-37-.01 DEFINITION

(1) A Mental Health Residential Treatment Facility for Children and Youth - A facility which provides twenty-four (24) hour residential treatment and habilitation to persons under 18 years of age, with a mental illness or who are seriously emotionally disturbed (SED). The focus of the program may be on short-term stabilization or longer term treatment and habilitation. The program must provide, or arrange for an education component in compliance with the Rules, Regulations, and Minimum Standards of the Tennessee State Board of Education.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.02 APPLICATION OF RULES

(1) The governing body of a residential treatment program must comply with the following rules:

(a) Applicable Life Safety Rules for Health Care, or Board and Care, or One and Two- Family Dwellings, Occupancy Classifications;

(b) Adequacy of Program Environment and Ancillary Services Rule;

(d) Minimum Program Requirements for Mental Health Residential Treatment Facilities for Children and Youth;

(e) Isolation and Restraint in Mental Health Residential Treatment Facilities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.03 PERSONNEL AND STAFFING REQUIREMENTS

(1) The program must be under the direct clinical supervision of a licensed mental health professional with training and/or experience in mental health treatment of children and youth.

(2) Treatment and/or habilitation services must be provided by mental health professionals or by mental health personnel. Individual staff who will provide educational programs shall meet the employment standards outlined in the state Board of Education Rules, Regulations, and Minimum Standards.

(3) The program must maintain a written agreement with or employ a Tennessee-licensed physician as a medical consultant.

(4) If the consulting physician is not a psychiatrist, the facility must arrange for the regular, consultative, and emergency services of a licensed psychiatrist.

(5) During normal waking hours the program must provide at least one (1) staff person on-duty and on-site for each eight (8) service recipients present. Staff persons counted in the staff-toservice recipient ratio may only be persons who are assigned to provide direct program services as described by written job description. During normal sleeping hours the program must provide one direct care staff person on site in each building, or physically separated unit of a building, in which service recipients are housed. Support staff, such as clerical, housekeeping, van and bus driver staff, or students involved in an on-site practicum for academic credit may not be counted in the staff-to-service recipient ratio.

(6) The program must provide at all times at least one (1) on-duty staff member trained in First Aid and the Heimlich maneuver and certified in cardiopulmonary resuscitation (CPR).

(7) Staff must be trained in and practice infection control procedures.

(8) Staff must have a tuberculosis skin test within thirty (30) days of employment and as required thereafter by current Tennessee Department of Health guidelines.

(9) Staff training must include new staff orientation and continuing education for all staff. A training plan must be developed and implemented for all staff. Within three months, all staff must acquire knowledge and competency appropriate to the special needs of the service recipients served. Training topics must include, but not be limited to:

(a) managing disruptive behavior;

(b) physical holding procedures and techniques; and (c) child development.

(10) The program must perform background checks on all employees and volunteers. A person, whether an employee or a volunteer, who is named as a suspect in an “indicated” report of child sexual abuse, or who is currently charged with committing a crime against a child must not work in this program as a caregiver or have any contact with the children.

(11) Service recipients must not be in the care of or have any direct contact while in the care of the program with a person who has been convicted of a crime involving children or of violating a law enacted to protect children.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.04 ASSESSMENT REQUIREMENTS

(1) The program must ensure that the following assessments are completed prior to development of the service recipient’s Plan of Care:

(a) Assessment of current functioning, and a history in the following areas:

Community living skills;
Living skills appropriate to age;
Emotional, psychological health, and 4. Educational level (including educational history).

(b) Basic medical history and information (c) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol or other drug use.

(d) History of prior mental health and alcohol and drug treatment episodes.

(e) Assessment of whether service recipient is currently eligible for special education services in accordance with the State Board of Education Rules, Regulations, and Minimum Standards.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.05 INDIVIDUAL PLAN OF CARE REQUIREMENTS

(1) An individual Plan of Care must be developed and implemented for each service recipient.

The individual Plan of Care (POC) must be based on initial history and on-going assessment of the service recipient’s needs and strengths and must be completed within seventy-two (72) hours of admission.

(2) Documentation of the POC and of its implementation must be kept in the service recipient record and must include the following:

(a) The service recipient’s name on the POC;

(b) The date of development of the POC;

(c) Individual problems specified in the POC which are to be addressed within the particular service/program component, including treatment and educational components;

(d) Individual objectives which are related to specified problems identified in the POC and which are to be addressed by the particular service/program component;

(e) Interventions and staff responsible for addressing goals and objectives in the POC;

(f) Signatures of the staff providing the services;

(g) Documentation of participation of service recipient and parent/guardian/legal custodian or conservator where appropriate, in the treatment planning process; if any of the parties refuse to participate, reasons for refusal must be documented.

(h) Standardized diagnostic formulation(s), [including, but not limited to, the current Diagnostic and Statistical Manual (DSM) Axes I-V and/or ICD-9] where appropriate, and assessment documentation on file which is updated as recommended by POC team;

(i) Planned frequency of treatment contacts;

(j) A plan for family involvement in the service recipient’s treatment.

(3) A review of the POC must occur at least every thirty (30) days or upon completion of the stated goals and objectives and must include the following documentation:

(a) Dated signatures of appropriate staff, and (b) An assessment of progress toward each treatment goal and / or objective with revisions as indicated, and (c) A statement of justification for the level of service(s) needed, including suitability for treatment in a less restrictive environment and continued services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.06 RECORD REQUIREMENTS

(1) The individual record for each service recipient must contain the following information:

(a) Documentation of the POC and the Individualized Education Program (if required) and of their implementation;

(b) Progress notes must be recorded daily, and must include written documentation of service recipient progress and changes, which have occurred within the POC. The progress notes must be dated and include the signature, title or degree of the person who provided the service;

(c) Documentation of all drugs prescribed and/or administered by the facility which indicates date prescribed, type, dosage, frequency, amount, and reason;

(d) Narrative summary review at least every six (6) months of all medications prescribed which includes specific reasons for continuation of each medication;

(e) Documentation of significant behavior; and actions taken by staff;

(f) A list of each article of the service recipient’s personal property valued at one hundred dollars ($100.00) or more, and its disposition if no longer in use;

(g) Documentation of abuse, medical problems, accidents, seizures, and illnesses and treatment for such abuse, accidents, seizures, and illnesses, and any reports generated as the result;

(h) Results of assessments required by this rule;

(i) Discharge summary which states, service recipient’s condition at the time of discharge and signature of person preparing the summary.

(j) Documentation of an education plan developed for each service recipient that conforms to the Rules, Regulations, and Minimum Standards of the State Board of Education and the Individualized Education Program (IEP) test being developed by an appropriately constituted IEP-Team for all “qualified students with disabilities.”

The education plan may include education services provided either by the facility or by the local education agency.

(k) Appropriate consents and authorizations for the release and obtaining of information about the service recipient.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.07 OTHER SERVICES

(1) The program must arrange access to qualified dental, medical, nursing, and pharmaceutical care for service recipients of the program. Service recipients or their families may choose a professional for non-emergency services.

(2) The program must ensure that each service recipient has had a physical examination within the twelve (12) months prior to admission or within thirty (30) days after admission. Such examinations must include routine screenings (such as vision and hearing), and laboratory examinations (such as Pap smear and blood work), and immunizations as determined necessary by the physician, and special studies where the index of suspicion is high and thereafter as often as indicated by the service recipient’s physician. Documentation of the physical examination must be placed in the service recipient’s record and must include the name of the examining physician, clinic or hospital., and date of examination.

(3) In consultation with the service recipient/parent/guardian, the program must arrange access for each service recipient for ongoing mental health services not provided by the program and assist the service recipient in keeping appointments and participating in such treatment programs. Documentation of such referrals must be kept in the service recipient’s record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.08 EMERGENCY SERVICES

(1) In case of medical or other type of emergency, the program must provide for immediate access to relevant information in the service recipient’s record.

(2) The program must provide immediate notification to the parent/guardian/legal custodian in case of emergency.

(3) The program must provide direct or telephone access to at least one (1) Tennessee licensed mental health professional twenty-four (24) hours a day seven (7) days a week. If the professional is not a psychiatrist, the program must also arrange for the regular, consultative, and emergency services of a psychiatrist.

(4) The program must provide back-up coverage by staff trained to handle acute psychiatric problems on a twenty-four (24) hours per day and seven (7) days per week on-call basis.

(5) The program must secure emergency services for service recipients who pose an imminent physical danger to themselves or others.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.09 MEDICATION ADMINISTRATION

(1) All medications must be administered by licensed medical or licensed nursing personnel or by other qualified personnel. Qualified personnel under these rules means a certified or registered respiratory therapist, a radiological technologist, a nuclear medicine technologist, or a certified physician assistant practicing under a protocol approved by the medical staff.

Such qualified personnel may only administer medication within the scope of an established protocol.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.10 RECREATIONAL ACTIVITIES IN RESIDENTIAL TREATMENT PROGRAM FOR

CHILDREN AND YOUTH.

(1) The program must ensure that opportunities are provided for recreational activities, which are appropriate to and adapted to the needs, interests, and ages of the service recipients.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Tenn. Comp. R. & Regs. 0940-05-37-.11 INDIVIDUAL HEALTH, HYGIENE, AND GROOMING IN RESIDENTIAL TREATMENT

PROGRAM FOR CHILDREN AND YOUTH.

(1) The program must assist service recipients in the independent exercise of health, hygiene, and grooming practices.

(2) The program must assist each individual service recipient in securing an adequate allowance of personally owned, individualized, clean, and seasonal clothes that are the correct size.

(3) The program must assist and encourage individual service recipients in the use of dental, physical, or prosthetic appliances or devices and visual or hearing aids.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 32-2-302, and 33-2-404.
Administrative History: Original rule filed June 29, 2004; effective September 12, 2004.

Chapter 0940-05-38 Minimum Program Requirements for Personal Support Services Agencies

Tenn. Comp. R. & Regs. 0940-05-38-.01 DEFINITIONS

(1) “Personal Support Services” means one (1) or more of the following services provided to a service recipient, as defined in 0940-05-38-.01(2), in the individual’s permanent or temporary residence.

(a) Self-care assistance with tasks such as eating, dressing, toileting, bathing, mobility, transfer assistance and other services and supports to maintain health and wellness;

(b) Household assistance with tasks such as housekeeping, laundry, meal planning, meal preparation, shopping, bill paying, and use of telecommunication devices;

(c) Personal assistance to service recipients to access community activities such as transportation, social, recreational or other personal activities; and/or (d) Education services.

(2) “Service Recipient” means an individual who:

(a) Has substantial limitations in two (2) or more major life activities because of a chronic condition, acute episode of illness or injury, age, physical or other disability;

(b) Receives services in either a permanent or temporary residence; and (c) Depends on personal support services to perform major life activities, but does not require nursing level services to be provided in connection with an acute episode of illness or injury.

(3) “Personal Support Services Agency” or “Agency” means a sole proprietorship (someone who owns an unincorporated business by himself or herself), partnership, corporation, limited liability company or limited liability partnership providing personal support services. Agency includes all entities that employ or subcontract with individuals who provide personal support services to service recipients.

(4) “Personal Support Services Worker” (or “Worker”) means a person licensed as a personal support services agency, or an employee or an individual subcontracted by a personal support services agency who is providing personal support services under an arrangement between a service recipient and a personal support services agency.

(5) “Chronic Condition” means a mental and/or physical impairment that is expected to last indefinitely.

(6) “Education Services” means consultation provided by a registered nurse to the service recipient or primary family caregiver concerning a chronic condition.

(7) “Hold Out to the Public” means asserting expertise and availability through advertising, public notice, self-promotion, etc.

(8) “Major Life Activities” means:

(a) Self-care;

(b) Receptive and expressive language;

(d) Mobility;

(e) Self-direction;

(f) Capacity for independent living; or (g) Economic self-sufficiency.

(9) “Medication Assistance” means providing medication reminders and opening medication packaging, but does not mean giving the service recipient injections or any form of medication or medication administration that would only be appropriate and acceptable for persons who are authorized to do so by Title 63, Chapter 7. Medication assistance includes, but is not limited to, any of the following:

(a) Loosening the cap on a pill bottle for oral medication;

(b) Opening pill reminder box if the box is filled by the service recipient or authorized representative or licensed medical personnel practicing within the scope of their license;

(d) Holding a service recipient’s hand steady to help them with drinking liquid medication;

(e) Guiding the service recipient’s hand when the individual is applying eye/ear/nose drops and wiping the excess liquid;

(f) Helping with a nasal cannula or mask for oxygen, plugging the machine in and turning it on;

(g) Applying non-prescription cream and lotions purchased over-the-counter to external parts of the body.

(10) “Self- administration of Medication” means the ability of a service recipient to take prescribed or over-the-counter medications without assistance from another person.

(11) “Written” means, as applied to licensee’s records, any generally accepted format, including electronic or paper, used for retaining business or client records.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rule filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.02 APPLICATION OF RULES

(1) The licensee providing personal support services shall comply with and provide services that comply with the following rules:

(a) Chapter 0940-05-02 Licensure Administration and Procedures;

(b) Chapter 0940-05-38 Minimum Program Requirements for Personal Support Services Agencies; and (c) Chapter 0940-05-06-.03(1)-(6) Minimum Program Requirements for All Facilities- Financial Management of All Facilities.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rule filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.03 SCOPE OF PERSONAL SUPPORT SERVICES AGENCIES

(1) These rules apply to all agencies or personal support services workers who provide personal support services in the permanent or temporary residence of service recipients who meet the criteria specified in Rule 0940-05-38-.01(2).

(2) The following are exempt from licensure under this chapter:

(a) A person who provides personal support services to only one (1) service recipient and who is not in a business arrangement to provide personal support services to any other service recipient. This exception shall not apply to an individual who holds themselves out to the public as being in the business of personal support services for compensation;

(b) A person who provides personal support services only to members of the individual’s own family;

(c) A person who provides only housekeeping services to a service recipient and no other assistance with major life activities;

(d) A person who provides only transportation services and no other assistance with major life activities;

(e) A person who provides services in homeless shelters;

(f) A person who provides only delivery services, such as dry-cleaning, food, medication delivery, or medical equipment; and (g) Home care organizations licensed under T.C.A., Title 68, Chapter 11, Part 2 as a home care organization.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.04 APPLICATION

(1) To provide personal support services, an agency needs a license from either the Department of Mental Health and Substance Abuse Services or the Department of Intellectual and Developmental Disabilities.

(2) An agency licensed by either Department may provide personal support services to individuals with physical or other disabilities.

(3) An agency seeking an initial license as a personal support service agency must submit a written attestation at the time of application acknowledging the categorization of the majority of its client population base, as described in (a) and (b) below. The written attestation shall be on a form developed by the department to whom application for a license is made.

(a) An agency with 50% or more of its client base being aged and/or having a diagnosis of mental illness and/or substance abuse should obtain a license from the Department of Mental Health and Substance Abuse Services.

(b) An agency with 50% or more of its client base having a diagnosis of developmental disability or intellectual disability should obtain a license from the Department of Intellectual and Developmental Disabilities.

(4) After July 1, 2016, any agency seeking renewal of a personal support services license need only make application with the department that licenses 50% or more of its client base, as described in sections (3)(a) and (b) above. The renewing agency shall submit with the renewal application a written attestation acknowledging the categorization of the majority of its client population base.

(5) No license shall be issued until the appropriate fee or fees are submitted by the agency seeking an initial or renewal license, as set forth in Rule 0940-05-02-.05. All fees submitted are non-refundable.

(6) The agency should submit to the licensing department a list of the counties in which they provide services and the address at which the agency maintains its employee and service recipient records.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.05 GOVERNANCE REQUIREMENTS

(1) The licensee shall comply with all federal, state, and local laws, ordinances, rules and regulations.

(2) The lic ensee shall ensure that the agency is administered and operated in accordance with written policies and procedures including, but not limited to, those specified in Rule 0940-05- 38-.06.

(3) The licensee shall exercise general direction over the agency and establish policies governing the operation of the agency and the welfare of service recipients.

(4) The licensee shall designate an individual responsible for the operation of the agency.

(5) The licensee shall ensure that the licensed agency serves only service recipients who will not cause the agency to violate its licensed status based on the distinct licensure category.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.06 POLICIES AND PROCEDURES

(1) The licensee shall maintain written policies and procedures that include the following:

(a) A description of services provided by the licensee. The description shall include enrollment and termination criteria;

(b) An organizational chart which clearly shows or describes the lines of authority;

(c) A policy and procedure which outlines the plan of action to be followed when the personal support worker is absent including, but not limited to, notice to the service recipient, the action that shall be taken, and the timeframes for action;

(d) A schedule of fees when applicable;

(e) A statement of service recipient rights as listed in 0940-05-38-.10 and the grievance procedures to be followed when a suspected violation of rights has been reported;

(f) A policy which ensures the confidentiality of service recipients’ information and which includes the following provisions:

The licensee’s personal support services workers shall comply with applicable confidentiality laws and regulations;
The service recipient shall not be required to make public statements which acknowledge gratitude to the licensee or for the licensee’s services; and 3. Identifiable photographs of service recipients shall not be used without the written and signed consent of the individual or the individual’s legal guardian and/or conservator.

(g) The plans and procedures to be followed in the event of an emergency including, but not limited to, fire evacuation and natural disaster emergencies;

(h) Policy and procedures to be followed in the reporting and investigation of suspected or alleged abuse or neglect of a service recipient, or other critical incidents. The procedures shall include provisions for corrective action, if any, to be taken as a result of such reporting and investigation, and reporting to the department’s Office of Licensure and to any authority as required by law;

(i) Requirement that personal support services workers comply with procedures for detection and prevention of communicable diseases according to procedures of the Tennessee Department of Health;

(j) Receipt and disbursement of money on behalf of service recipients;

(k) Access by department licensure staff to personal support services workers to discuss investigation of any service provided under this chapter;

(l) Procedures to be followed if a worker will be providing medication assistance if the licensee provides that service. Written policy shall minimally include the following elements:

Medication assistance shall be provided only after written authorization has been obtained from the service recipient or the service recipient’s authorized representative.
Medication assistance training shall be provided to personal support services workers prior to providing assistance and training shall be documented in the personal support service worker’s record.
Personal support workers shall have procedures for collecting information about medications taken by service recipients.

(m) Polices to ensure that licensees or personal support services workers providing transportation to service recipients meet the following requirements:

All vehicles shall be maintained and operated in a safe manner;
All licensees or personal support services workers providing transportation shall possess an appropriate driver’s license from the Tennessee Department of Safety and documentation of such license shall be maintained in the licensee’s records; and 3. All vehicles used for service recipient transportation and owned by the licensee or personal support services worker shall be adequately covered by vehicular liability insurance for personal injury to occupants of the vehicle, and documentation of such insurance shall be maintained in the facility’s records.

(n) Polices to address use of devices such as a hoyer lift or gait belt, after training, to assist the service recipient in getting out of or into bed, a chair, toilet or shower but not as part of a therapeutic regimen.

(o) Polices to address categorization of the majority (over fifty-percent (50%)) of the agency’s client population base.

(p) Policy that the agency will cooperate with the department when investigating any case of alleged abuse, neglect, mistreatment, misappropriation or exploitation of a service recipient.

(q) Policy that an alternate plan for staffing will be prepared in case of absence or the assigned personal support services worker.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.07 PERSONNEL REQUIREMENTS

(1) The licensee shall maintain a personnel file for each personal support services worker with the following information:

(a) A written, signed and dated job description including the employment requirements and job responsibilities for each staff position held;

(b) Verification that the worker meets the respective employment requirements for each position held;

(d) Evidence that the worker’s status on the Tennessee registry of persons who have abused, neglected or misappropriated the property of vulnerable individuals (“Abuse Registry”) maintained by the Department of Health, has been checked pursuant to T.C.A. § 68-11-1004(b). No employee or volunteer who is listed on the Abuse Registry may be hired or otherwise permitted to provider services;

(e) Evidence of the worker’s status on the state’s sexual offender registry. No individual or volunteer who is listed on the state’s sexual offender registry may be hired or otherwise permitted to provide services;

(f) The worker’s date of birth;

(g) Annual performance evaluation reports evaluating, at a minimum, the ability of personal support services workers to provide daily supports to service recipients;

(h) A worker notice that outlines the general relationship between an agency and the personal support services worker that includes the following:

The status of the personal support services agency as an employer or contractor of services;
The responsibility of the personal support services agency for the payment of the personal support services worker’s wages, taxes, social security, workers compensation and unemployment compensation payments, and overtime pay for hours worked in excess of forty (40) hours in a week; and 3. Duties, responsibilities, obligations and legal liabilities of the agency and the service recipient including, but not limited to, insurance and personnel management.

(i) The personal support service worker’s work history containing a continuous description of activities over the past five (5) years; and (j) Personal references from at least three (3) individuals, one of whom shall have known the personal support service worker/applicant for at least five (5) years.

(2) The licensee shall have written personnel policies. The personnel policies shall, at a minimum address the following:

(a) That all personal support services workers shall be eighteen (18) years of age or older;

(b) That all personal support services workers shall practice infection control procedures and standard precautions that will protect the service recipient from infectious diseases;

(c) That all personal support services workers shall submit to a criminal background check every two (2) years or within ten (10) days of employment or within ten (10) days of a change of responsibilities that includes direct contact with or direct responsibility for service recipients, as required by T.C.A. § 33-2-1202;

(d) That evidence of the status of every personal support services worker on the Tennessee registry of persons who have abused, neglected or misappropriated the property of vulnerable individuals (“Abuse Registry”) maintained by the Department of Health shall be checked annually and prior to direct contact with service recipients. No employee or volunteer who is listed on the Abuse Registry may be hired or otherwise permitted to provider services;

(e) That evidence of the status of every personal support services worker on the Tennessee Sexual Offender Registry shall be checked annually and prior to direct contact with service recipients;

(f) That the personal support services worker shall demonstrate the following prior to providing personal support services:

Language skills sufficient to read and understand instructions; prepare and maintain written reports and records;
Language skills sufficient to communicate with the service recipient; and 3. Documented training specific to meeting individual service recipient needs in the area of self-care, household management and community living, and methodologies for service delivery.

(g) That personal support services workers shall have access to consultation for any of the services provided under this chapter. Consultation may include providing the personal support service worker access to or consultation with a registered nurse, other agency staff or the primary family caregiver to assist the staff in providing personal support services; and (h) That the personal support service worker shall neither borrow, receive nor take funds or other personal property from the service recipient.

(3) The licensee shall have proof of liability insurance coverage for the agency, workers and others who provide personal support services.

(4) The licensee shall maintain a current roster of all personal support workers at all times including workers kept on an on-call or back-up basis.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 21, 2004; effective November 26, 2004. Repeal and new rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.08 STANDARDIZED TRAINING AND CONTINUING EDUCATION REQUIREMENTS

(1) The licensee shall ensure and document that:

(a) Individuals who provide personal support services demonstrate basic competency in the following skill/knowledge areas prior to beginning work with service recipients:

Observing, reporting and documenting changes in service recipient’s daily living skills;
Abuse, neglect, exploitation, detection, reporting and prevention;
Service recipient rights;
Universal health precautions, including infection control;
How to assist service recipients with personal hygiene;
Service recipient safety; and 7. Procedures to be followed in the event of an emergency or disaster that at least includes emergency transportation, emergency medical care and staff coverage in such events;

(b) Individuals who provide medication assistance receive documented training in medication assistance performed by, or under the general supervision of, a registered nurse and consistent with T.C.A. § 63-7-102;

(c) Individuals who provide personal support services receive training on job related topics at least annually; and (d) Documented training specific to meeting individual service recipient needs in the areas of self-care, household management and community living, and methodologies for service delivery.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.09 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The licensee shall ensure that each service recipient’s record includes at least the following information:

(a) Name, address, telephone number, gender, and date of birth;

(b) Date of service enrollment;

(d) Written fee agreement. If the licensee charges fees for personal support services, a written agreement dated and signed by the service recipient or the service recipient’s legal representative (conservator, parent, guardian or legal custodian) or person paying for services prior to the provision of services. The written agreement shall include at least the following information:

The fee or fees to be paid by the service recipient;
The services covered by such fees; and 3. Any additional charges for services not covered by the basic service fee.

(e) Written acknowledgement that the service recipient or service recipient’s legal representative (conservator, parent, guardian or legal custodian) has been informed of the service recipient’s rights and responsibilities and the agency’s general rules affecting the service recipients;

(f) A written service plan based on a needs assessment which indicates type, frequency, duration, and amount of personal support services provided to assist the service recipient in performing major life duties.

(g) Consent for services by the service recipient or service recipient’s legal representative (conservator, parent, guardian, or legal custodian), surrogate decision maker under T.C.A. § 33-3-219 or attorney-in-fact under a durable power of attorney for health care, when applicable;

(h) If applicable, address, phone number or e-mail address to reach the service recipient’s legal representative (conservator, parent, guardian or legal custodian) or surrogate decision maker under T.C.A. § 33-3-219 or attorney-in-fact under a durable power of attorney for health care;

(i) Documentation of party responsible for payment of services;

(j) A record of services actually delivered with dates and times documented;

(k) Documentation of medical problems, illnesses and treatments, accidents, seizures, adverse incidents and follow-up, while the service recipient receives services;

(l) Documentation of all funds received and disbursed on behalf of the service recipient;

(m) An alternate plan for staffing in case of absence of the personal support services worker;

(n) Written authorization by the service recipient or the service recipient’s authorized representative if the agency is providing medication assistance;

(o) Written documentation that the service recipient has evaluated the quality of personal support services provided at least semi-annually. Each agency shall develop an evaluation form for the service recipient, or legal representative of the service recipient, to fill out and sign to acknowledge this requirement has occurred;

(p) A written consumer notice outlining general service responsibilities as well as general notification of the agency’s responsibilities as an employer or contractor provided to service recipients before beginning service, which shall include, at a minimum the duties, responsibilities, obligations and legal liabilities of the personal support services agency; the personal support services worker; and the service recipient. The description shall clearly set forth the service recipient’s responsibility, if any, for the following:

Day to day supervision of the personal support services worker;
Assigning duties to the personal support services worker;
Hiring, firing and discipline of the personal support services worker;
Provision of equipment or materials for use by the personal support services worker;
Performing a criminal background check on the personal support services worker;
Checking the personal support services worker’s references; and 7. Ensuring credentials and appropriate licensure/certification of a personal support services worker; and (q) Copy of legal document granting another individual or corporation authority to act as the service recipient’s legal representative/conservator/power of attorney/durable power of attorney for health care/mental health care.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed November 20, 2009; effective February 18, 2010. Repeal and new rule filed March 4, 2016; effective June 2, 2016.

Tenn. Comp. R. & Regs. 0940-05-38-.10 SERVICE RECIPIENT RIGHTS

(1) The following rights shall be afforded to all individuals receiving personal support services from the licensee:

(a) Service recipients have the right to be fully informed before the initiation of services about their rights and responsibilities and about any limitation on these rights imposed by the rules of the licensee. The licensee shall ensure that the service recipient is given oral and/or written rights information that includes at least the following:

A statement of the specific rights guaranteed the service recipient by these rules and applicable state laws;
A description of the licensee’s grievance procedures;
A listing of available advocacy services; and 4. A copy of all agency rules and regulations pertinent to the service recipient. The information shall be presented in a manner that promoted understanding by the service recipient of his or her rights, and the individual shall be given an opportunity to ask questions about the information. If the service recipient is unable to understand the information at the time of admission to service but later becomes able to do so, the information shall be presented to the service recipient at that time. If the service recipient is likely to continue indefinitely to be unable to understand the information, the licensee shall promptly attempt to provide the required information to a guardian or other appropriate person or an agency responsible for protecting the service recipients’ rights.

(b) Service recipients have the right to voice grievances to the licensee and to outside representatives of their choice with freedom from restraint, interference, coercion, discrimination, or reprisal;

(c) Service recipients have the right to be treated with consideration, respect and full recognition of their dignity, and individuality;

(d) Service recipients have the right to be protected by the licensee from neglect, physical, verbal, and emotional abuse (including corporal punishment), and from all forms of misappropriation and/or exploitation; and (e) Service recipients have the right to be assisted by the licensee in the exercise of their civil rights.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed November 20, 2009; effective February 18, 2010. Repeal and new rules filed March 4, 2016; effective June 2, 2016.

Chapter 0940-05-39 Minimum Program Requirements for Alcohol and Drug DUI School Services

Tenn. Comp. R. & Regs. 0940-05-39-.01 DEFINITION

(1) “Alcohol and Drug Abuse D.U.I. School Services” means an intervention program providing assessment, education and, if indicated, appropriate treatment referral, for offenders of driving under the influence of alcohol and/or other drugs (i.e., convicted of violation of T.C.A. § 55-10-401).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed February 23, 2007; effective May 9, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.02 APPLICATION OF RULES

(1) The governing body of a D.U.I. School Service must provide services and facilities where services are rendered which comply with the following rules:

(a) Rule 0940-05-04-.04 Life Safety Licensure Rule for Business Occupancies or D.U.I.

School Services may be delivered from a location which is used for other purposes, if such facility meets the provisions of Rule 0940-05-04-.01 Life Safety Requirements for the primary use of the building;

(b) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (c) Chapter 0940-05-39 Minimum Program Requirements for D.U.I. School Services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed February 23, 2007; effective May 9, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.03 POLICIES AND PROCEDURES

(1) The facility must maintain a written policy and procedure manual which includes the following:

(a) Documentation of court referral procedures including relationship with courts and communication procedures;

(b) A description of course curriculum;

(d) Procedures directed toward maintaining confidentiality by having all students acknowledge that they understand the confidentiality rules and will abide by them;

(e) Exclusion criteria for service recipients not appropriate for admission;

(f) In addition to meeting the requirements of 0940-05-06-.02(d), an explanation of fees charged to the service recipient for all services provided by the Licensee;

(g) Procedures for intake and assessment, including the use of a standardized nationally recognized assessment instrument approved by the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse Services;

(h) Procedures to inform service recipients who do not speak English about their right to have assessments and instruction in their native language or to have the services of a state registered or state certified court interpreter, as defined by Tennessee Supreme Court Rule 42 Standards for Court Interpreters. D.U.I. service recipients requesting services must be provided an interpreter at no additional cost to the service recipient;

(i) A statement of service recipient rights including, but not limited to, obligations to disclose information to referring agencies; and (j) Grievance procedures for the service recipient.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-39-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) Assessment, screening, education and referral services must be provided by qualified alcohol and drug abuse personnel.

(2) All teachers shall be certified in cardiopulmonary resuscitation (CPR), first aid, and the abdominal thrust.

(3) All staff members providing direct services to D.U.I. school recipients must have six (6) hours of continuing education annually in screening and assessing alcohol and drug abuse issues.

(4) Staffing:

(a) A personnel record for each staff member of a service must include an application for employment and a record of any disciplinary action taken.

(b) In addition to the requirements of Rule 0940-05-06-.04(2), an annual verification of basic skills and annual evaluation of personnel performance must be documented in the personnel record. There must be documentation to verify that the employee has reviewed the evaluation and has had an opportunity to comment on it.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.05 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The individual service recipient record must include the following:

(a) Documented findings of an assessment using a standardized nationally recognized assessment instrument approved by the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse Services; and (b) Referral to an appropriate treatment resource and notification of such referral to the initial referral source, if the service recipient assessment indicates an alcohol and drug problem. The facility must document referral services recommended and/or required for the service recipient, if applicable.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200- 08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-39-.06 CLASS REQUIREMENTS

(1) All D.U.I. School Services must provide a minimum of twelve (12) hours of instruction to each student. Any student who does not complete twelve (12) hours of curriculum instruction has not completed the requirements for D.U.I. School.

(2) Class size must not exceed twenty-five (25) students. The number of students in a class must be based on the occupancy load approved by the Fire Marshall.

(3) Service recipients who do not speak English must have access to instruction in their native language or a court interpreter as defined in Rule 0940-05-39-.03(1)(j).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200- 08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.07 CURRICULUM REQUIREMENTS

(1) The facility shall use a curriculum approved by the Tennessee Department of Mental Health and Substance Abuse Services, Division of Alcohol and Drug Abuse Services. The curriculum shall minimally include current information areas including the following:

(a) Traffic Safety aspects of alcohol and drug use, including:

Overview of the D.U.I. problem in Tennessee;
Tennessee laws relevant to D.U.I.;
Why the offenders are in school (probable cause for stopping an impaired driver);
Relationship of blood alcohol and other drug use on driving ability;
Techniques for avoiding driving while impaired; and (b) Physiological aspects of alcohol and other drug use, including:
Pharmacological and physical effects of alcohol and other depressants;
Pharmacological and physical effects of other drugs;
The potentiating effect of combining alcohol and other drugs; and (c) Psychological aspects of alcohol and other drug use, including:
Dynamics of alcohol and other drug use, abuse, and addiction, e.g., loss of control, denial, delusion, blaming, and guilt;
The progression of addictive behavior;
Dynamics in an alcohol and/or other drug abusive family;
The impact of alcohol and other drug addiction on other life aspects, e.g., emotional, physical, professional, legal, spiritual, rational, and intellectual; and 5. Local treatment resources and community support groups, e.g., Alcoholics Anonymous, Narcotics Anonymous, and Adult Children of Alcoholics.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008. Amendment filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-39-.08 REPORTING REQUIREMENTS

(1) The facility must report to the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse Services on a quarterly basis the following data:

(a) Number of offenders entering the school;

(b) Number of offenders completing the school;

(d) Number of out-of-state D.U.I. referrals;

(e) Number of offenders in each problem severity category per the screening for alcohol and drug problem; and (f) Number of offenders referred for treatment.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal and new rule filed August 27, 2008; effective November 10, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-39-.09 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200- 08-19 on May 15, 2008. Repeal filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.10 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.11 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200- 08-19 on May 15, 2008. Repeal filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.12 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Repeal filed April 30, 2003; effective July 14, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-19 on May 15, 2008. Repeal filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-39-.13 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200- 08-19 on May 15, 2008. Repeal filed August 27, 2008; effective November 10, 2008.

Chapter 0940-05-40 Repealed

Tenn. Comp. R. & Regs. 0940-05-40-.01 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed February 23, 2007; effective May 9, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.13 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.02 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed February 23, 2007; effective May 9, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.03 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.04 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed July 18, 2007; effective October 1, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.05 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.06 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.07 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.08 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.09 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.10 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 30, 1976; effective August 30, 1976. Repeal and new rule filed September 12, 1994; effective November 26, 1994. Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.11 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407..
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Tenn. Comp. R. & Regs. 0940-05-40-.12 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305; 33-1-309; 33-2-301, 33-2-302, 33-2-404, and 33-2- 407.
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Repeal filed April 30, 2003; effective July 14, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-20 on May 15, 2008. Repeal filed March 19, 2010; effective August 29, 2010.

Chapter 0940-05-41 Minimum Program Requirements for Alcohol and Drug Halfway House Treatment Facilities

Tenn. Comp. R. & Regs. 0940-05-41-.01 DEFINITION

(1) “Alcohol and Drug Halfway House Treatment Facility” means a transitional residential program providing services to service recipients with alcohol and/or drug abuse or dependency disorders with the primary purpose of establishing vocational stability and counseling focused on re-entering the community. Service recipients are expected to be able to self-administer medication and to work, seek work, or attend vocational/educational activities away from the residence for part of the day. Services include counseling contacts, lectures, seminars, and other services necessary to meet the service recipient’s assessed needs.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendments filed February 27, 2006; effective May 13, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08- 22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.02 APPLICABLE RULES

(1) The governing body of an alcohol and drug halfway house treatment facility must comply with the following rules:

(a) Applicable occupancy rules found in Chapter 0940-05-04 Life Safety Licensure Rules:

Rule 0940-05-04-.02 Health Care Occupancies for facilities providing services for four (4) or more service recipients who are not capable of self-preservation; or 2. Rule 0940-05-04-.06 Residential Occupancies - Board and Care for facilities providing services to four (4) or more service recipients; or 3. Rule 0940-05-04-.07 Residential Occupancies - One- or Two-Family Dwellings (Two or Three Service recipients) for facilities providing services to two (2) or three (3) service recipients;

(b) If services are to be provided in a facility meeting the requirements for Rule 0940-05- 04-.06 Residential Occupancies - Board and Care or Rule 0940-05-04-.07 Residential Occupancies - One- or Two-Family Dwelling Occupancy and services are provided to one (1) or more mobile non-ambulatory service recipients, then Rule 0940-05-04-.09(2)

Mobile Non-Ambulatory Rule;

(d) Minimum Program Requirements for All Facilities found in Chapter 0940-05-06;

(e) Minimum Program Requirements for Alcohol and Drug Halfway House Treatment Facilities found in Chapter 0940-05-41; and (f) Rules for Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Treatment Facilities found in Chapter 0940-03-09.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.03 POLICIES AND PROCEDURES

(1) The facility must maintain a written policy and procedure manual which includes the following:

(a) The intake and assessment process;

(b) A description of its aftercare service;

(c) A policy ensuring that employees and volunteers practice standard precautions as specified by the Centers for Disease Control (CDC) to prevent transmission of infections, HIV, and communicable diseases;

(d) Guidelines and techniques for volunteers and employees to monitor, control and report facility infections;

(e) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure treatment has been delivered according to acceptable clinical practice;

(f) Drug testing procedures if used by the facility;

(g) Exclusion criteria for service recipients not appropriate for the facility’s services;

(h) Policy and procedures which address the methods for managing disruptive behavior. If restrictive procedures are used to manage disruptive behaviors, these policies and procedures must comply with Chapter 0940-3-9 Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities;

(i) A policy that identifies efforts to reduce the use of isolation and restraint;

(j) Procedures to ensure that the facility, either directly or through arrangements with other public or private non-profit entities, will make available tuberculosis (TB) services in accordance with current Tennessee TB Guidelines for Alcohol and Drug Treatment Facilities (TB Guidelines), established by the Department of Health TB Elimination Program and the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse, including:

Counseling the service recipients about TB;
Screening all service recipients for TB and, if applicable, testing service recipients at high risk for TB to determine whether the service recipients have been infected with TB;
Providing for or referring the service recipients infected by TB for appropriate medical evaluation and treatment; and 4. Conducting case management activities to ensure that service recipients receive such services.

(k) A policy and procedure that establishes when employment is appropriate and requires all service recipients be gainfully employed, actively pursuing employment, or participating in vocation education/rehabilitation;

(l) A weekly schedule of all program services and service recipient activities for each day specifying the type of service/activities and scheduled times;

(m) A requirement that the facility provide to the service recipient, upon admission, a written statement outlining in simple, non-technical language all rights of service recipients under Title 33. These rights must include provisions to prohibit:

Denial to the service recipient of adequate food, treatment/rehabilitation activities, religious activities, mail or other contacts with family as punishment; and 2. Confinement of the service recipient to his/her room or other place of isolation as punishment. This does not preclude requesting service recipients to remove themselves from potentially harmful situations in order to regain self-control.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-41-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) Direct treatment and/or rehabilitation services must be provided by qualified alcohol and drug abuse personnel who as a requirement of employment were subject to a criminal background and abuse registry check.

(2) A physician must be employed or retained by written agreement to serve as medical consultant to the program.

(3) The facility must provide at least one (1) on-duty staff and on-site member certified in cardiopulmonary resuscitation (CPR), and trained in first aid, abdominal thrust, and standard precautions of infection control.

(4) During waking hours, the facility must maintain an on-duty and on-site staff-to-service recipient ratio of at least one (1) to sixteen (16) when service recipients are present. During sleeping hours, facilities must provide at least one (1) awake on-duty and on-site staff person for each thirty (30) service recipients.

(5) The facility must provide annual STD/HIV education to all direct care staff.

(6) The facility must follow current TB Guidelines for screening and testing employees for TB infection;

(7) Employee records must include date and results of TB screening and, if applicable, tuberculin skin test or equivalent used, date and results of tuberculin skin test, date and results of chest x-ray, and any drug treatment for tuberculosis; and (8) The facility must provide annual training to personnel responsible for counseling, screening, and providing case management service to service recipients to prevent the transmission of TB.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.05 SERVICE RECIPIENT ASSESSMENT REQUIREMENTS

(1) The facility must document that the following assessments are completed prior to development of the Individual Program Plan (IPP); re-admission assessments must document the following information from the date of last service:

(a) Assessment of current functioning according to presenting problem, including history of the presenting problem;

(b) Basic medical history and determination of the necessity of a medical evaluation and a copy, where applicable, of the results of the medical evaluation;

(c) Screening to identify service recipients who are at high risk for infection with TB according to TB Guidelines, including documentation of risk level of the service recipient and, if applicable, a tuberculin skin test or equivalent, the results of the tuberculin skin test, the date and result of a chest x-ray, and any drug treatment for TB.

(d) Assessment information must include employment and educational skills, financial status, emotional and psychological health, legal issues, community living skills and housing needs, and the impact of alcohol and/or drug abuse or dependency on each area of the service recipient’s life functioning; and (e) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol or other drugs, including patterns of specific usage for the past thirty (30) days.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 20, 2006; effective July 4, 2006. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.06 INDIVIDUAL PROGRAM PLAN (IPP) REQUIREMENTS

(1) An IPP which includes the following requirements must be developed and documented for each service recipient within seven (7) days of admission:

(a) The service recipient’s name;

(b) The date of the IPP’s development;

(c) Standardized diagnostic formulation(s) including but not limited to the current Diagnostic and Statistical Manual (DSM) and/or International Classification of Diseases (ICD); and current American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance Abuse Disorders (ASAM PPC);

(d) Specified service recipient problems which are to be addressed within the particular service/program component;

(e) Service recipient goals which are related to specified problems and which are to be addressed within the particular service/program component;

(f) Interventions addressing goals;

(g) Planned frequency of contact;

(h) The signatures of appropriate staff; and (i) Documentation of service recipient’s participation in the treatment planning process.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 24, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.07 IPP MONITORING AND REVIEW REQUIREMENTS

(1) Progress notes which include written documentation of progress or changes occurring within the IPP must be made in the individual service recipient record for each treatment contact or on a weekly basis.

(2) The facility must review and, if indicated, revise the IPP at least every sixty (60) days. The revision shall document any of the following which apply:

(a) Change in goals and objectives based upon service recipient’s documented progress or identification of any new problems;

(b) Change in primary counselor assignment;

(c) Change in frequency and types of services provided; and (d) A statement documenting the review and an explanation if no changes were made in the IPP.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed April 30, 2003; effective July 14, 2003. Repeal and new rule filed February 27, 2006; effective May 13, 2006. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.08 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The individual service recipient record must include the following:

(a) Documentation on a medications log sheet of all medications prescribed or administered with the date of the prescription, date of administration, type, dosage, frequency, amount, and reason;

(b) Documentation of the service recipient’s employment related problem or problems and goal or goals on the IPP, and the service recipient’s progress or lack of progress towards meeting the goal or goals in the progress notes, or clinical justification for an exception to the policy and procedure;

(c) A list of each individual article of each service recipient’s personal property valued at one hundred dollars ($100.00) or more including its disposition, if no longer in use;

(d) Written accounts of all monies received and disbursed on behalf of the service recipient;

(e) Reports of medical problems, accidents, seizures, and illnesses and treatments for such accidents, seizures, and illnesses;

(f) Reports of significant behavior incidents;

(g) Reports of any instance of physical holding or restriction with documented justification and authorization;

(h) A discharge summary which states the date of discharge, reasons for discharge, and referral for other services, if appropriate; and (i) An aftercare plan which specifies the type of contact, planned frequency of contact, and responsible staff; or documentation that the service recipient was offered aftercare but decided not to participate; or documentation that the service recipient dropped out of treatment and is therefore not available for aftercare planning; or verification that the service recipient is admitted for further alcohol and drug treatment services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Repeal and new rule filed February 27, 2006; effective May 13, 2006. Amendment filed June 21, 2007; September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.09 PROFESSIONAL SERVICES

(1) In addition to the alcohol and drug treatment services provided, the facility must provide services to service recipients to address their needs as indicated in the assessment/history in the areas of social, family, and peer interactions; employment and educational needs; financial status; emotional and psychological health; physical health; legal issues; and community living skills and housing needs. Such services may be provided directly by the agency or indirectly by referral to other service providers. Referral agreements with frequently used providers must be documented. The provision of such services to individual service recipients must be documented in the service recipient record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.10 SERVICE RECIPIENT MEDICATION ADMINISTRATION REQUIREMENTS

(1) When supervising the self-administration of medication, the facility must consider the service recipient’s self-management skills and ability.

(2) The facility must ensure that prescription medications are taken only by service recipients for whom they are prescribed and in accordance with the directions of a physician.

(3) Discontinued and outdated medication and containers with worn, illegible, or missing labels must be disposed.

(4) All medication errors, medication reactions, or suspected inappropriate medication use must be reported to the Medical Director of the facility who will report to the prescriber, if known.

(5) Evidence of the current prescription of each medication taken by a service recipient must be maintained by the facility.

(6) All direct service staff must be trained about medications used by the service recipient. This training must include information about the purpose and function of the medications, their major side effects and contraindications, and ways to recognize signs that medication is not being taken or is ineffective.

(7) Staff must have access to medications at all times.

(8) For any service recipient incapable of self-administration, all medications must be administered by personnel licensed to administer medication.

(9) Schedule II medications must be stored within two (2) separately locked compartments at all times and be accessible only to staff in charge of administering medication.

(10) All medications and other medical preparations intended for internal or external human use must be stored in sanitary and secure medicine cabinets or medication rooms. Such cabinet or medication rooms must be kept securely locked when not in use and the key must be in the possession of the supervising nurse or other authorized staff. Locks in doors to medicine cabinets and medication rooms must require an action on the part of staff to lock and unlock.

(11) Staff must document each time a service recipient self -administers medication or refuses a medication. This documentation must include the date, time, medication name, and dosage, as well as over the counter medication. This documentation must be made on the medication log sheet in the service recipient’s chart.

History

Authority: T. C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed July 27, 2000; effective October 10, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-41-.11 HEALTH PROVISIONS FOR SERVICE RECIPIENTS

(1) The facility must have provisions that address the following health issues while the service recipient is at the facility:

(a) Nutritional needs;

(b) Exercise;

(d) Adequate, uninterrupted sleep; and (e) Designated smoking areas outside the building.

(2) The facility must educate and encourage service recipients in independent exercise of hygiene, and grooming practices, as appropriate.

(3) The facility will encourage the use of adaptive equipment including but not limited to dental appliances, eyeglasses, and hearing aids if used by service recipients.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule July 27, 2000; effective October 10, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-22 on May 15, 2008. Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Chapter 0940-05-42 Minimum Program Requirements for Non-Residential Opioid Treatment Program Facilities

Tenn. Comp. R. & Regs. 0940-05-42-.01 DEFINITIONS

(1) Definitions of general terms used in these rules can be found in Rules Chapter 0940-05-01.

(2) Definitions specific to this chapter are as follows:

(a) “Opioid Treatment Program (OTP)” or “Alcohol & Drug Non-Residential Opioid Treatment Program” (also may be referred to herein as “Facility” or “Program,” previously referred to as “Non-Residential Substitution-Based Treatment Center for Opiate Addiction”) includes, but is not limited to, standalone clinics offering methadone, products containing buprenorphine, or products containing any other formulation approved by the FDA for detoxification and maintenance treatment of opioid use disorder by preventing symptoms of withdrawal, with the goal of the service recipient becoming free from any drug which is not medically indicated.

(b) “Advanced Practice Nurse” means a person qualified by the Tennessee Board of Nursing under Rules Division 1000-04 as an advanced practice nurse with a certificate of fitness with privileges to write and sign prescriptions and/or issue legend drugs.

Advanced practice nurses may perform any and all functions allowed by current federal and state laws and regulations within this practice setting and within their scope of allowed professional licensure.

(c) “Buprenorphine” means a partial opioid agonist used as an analgesic and as a medication treatment in the management of opioid use disorder. It has been approved by the FDA for maintenance treatment of opioid use disorder.

(d) “Central Registry” means an electronic system used to register service recipients currently receiving medication-assisted treatment at an OTP. The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS or department) or State Opioid Treatment Authority (SOTA) may require Facilities to initiate a clearance inquiry and service recipient registration into an approved central registry for the purpose of gathering Facility information, evaluating treatment outcomes, collecting demographic information, and preventing simultaneous enrollment in other Facilities.

(e) “Coordination of Care” means the process of coordinating care, treatment, or services provided by an organization, including referral to appropriate community resources and liaison with others involved in care, treatment, or services (for example, with an individual’s physician, primary care provider, or another healthcare organization or agency) to meet the ongoing identified needs of the individual served, to ensure implementation of the plan of care, treatment, or services, and to avoid unnecessary duplication of services. The aim is to facilitate the appropriate and efficient delivery of healthcare services both within and across systems.

(f) “Counseling Session” means a therapeutic discussion between service recipient(s) and a Facility counselor for a period of no less than thirty (30) minutes designated to address a service recipient’s opioid use disorder, coping strategies, and Individualized Treatment Plans. Therapeutic discussions may be delivered across different platforms but must be in compliance with all applicable state and federal regulations.

(g) “DEA” means the United States Drug Enforcement Administration.

(h) “Detoxification” or “Short-Term Withdrawal Management” means the dispensing of treatment medication in decreasing doses to the service recipient to alleviate adverse physical or psychological effects incident to withdrawal from the continuous or substantial use of an opioid drug and as a method of bringing the service recipient to a drug-free state.

(i) “Dispense” or “Dispensing” means to prepare and give out dose(s) of a medication for opioid use disorder to a service recipient at the Facility.

(j) “Diversion Control Plan” means specific measures, including assigning responsibilities to medical and administrative staff, to reduce the possibility of diversion of controlled substances.

(k) “FDA” means the United States Food and Drug Administration.

(l) “Guest Dose” means any treatment dose provided on a temporary basis at a Facility other than the service recipient’s home clinic.

(m) “Home Clinic” means the Facility where an individual is admitted and primarily treated as a Facility service recipient.

(n) “Inspection” means any examination, either onsite or by virtual means, by the department, or its representatives, of a Facility including, but not limited to, the premises, staff, persons in care, and documents pertinent to initial and continued licensing, so that the department may determine whether or not a Facility is operating in compliance with licensing requirements. The term “inspection” includes any survey, monitoring visit, complaint investigation, or other inquiry conducted for the purposes of making a compliance determination with respect to licensing requirements.

(o) “Maintenance Treatment” means the dispensing of a medication intended to treat opioid use disorder, at relatively stable dosage levels, for a continuous, open-ended period deemed medically necessary by a program provider or medical director. The medication shall be provided in conjunction with efforts to address the service recipient’s needs and goals for treatment, and with the intention to restore normal function in a service recipient’s life and improve family and community relationships.

The maintenance dose, or dose rendered as part of a service recipient’s maintenance treatment, is the individualized dose of the treatment medication considered to consistently suppress signs or symptoms of withdrawal from opioid drugs and opioid drug cravings for individuals with opioid use disorder.

(p) “Medical Director” means a physician licensed by the Tennessee Board of Medical Examiners or the Tennessee Board of Osteopathic Examination who has been designated by the governing body of the Facility to be responsible for the administration of all medical services performed by the Facility, including compliance with all federal, state, and local laws and rules regarding medical treatment of opioid use disorder. The medical director shall have the experience and credentials specified in paragraph 0940-05-42-.29(4) of these rules.

(q) “Medical Record” means medical histories, records, reports, summaries, diagnoses, prognoses, records of treatment and medication ordered and given, entries, x-rays, radiology interpretations and other written electronics, or graphic data prepared, kept, made, or maintained in a Facility that pertains to services rendered to service recipients.

(r) “Medication-Assisted Treatment” means the use of FDA approved medications for the

purpose of detoxification and maintenance treatment of opioid use disorder in combination with counseling and behavioral therapies.

(s) “Methadone” means a synthetic opioid agonist which has been approved by the FDA for detoxification and maintenance treatment of opioid use disorder.

(t) “Mobile Unit” or a “Mobile Methadone Unit,” refers to the operation of a “mobile narcotic treatment program” as described in 21 C.F.R. Part 1301.

(u) “Multidisciplinary Treatment Team” or “Treatment Team” means professionals, which may include a licensed physician, licensed advanced practice nurse, licensed physician assistant, licensed nurse, or qualified counseling provider, who assess service recipient progress.

(v) “Office of Licensure” means the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) Office of Licensure.

(w) “Opiate/Opioid” means a drug that contains opium, derivatives of opium or any of several semi-synthetic or synthetic drugs with opium-like activity.

(x) “Opioid Use Disorder” means a problematic pattern of opioid use leading to problems or distress, with at least two (2) present symptoms listed within the current DSM in a twelve (12)-month period. It is a chronic, lifelong disorder, with serious potential consequences including disability, return to illicit drug use, and death.

(y) “Observed Drug Screen” means testing conducted and witnessed by a Facility staff person to ensure against falsification of, or tampering with, the results of a drug screen.

(z) “Patient” or “Service Recipient” shall refer to an individual receiving treatment for opioid use disorder at an OTP.

(aa) “Physician Assistant” means a person licensed by the Tennessee Board of Physician Assistants, with authorization from their supervising physician, to write and sign prescriptions and/or issue legend drugs. Physician assistants may perform any and all functions allowed by the current federal and state regulations within this practice setting and within their scope of allowed professional licensure.

(bb) “Program Director” means the person designated by the Facility’s governing body who is responsible for the operation of the Facility, for the overall compliance with federal, state, and local laws, rules, and regulations, and for all Facility employees including practitioners, agents, or other persons providing services at the Facility.

(cc) “Program Provider” means any physician, physician assistant, pharmacist, or advanced practice nurse, including the medical director, who is employed by the Facility to provide medical services to service recipients. Any Facility program provider who is not a medical director shall work under the supervision of the Facility’s medical director.

(dd) “Prescription Monitoring Program” or “PMP” means a program established by the Tennessee Department of Health to monitor the prescribing and dispensing of Schedule II, III, IV and V controlled substances.

(ee) “Psychiatrist” means a physician, who specializes in the assessment and treatment of individuals having psychiatric disorders, is certified by the American Board of Psychiatry and Neurology or has the documented equivalent in education and training, and who is fully licensed to practice medicine in the State of Tennessee.

(ff) “Qualified Counseling Provider” means an individual qualified by education and/or experience for the specific duties of their position as outlined in Subparagraph 0940- 05-42-.29(4)(f) of these rules to provide counseling services to individuals receiving treatment at a Facility. Qualified Counseling Providers may only perform those duties within the scope of their applicable professional practice acts and Tennessee licensure requirements.

(gg) “Random Testing” means drug screens conducted by the Facility that lack a definite pattern of which service recipients are tested and when they are tested; indiscriminate testing.

(hh) “Service Recipient Transfer” means any service recipient who changes locations of their home clinic without receiving a discharge status or without a break in treatment between clinics.

(ii) “S.M.A.R.T. goals” means objective goals created using the S.M.A.R.T. goal framework that aids in creating personal and professional goals for service recipients. These goals are intended to be utilized in a service recipient’s treatment plan or individual counseling sessions to track achievement of short- and long-term goals and progress at the Facility. S.M.A.R.T. goals shall be specific, measurable, achievable, relevant, and time-sensitive.

(jj) “State Opioid Treatment Authority,” “SOTA,” or “Office of the SOTA” means any individual person(s) designated by the Commissioner of Mental Health and Substance Abuse Services to exercise the responsibility and authority for governing the treatment of opioid use disorder in accordance with all applicable state and federal regulations.

The individual(s) also serve(s) as a liaison with the appropriate federal agencies.

(kk) “Supervising Physician” means a licensed and actively practicing physician who has been identified as accepting the responsibility for supervising physician assistants and advanced practice nurses.

(ll) “TDMHSAS” means the Tennessee Department of Mental Health and Substance Abuse Services.

(mm) “Telehealth” means the distribution of health-related services and information via electronic information and telecommunication technologies. Telehealth services are intended to remotely support and facilitate the delivery of both clinical and non-clinical services to its recipients. Telehealth technologies include, but are not limited to, live video conferencing, mobile health applications, and phone calls.

(nn) “Treatment” means a broad range of services including outreach, identification, assessment, diagnosis, short-term withdrawal management, therapy, medical services, lectures/seminars, group process social services, and follow-up or aftercare for individuals with opioid use disorder. The overall goal is to eliminate the opioid use disorder as a contributing factor to physical, psychological, and social dysfunction and to decrease or reverse the progress of any associated problems.

(oo) “Treatment Plan,” “Individualized Treatment Plan,” or “ITP” means a comprehensive, progressive, personalized plan that includes all prescribed treatment services. It is person-centered, recovery oriented, culturally competent and addresses personalized goals and objectives.

(pp) “Volunteer” means a person who is not paid by the licensee and whose varied skills are used by the licensee to support and supplement the efforts of the paid Facility staff.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2-407.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed April 11, 2003; effective June 25, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.02 APPLICATION OF RULES

(1) In addition to this chapter, the licensee of a Facility shall comply with the following rules:

(a) Chapter 0940-05-02 Licensure Administration and Procedures;

(b) Applicable Life Safety Rules for Business Occupancies (Rule 0940-05-04-.04);

(c) If services are provided to mobile, non-ambulatory service recipients, then Mobile Non- Ambulatory Rule (Rule 0940-05-04-.09);

(d) Rules for Adequacy of Facility Environment and Ancillary Services found in Chapter 0940-05-05; and (e) Applicable Minimum Program Requirements for All Services and Facilities found in

Chapter 0940-05-06.

(2) If any provision of these rules or the application thereof to any person or circumstance is held invalid, such invalidity shall not affect other provisions or applications of these rules which can be given effect without the invalid provision or application, and to that end the provisions of these rules are declared severable.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2-407.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed February 18, 2003; effective May 4, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.03 LICENSING PROCEDURES

(1) When making an application for a new license, the applicant shall submit an application on a form provided by the department along with a copy of the Certificate of Need (CON) issued by the Tennessee Health Facilities Commission or any other applicable state agency. If the CON is not required, documentation must be submitted to the Office of Licensure and the SOTA office as to why it was not required. Any condition placed on the CON will also be placed on the license.

(2) The written application for operation of a Facility shall be filed simultaneously with the Federal Substance Abuse and Mental Health Service Administration (SAMHSA) and the DEA, and/or any other applicable federal agencies.

(3) Service recipients shall not be admitted to the Facility until a license has been issued.

(4) Service recipients shall not be admitted to the Facility until the Facility is registered and active in the Central Registry.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-404, and 33-2-407.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed March 1, 2007; effective May 15, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.04 DESIGNATION OF STATE OPIOID TREATMENT AUTHORITY (SOTA) AND

POWERS AND DUTIES OF SOTA.

(1) The Commissioner of the Department of Mental Health and Substance Abuse Services shall designate an individual within the department to serve as the SOTA to facilitate oversight and technical assistance to licensed Facilities under this Chapter. The individual designated shall have demonstrated education and background evidencing comprehensive knowledge of opioid drugs and their effects.

(2) The powers and duties of the SOTA, and SOTA designees, include, but are not limited to, the following:

(a) Facilitating the development and implementation of rules, regulations, standards and best practice guidelines to assure the quality of services delivered by Facilities;

(b) Acting as a liaison between relevant State and federal agencies;

(d) Assuring delivery of technical assistance and informational materials to Facilities as needed;

(e) Performing unannounced inspections of Facilities;

(f) Consulting with the federal government regarding approval or disapproval of requests for exceptions to federal regulations, where appropriate;

(g) Reviewing and approving exceptions to federal and state dosage policies and procedures;

(h) Receiving and addressing service recipient appeals and grievances;

(i) Monitoring of performance outcomes. The following performance indicators may be used to evaluate the impact of the Facility on service recipients and the community and may include, but not be limited to:

Service recipient satisfaction;
Service recipient employment status;
Improvement in medical conditions;
Drop-out rate;
Recidivism rates;
Alcohol use;
Criminal arrests;
Illicit drug use, as indicated by drug screens; and 9. Improvement in social and living standards.

(j) Working cooperatively with other relevant state agencies to determine the service need in the location of a proposed Facility.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.06 INTAKE, ADMISSIONS, AND DISCHARGES

(1) Prior to admission to the Facility, each prospective service recipient shall be evaluated by the medical director or program provider and clinical staff who have been determined to be qualified by education, training, and experience to perform or coordinate the provision of such assessments. The purpose of such assessments shall be to determine whether medicationassisted treatment will be the most appropriate treatment modality for the service recipient.

No prospective service recipient shall be processed for admission until it has been verified that the prospective service recipient meets all applicable criteria.

(2) Except as otherwise authorized by law, no prospective service recipient shall be admitted for treatment without written authorization. If a prospective service recipient lacks the legal

authority to consent for treatment, the Facility shall obtain consent from a parent, legal guardian, and/or legal representative in writing for admission to such treatment. Such consent shall be documented in the service recipient’s medical record. The following information shall be explained by a trained staff person to the service recipient and other consenters and documented in the service recipient’s file:

(a) The Facility’s services and treatment;

(b) The specific conditions that will be treated;

(c) Explanation of treatment options, including maintenance treatment and short-term withdrawal management, if available, and clinic charges, including the fee agreement, signed by the prospective service recipient or the service recipient’s legal representative; and (d) The Facility’s rules regarding service recipient conduct and responsibilities.

(3) A program provider shall document that treatment is medically necessary. The admissions and initial dosing decision ultimately rests with the medical director or a program provider, as applicable and allowed by federal and state laws, rules, and regulations.

(4) A Facility shall only admit and retain service recipients whose known needs can be met by the Facility in accordance with its licensed Facility purpose and applicable federal and state laws, rules, and regulations.

(5) Pregnant females with an opioid use disorder shall be given priority for admission and services when a Facility has a waiting list for admissions and it is determined that the health of the mother and/or unborn child is more endangered than is the health of other service recipients waiting for services.

(6) No Facility shall provide incentives for referral of prospective service recipients to the clinic.

(7) Initial Assessment. Within fourteen (14) days of admission, the Facility shall complete an initial assessment. The initial assessment shall focus on the service recipient’s eligibility and need for treatment and shall provide indicators for the service recipient’s disease severity and the need for any appropriate referrals. Whenever possible and with service recipient consent, the initial assessment shall include a family member or significant other to assist in the provision of accurate information and a full understanding and retention of instructions given to the service recipient. The initial assessment shall include, but not be limited to, the following:

(a) A physical examination that includes a review of systems, vital signs, a pain assessment, and laboratory testing;

(b) Relevant health history (e.g., determination of chronic or acute medical conditions such as diabetes, renal disease, hepatitis, sickle cell anemia, tuberculosis, HIV exposure, sexually transmitted infections, chronic cardiopulmonary disease, and pregnancy);

(d) A determination of currently prescribed medications;

(e) A personal and family history of substance use;

(f) A determination of current opioid use disorder;

(g) Determination of length of opioid use disorder;

(h) An observed drug screen in compliance with Paragraph 0940-05-42-.17(4);

(i) A screening for sexually transmitted infections (STIs), tuberculosis, and other communicable diseases based on the medical director’s discretion. The Facility shall maintain a documented policy and procedure for screening for communicable diseases, which includes the process for screening methods used by the Facility and the process for providing referrals for patients for further communicable disease screening, testing, or treatment, as appropriate. Patient-specific factors that warrant a deviation from these rules or the Facility’s policy and procedures shall be documented in the patient’s medical record;

(j) Other tests as determined to be necessary by the Facility’s policies and procedures or by the program provider (e.g., CBC, EKG, chest x-ray, hepatitis B, hepatitis C, HIV testing). Tests not directly conducted by the Facility at admission shall be conducted within seven (7) days after admission. The Facility is responsible for obtaining and maintaining documentation of required laboratory tests performed by an alternative provider.

(k) A determination if the service recipient needs special services, such as treatment for alcohol use disorder or psychiatric services, and determination that the Facility is capable of addressing these needs either directly or through referral. If referral to an outside provider is deemed necessary, efforts of the Facility in making the referral shall be documented in the service recipient’s medical record.

(l) The Facility may utilize components of the initial assessment performed by an outside provider if conducted within fourteen (14) days of admission and obtained by the Facility within seven (7) days of admission.

(8) Comprehensive Assessment. Within thirty (30) days of admission, the Facility shall have completed a comprehensive assessment. The comprehensive assessment shall include information obtained from the patient, family members, friends, peers, and other collateral sources, where appropriate and with the service recipient’s written consent. The comprehensive assessment shall include, but not be limited to, the following:

(a) A review of the information collected in the initial assessment;

(b) A review of any outside medical records obtained by the Facility with the service recipient’s, or their legal representative’s, written consent;

(d) A criminal justice history, including any current criminal justice involvement; and (e) A psychosocial assessment that shall include information about the service recipient’s:

Motivation for treatment;
Personal treatment goals;
Personal strengths;
Individualized needs;
Urgent needs, including suicide risk;
Abilities and/or interests;
Presenting problems, including a thorough analysis of the service recipient’s high-risk behaviors such as:

(i) Licit and illicit drugs used, including alcohol;

(I) Amount(s) and method(s) used;

(II) Frequency of use; and (III) Duration of use;

(ii) Symptoms of physical dependence or withdrawal;

(iii) History of treatment for addictive behaviors;

(iv) Adverse consequences of use; and (v) Inappropriate use of prescribed substances;

Use of tobacco and other nicotine products;
Previous behavioral health services, including:

(i) Diagnostic information;

(ii) Treatment information; and (iii) Efficacy of current or previously used medication;

Mental status;
Current level of functioning;
Need for, and availability of, social supports;
Adverse childhood experiences;
Level of education; and 15. Adjustment to disabilities/disorders.

(9) At the time of admission, the Facility shall conduct an inquiry with the Central Registry in accordance with Rule 0940-05-42-.20.

(10) Non-Admissions. The Facility shall maintain written logs that identify persons who were considered for admission or initially screened for admission but were not admitted. Such logs shall identify the reasons why the persons were not admitted and what referrals were made for them by the Facility.

(11) Discharge and Aftercare Plans. A Facility shall complete an individualized discharge and aftercare plan for service recipients who complete their course of treatment.

(a) Upon admission a Facility shall begin development of a service recipient’s discharge plan.

(b) All discharge and aftercare plans shall include documentation that the Facility’s treatment team has discussed with the service recipient an individualized treatment plan appropriate to the service recipient’s discharge and aftercare plans.

(c) The service recipient’s discharge planning shall include the development of a list of treatment resources available to the service recipient in their community. This list shall be developed in consultation with the service recipient, shall be in writing, and shall be made available to the service recipient upon discharge. The Facility shall assist the service recipient in obtaining the appropriate referral.

(d) The discharge plan shall be completed within seven (7) days of discharge by the person who has primary responsibility for coordinating or providing for the care of the service recipient. It shall include a final assessment of the service recipient’s status at the time of discharge and aftercare planning. If applicable, parents or guardian, or responsible persons may participate in discharge and aftercare planning. The reason for any service recipient not participating in discharge and aftercare planning shall be documented in the service recipient’s medical record.

(e) Service recipients that have lost contact with the Facility for greater than thirty (30) days shall be discharged from the Facility and will require a new admission upon return.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed February 18, 2003; effective May 4, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.07 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) Facilities shall organize and coordinate service recipient records in a manner which demonstrates that all pertinent service recipient information is accessible to all appropriate staff and to the SOTA and TDMHSAS.

(2) All documentation will be clearly dated and initialed or signed by the staff member involved.

(3) Records shall be preserved in accordance with T.C.A. § 33-3-101(d). The records may be generated, maintained, or transferred in whole or in part to any recording medium that assures accurate preservation of the record.

(4) The Facility shall discuss final storage or disposition of the Facility’s records with TDMHSAS ninety (90) days in advance of the closing of a Facility.

(5) The service recipient’s records shall include, but not be limited to, the following documentation:

(a) A voluntary, written, Facility-specific informed consent to treatment from each service recipient at admission to include:

Information about all treatment procedures, services, and other policies and regulations throughout the course of treatment shall be presented to the patient.

This information shall include clinic charges in the form of a fee agreement that is signed, either in person or electronically, by the service recipient;

Acknowledgment of the individualized, prescribed therapy before dosing begins, including information about potential interactions with and adverse reactions to other substances, including interactions and adverse reactions to alcohol, other prescribed medications, over-the-counter medications, other medical procedures, and food;
Information that the goal of opioid treatment is stabilization of functioning;
Information that short-term withdrawal management from opioids over thirty (30) to one hundred eighty (180) days is a treatment alternative to long-term maintenance, if available;
Acknowledgment that the service recipient has been informed of the Facility’s rules regarding service recipient conduct and responsibilities and continuing documentation of the service recipient’s compliance with the Facility’s policies;
Acknowledgment that the service recipient has been informed of their rights (Rule 0940-05-42-.27);
Information that, at regular intervals and in full consultation with the service recipient, the Facility shall discuss the service recipient’s present level of functioning, course of treatment and future goals; and 8. Information that the service recipient may choose to withdraw from or be maintained on the medication as they desire, unless medically contraindicated.

(b) Documentation of the initial and comprehensive assessments as required by Paragraphs 0940-05-42-.06(8) and (9);

history; review of systems; laboratory reports, including results of required toxicology screens; and progress notes, including documentation of current dose and other dosage data. Information in the medical record shall be entered by a program provider and other licensed health professionals. The service recipient’s medical record may also include clinical data obtained from outside medical providers with the patient’s written consent;

(d) Dated and signed case entries of all significant contacts with service recipients, including a record of each counseling session in chronological order;

(e) Dates and results of treatment team meetings for service recipients;

(f) The initial treatment plan, any amendments to the plan, reviews of the plan, and the long-term, individualized treatment plan, including any amendments to that document and reviews of the plan;

(g) Documentation that services listed in the plan are available and have been provided or offered;

(h) Documentation that the service recipient was informed about the process and factors considered in decisions impacting the service recipient’s treatment (for example, takehome medication privileges, changes in counseling sessions, changes in frequency of toxicology screens);

(i) A record of correspondence with the service recipient, family members and other individuals and a record of each referral for services and its results;

(j) Documentation that the service recipient was provided a copy of the Facility’s rules and regulations and a copy of the service recipient’s rights and responsibilities and that these items were discussed with them;

(k) A closing summary, including reasons for discharge and any referral. In the case of death, the reported cause of death shall be documented;

(l) A written fee agreement as detailed in Rule 0940-05-42-.06 dated and signed by the service recipient, or the service recipient’s legal representative, prior to provision of any services. This fee agreement shall include an explanation of the financial aspects of treatment and the consequences of nonpayment of required fees, including the procedures for medically supervised withdrawal in the event that a service recipient becomes unable to pay for treatment. If the service recipient’s financial responsibility changes, a new fee agreement shall be signed, either in person or electronically, prior to the provision of further services;

(m) Documentation of Central Registry clearance as required under these rules; and (n) All other information and documents as required by the SOTA and these rules.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.08 MULTIPLE ENROLLMENTS

(1) The Facility shall have a procedure which shall ensure that no service recipient is enrolled in more than one (1) Facility at a time.

(2) The procedure shall take into account requirements for service recipient confidentiality.

(3) The Facility shall obtain a written release of information from the service recipient in order to check the records of every Facility within Tennessee and those Facilities within seventy-five (75) miles of the Facility, or those Facilities that participate with the Central Registry. The release of information shall state that its purpose is to obtain information and records developed during prior admission(s). Results of this check shall be maintained in the service recipient’s medical record. This check shall be duplicated if the service recipient is discharged and readmitted at any time.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.09 ORIENTATION

(1) The Facility shall provide, and document, an orientation to service recipients within twentyfour (24) hours of admission for treatment and again within thirty (30) days following the admission date. The orientation shall be designed to educate the service recipient and ensure that the service recipient understands the Facility’s program.

(2) Orientation shall be done by a designated staff person who has been determined to be qualified by education, training, and experience to perform the task.

(3) Facilities shall ensure that each service recipient signs, either in person, electronically, or by documented verbal acknowledgment, a statement confirming that the following information has been explained to the service recipient:

(a) The expected benefits of the treatment that the service recipient is expected to receive;

(b) The service recipient’s responsibilities for adhering to the treatment regimen and the consequences of non-adherence; and (c) An explanation of individualized treatment planning.

(4) Facilities shall ensure that each service recipient signs, either in person or electronically, a statement confirming that they have been offered short-term withdrawal management services as an admission alternative, if available, and that the following has been discussed with the service recipient:

(a) An explanation of the types of short-term withdrawal management services offered by the Facility, including administrative short-term withdrawal management; and (b) An individualized assessment of the medical risks and benefits of short-term withdrawal management for the service recipient.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.10 SERVICE RECIPIENT TRANSFERS

(1) If a prospective service recipient has previously been discharged from treatment at another OTP, the admitting Facility shall initiate an investigation into the prospective service recipient’s prior treatment history, inquiring of the last program attended and the reasons for discharge from treatment.

(2) Service recipients who were terminated from a prior Facility due to noncompliance shall be admitted as a new service recipient.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.11 INDIVIDUALIZED TREATMENT PLAN

(1) A Facility shall develop an Individualized Treatment Plan (ITP) for each service recipient within thirty (30) days of admission. Each service recipient shall be involved in the development and review of their ITP. The initial ITP and all reviews shall be signed, either in person, electronically, or by documented verbal acknowledgement, by the service recipient, qualified counseling provider, and program provider. ITPs shall document the following:

(a) A consistent pattern of substance use treatment services and medical care appropriate to the individual service recipient’s needs; and (b) S.M.A.R.T. goals discussed and agreed upon by the qualified counseling provider, program provider and the service recipient. The Facility may use alternative treatment planning methods provided that the methodology is evidence-based and provides similar details to those of the S.M.A.R.T. goals as defined by these rules.

(2) The admission requirements of Rule 0940-05-42-.06 shall be completed prior to the development of an ITP.

(3) Medical care, including referral for necessary medical service, and evaluation and follow-up of service recipient complaints shall be compatible with current and accepted standards of medical practice. All service recipients shall receive a physical examination at least annually.

All other medical procedures performed at the time of admission shall be reviewed by the medical staff on an annual basis, and all clinically indicated tests and procedures shall be repeated. The medical director or program provider shall record the results of the annual medical examination and review of service recipient medical records in each service recipient’s medical record.

(4) In recognition of the varied medical needs of service recipients, any case histories, ITPs, short-term withdrawal management plans, and discharge plans shall be reviewed at least every ninety (90) days for service recipients in treatment less than one (1) year and at least every six (6) months for service recipients in treatment more than one (1) year. This review will be conducted by the medical director or program provider along with the primary qualified counseling provider and other appropriate members of the treatment team involved in the service recipient’s treatment. This review shall also include an assessment of the current dosage, schedule, and the rehabilitative progress of the individual, as part of a determination that additional medical services are indicated. If this review results in a determination that additional or different medical or behavioral health services are indicated, the Facility shall ensure that such services are made available to the service recipient, either at the Facility or by referral to the appropriate medical professional. Any referrals shall be documented in the service recipient’s medical record and followed up on as appropriate.

(5) When the program provider prescribes other controlled substances to service recipients in the Facility, the Facility shall ensure that such prescription is in compliance with all applicable statutes and regulations and with current and accepted standards of medical practice. Such prescriptions shall not be issued to any service recipient unless the program provider first sees the service recipient and assesses the service recipient’s potential for misuse of such medications.

(6) As part of the rehabilitative services provided by the Facility, each service recipient shall be provided with individual and group counseling appropriate to their needs. The frequency and duration of counseling provided to service recipients shall be in conformity with Rule 0940- 05-42-.14 and be consistent with the ITP. ITPs shall indicate a specific level of counseling services needed by the service recipient as part of the rehabilitative process.

(7) All service recipients shall receive HIV and hepatitis risk reduction education appropriate to their needs.

(8) When appropriate, the Facility shall provide each service recipient information regarding enrollment in a vocational education program, engaging in a vocational activity (vocational evaluation, education, or skill training), or assisting the service recipient in efforts to seek gainful employment. Deviations from compliance with these requirements shall be explained in the service recipient’s medical record. Each Facility shall take steps to ensure that a comprehensive range of rehabilitative services, including vocational, educational, legal, mental health, treatment for other substances of misuse, and social services, are made available to the service recipients who demonstrate a need for such services. The Facility can fulfill this responsibility by providing support services directly or by appropriate referral.

Support service(s) recommended and utilized shall be documented in the service recipient’s medical record.

(9) All Facilities will develop and implement policies for matching service recipient’s needs to treatment. These policies may include treatment phasing in which the intensity of medical, counseling, and rehabilitative services provided to a service recipient is individualized for each service recipient depending upon the service recipient’s phase of treatment.

(10) If the service recipient experiences a return to drug use, their ITP shall document evidence of intensified services. Such evidence shall include, but is not limited to, an increase in individual or group counseling session(s) and a reduction in the service recipient’s take-home privileges.

(11) The program providers shall initiate and lead a discussion regarding patient readiness to taper down or taper off treatment medications employed in the patient’s treatment with each patient no later than one (1) year after initiating treatment and then every six (6) months thereafter or at any time upon the patient’s request. Documentation of this discussion shall be included in the patient’s ITP. Nothing in this part shall be construed to mean that patients should be forced to taper down or off of treatment medications.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed April 11, 2003; effective June 25, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.12 SPECIAL POPULATIONS

(1) The Facility shall ensure that program providers are knowledgeable in the management of opioid use disorder in the context of chronic pain and pain management. The Facility may not prohibit a service recipient diagnosed with chronic pain from receiving medication-assisted treatment for either maintenance treatment or short-term withdrawal management.

(a) With the service recipient’s written consent, the Facility shall ensure continuity of care and communication between the Facility’s program providers and any outside providers regarding the service recipients receiving opioid use disorder and pain treatment.

(b) If the service recipient refuses consent for the two (2) entities to communicate and coordinate care, the Facility shall document refusal and may make clinically appropriate decisions regarding treatment, such as, take-home medication privileges, medication dosing, or an increase in counseling.

(2) The Facility shall ensure that service recipients with mental health needs are identified and referred to appropriate treatment with appropriate follow up. Any referrals or attempts at referrals shall be documented in the service recipient’s medical record.

(a) The Facility shall closely monitor service recipients during medically supervised withdrawal, or dose tapering, to identify symptoms of mental illness.

(b) The Facility shall establish and document a list of available mental health providers in the community that the Facility can refer patients to, as appropriate.

(3) The Facility shall have a policy regarding the treatment of co-morbid disorders such as psychiatric and medical disorders. The goal of treatment shall be to facilitate treatment for these disorders as seamlessly as possible, while maximizing service recipient convenience and compliance with appointments and recommendations. The Facility shall attempt to ensure a smooth referral process and exchange of information. The Facility shall organize and facilitate communication between two or more participants involved in a service recipient’s care (such as the Facility and primary care provider, specialty services, mental health services, family members, and/or significant others) to achieve safer and more effective care. This shall be documented in the service recipient’s medical record.

(4) The Facility shall address misuse of alcohol and other non-opioid substances by providing treatment or referral to outside providers, as appropriate.

(a) The Facility shall ensure that staff is trained and knowledgeable regarding current effective strategies for treating misuse of alcohol, opioids, methadone, amphetamines, cocaine, barbiturates, benzodiazepines and other drugs.

(b) Ongoing multi-drug use is not necessarily a reason for discharge. The treatment team shall consider the service recipient’s condition and address the situation from an individualized clinical perspective. The program provider shall consider the risks and benefits of the service recipient’s current level of care being provided, medication dosage, and other services being provided when treating service recipients with ongoing multi-drug use. The program provider shall refer the service recipient to a higher level of care when indicated. This referral shall be documented in the service recipient’s medical record.

(c) Social barriers to higher levels of care, such as inability to pay or concerns regarding loss of employment, shall be documented. In cases where a higher level of care is recommended yet declined by the client or unattainable due to external factors, the clinician shall document the rationale for the refusal or reasons for not being able to access the recommended higher level of care.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.13 REPEALED

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Repeal filed April 30, 2003; effective July 14, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Repeal filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.14 COUNSELING

(1) Counseling is essential to promote and guide the service recipient to a more productive lifestyle of abstinence from illicit medications or drugs. The assigned qualified counseling provider is responsible for developing and implementing the service recipient’s ITP, in coordination with the treatment team. The ITP shall include S.M.A.R.T. goals or a similar treatment planning method, developed by the qualified counseling provider, the service recipient, and the treatment team. The qualified counseling provider is responsible for assisting the service recipient to alter lifestyles and patterns of behavior to improve the service recipient’s quality of life.

(2) The qualified counseling provider caseload shall:

(a) Be no larger than one (1) qualified counseling provider to fifty (50) service recipients;

The Facility can petition the SOTA office, in writing, for a consideration to exceed the ratio for a period no longer than six (6) months. The Facility shall include justification and documentation for requiring the adjustment; and 2. An extension can be submitted, for a period not to exceed an additional six (6) months, to the SOTA office with sufficient documentation outlining why an extension is necessary;

(b) Allow the Facility to provide adequate:

Psychosocial assessment;
Treatment planning; and 3. Individualized counseling;

(c) Allow for regularly scheduled counseling sessions; and (d) Allow service recipients access to their primary counselor if more frequent contact is merited by need or is requested by the service recipient.

Telehealth is available as an option for more frequent contact with the counselor if desired or needed by the service recipient. Telehealth visits shall not exceed fifty percent (50%) of the service recipient’s total visits.
In extraordinary situations, telehealth sessions may account for more than fifty percent (50%) of a patient’s counseling sessions if first approved by the SOTA.

(3) The qualified counseling provider supervisor caseload shall be no larger than one (1) qualified counseling provider supervisor to twenty-five (25) service recipients. The Facility can petition the SOTA office, in writing, for consideration to exceed the ratio for a period no longer than six (6) months. The Facility shall include justification and documentation for requiring the adjustment.

(4) The Facility shall take service recipient preferences into account when assigning their qualified counseling provider, as appropriate.

(5) For all service recipients, the following counseling schedule shall be followed:

(a) During the first thirty (30) days of treatment, counseling session(s) shall be scheduled to take place at least two (2) times per week. The initial counseling session shall be conducted in person, and counseling sessions conducted via telehealth shall not exceed twenty-five percent (25%) of the required sessions.

(b) During the next ninety (90) days of treatment (day thirty-one (31) to day one hundred twenty (120)), counseling session(s) shall be scheduled to take place either via telehealth or in person at least one (1) time per week.

(c) During the following ninety (90) days of treatment (day one hundred twenty-one (121) to day two hundred ten (210)), counseling session(s) shall be scheduled to take place either via telehealth or in person at least two (2) times per month.

(d) For subsequent ninety (90)-day periods of treatment (day two hundred eleven (211) forward), counseling session(s) shall be scheduled to take place either via telehealth or in person as needed or indicated in the service recipient’s ITP, but not less frequently than monthly.

(e) Counseling sessions occurring on day thirty-one (31) and forward can utilize telehealth visits for up to fifty percent (50%) of the service recipient’s sessions. Session type shall be based on counselor evaluation and service recipient needs and be clearly documented in the service recipient’s medical record. In extraordinary situations, telehealth sessions accounting for more than fifty percent (50%) of a patient’s counseling sessions may be approved by the SOTA upon request.

(6) Exceptions to the frequency of counseling sessions shall be service recipient-specific and clearly justified and documented in the patient’s ITP.

(7) The program provider evaluating the service recipient’s eligibility for take-home doses shall carefully consider the service recipient’s participation in the counseling sessions as a factor in their decision.

(8) The qualified counseling provider or program provider is responsible for documentation of their significant contact with each service recipient, which shall be filed in the service recipient’s medical record. Significant contact can include, but not be limited to, in-person counseling, telephone calls, telehealth calls, or web-based calls.

(9) The counseling session documentation shall include a thorough and detailed description of:

(a) The reason for or nature of the contact;

(b) The service recipient’s current condition;

(d) The assessment of the service recipient’s status;

(e) A description of the therapeutic technique used during the session; and (f) A plan for action or further treatment that addresses the goals of the treatment plan.

(10) Each entry shall be completed within twenty-four (24) hours of the contact and shall be clearly dated and initialed or signed by the staff person involved.

(11) Opportunities for family involvement in counseling shall be provided and documented.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.0 5 POLICY AND PROCEDURES

(1) The governing body of the Facility shall ensure it is administered and operated in accordance with written policies and procedures in the below-listed subject areas and in accordance with these rules. Each Facility shall clearly identify the governing body, as defined in Paragraph 0940-05-01-.01(18), in its policies and procedures manual including the name and contact information of the governing body.

(a) Intake, Admissions, and Discharges (0940-05-42-.06);

(b) Service Recipient Record Requirements (0940-05-42-.07);

(d) Orientation (0940-05-42-.09);

(e) Service Recipient Transfers (0940-05-42-.10);

(f) Individual Program Plan (0940-05-42-.11);

(g) Special Populations (0940-05-42-.12);

(h) [REPEALED] (0940-05-42-.13);

(i) Counseling (0940-05-42-.14);

(j) Medication Management (0940-05-42-.15);

(k) Pharmacotherapy Guidelines (0940-05-42-.16);

(l) Drug Screens (0940-05-42-.17);

(m) Medically Supervised Withdrawal (0940-05-42-.18);

(n) Diversion Control Plan (0940-05-42-.19);

(o) Central Registry (0940-05-42-.20);

(p) Reporting Requirements (0940-05-42-.21);

(q) Quality of Care (0940-05-42-.22);

(r) Infectious Hazardous Waste (0940-05-42-.23);

(s) Infection Control (0940-05-42-.24);

(t) Managing Disruptive Behavior (0940-05-42-.25);

(u) Hours of Operation (0940-05-42-.26);

(v) Service Recipients’ Rights (0940-05-42-.27);

(w) Community Relations (0940-05-42-.28);

(x) Personnel and Staffing Requirements (0940-05-42-.29); and (y) Mobile Units (0940-05-42-.30).

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed June 8, 1999; effective August 22, 1999. Amendment filed February 18, 2003; effective May 4, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-21 on May 15, 2008. Repeal and new rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.15 MEDICATION MANAGEMENT

(1) Opioid Drugs. Facilities shall develop and implement written policies and procedures for prescribing, dispensing, and administration of medications and their security. No standardized routines or schedules of increases or decreases of medications may be established or used. These policies and procedures shall include the following:

(a) Administration.

A program provider shall perform a medical assessment to determine the service recipient’s initial dose and schedule. The provider shall communicate the initial dose and schedule to the person supervising medication and document the dose in the service recipient’s medical record.
A program provider may assign such dose and schedule by verbal order only on an emergency basis. If a verbal order is given, the program provider shall examine the service recipient within seventy-two (72) hours of the verbal order.

Both the verbal order and the results of the physical examination shall be documented in the service recipient’s medical record.

The initial dose of methadone shall be based on the clinical judgment of the program provider and in compliance with relevant federal rules and regulations.

A transferring service recipient may receive an initial dosage of no more than the last daily dosage authorized at the former Facility unless in the clinical judgment of the medical director, there are extenuating circumstances documented in the service recipient’s medical records which justify an initial dosage that is greater than the last daily dosage authorized at the former Facility.

Subsequent doses shall be authorized by a program provider. Additional dosage may be dispensed on the first day where the program provider documents that the initial dose does not suppress withdrawal symptoms. Service recipients are stabilized on methadone when they are receiving a therapeutic dose that is sufficient to stop opioid cravings and misuse and sufficient to keep the service recipient comfortable for at least twenty-four (24) hours.
No dosage increases shall occur on the days that the Facility is closed.
No methadone may be administered unless the service recipient has undergone all of the screening and admission procedures required, unless there is an emergency situation that is fully documented in the service recipient’s medical record. In that case, intake procedures shall be completed on the next working day. No take-home medication may be given in such an emergency.
No dose of methadone in excess of one hundred eighty (180) milligrams per day may be ordered or administered without the prior approval of the SOTA. Except provided:

(i) Service recipients transferring to the Facility who are already established on doses greater than one hundred eighty (180) milligrams per day may continue their previously established dose, at the program provider’s discretion, for up to one (1) week to allow for sufficient time to receive SOTA approval; and (ii) Service recipients that are guest-dosing at the Facility and receiving a dose of greater than one hundred eighty (180) milligrams per day will not require SOTA approval.

Benzodiazepine Use. If a service recipient has a positive benzodiazepine screen:

(i) The treatment team shall meet with the service recipient, either in person or via video conferencing platform, within fourteen (14) days of receiving the results of the screen, to develop a benzodiazepine action plan in the service recipient’s medical record. The plan shall be reviewed and signed by the medical director or designated program provider;

(ii) If the plan requires the service recipient to become abstinent from benzodiazepines, a time period for supervised withdrawal shall be established. Coordination, or the attempt to coordinate with the benzodiazepine prescriber must be documented in the service recipient’s medical record;

(iii) The Facility shall provide benzodiazepine gradual dose reductions or tapering services either directly or through referral to another provider. Any referrals must be documented in the service recipient’s medical record;

(iv) If the plan calls for the continued use of benzodiazepines, the Facility shall coordinate the care with a qualified provider and document this coordination in the service recipient’s medical record;

(v) The Facility shall document any follow-up action to any deviation from the benzodiazepine action plan; and (vi) The benzodiazepine action plan and subsequent progress notes about plan implementation shall be documented in the service recipient’s medical record.

(b) Any opioid drug ordered and administered shall be documented on an individual medication administration record. The record shall include:

Name of medication;
Date prescribed;
Dosage;
Frequency of administration;
Route of administration;
Date and time administered; and 7. Documentation of staff administering medication or supervising selfadministration.

Take-home doses of methadone or buprenorphine shall not exceed what is permitted by the applicable rules of the Substance Abuse and Mental Health Administration or other applicable federal agency. Except provided:

(i) Service recipients that provide an unfavorable drug screen but otherwise demonstrate treatment stability, as determined and documented by the program provider, shall receive not more than thirteen (13) take-homes at a time (i.e., presenting to the Facility once every other week) for a minimum of twenty-eight (28) days beginning the day the service recipient first receives the reduced number of take-homes;

(ii) Service recipients that provide an unfavorable drug screen and demonstrate treatment instability, as determined and documented by the program provider, shall receive not more than four (4) take-homes per week (i.e., presenting to the clinic three (3) nonconsecutive days per week) for a minimum of twenty-eight (28) days beginning the day the service recipient first receives the reduced number of take-homes; or (iii) Service recipients that pose a high risk of diversion, including presenting an inappropriate amount of medication for a diversion control call-back, or otherwise demonstrating noncompliance with the service recipient’s responsibilities of the Facility’s diversion control plan, shall receive not more than four (4) take-homes per week (i.e., presenting to the clinic three (3) nonconsecutive days per week) for a minimum of twenty-eight (28) days beginning the day the service recipient first receives the reduced number of take-homes.

All requests for take-home exceptions shall be submitted to the SOTA and any other applicable federal agency for approval consideration.

(i) The Facility shall check the PMP database prior to requesting any takehome or dosing exceptions and include this information with the exception request.

(ii) The Facility shall provide counseling prior to providing take-home doses to any service recipient. Progress notes in the service recipient’s medical record shall document the counseling provided.

(iii) The Facility shall include the service recipient’s Central Registry ID number, details regarding the service recipient’s treatment stability, details regarding the need for the exception request and why alternatives would not be appropriate.

The Facility shall document in the service recipient’s medical record the basis for determining treatment stability approving and “take-home” medication for the service recipient. The following examples should be considered as a guide in determining the service recipient’s treatment stability and determining eligibility for “take-home” medications:

(i) Cessation of illicit drug use;

(ii) Regularity of program attendance;

(iii) Length of time and level of treatment in medication therapy (ability to responsibly self-medicate);

(iv) Absence of known recent criminal activity;

(v) Absence of serious behavioral problems;

(vi) Absence of misuse of drugs, including excessive use of alcohol;

(vii) Other special needs of the service recipient, such as split dosing, physical health needs, pain treatment, etc.;

(viii) Capacity to safely store “take-home” medication within the service recipient’s home;

(ix) Stability of the home environment and social relationships;

(x) Service recipient’s work, school, or other daily-life activity schedule; and (xi) Hardship experienced by the service recipient in traveling to and from the Facility.

(d) Adverse drug reactions and errors shall be reported to a program provider immediately and corrective action shall be initiated. The adverse reaction or error shall be recorded in the service recipient’s medical record, the medication administration record, the nurse progress notes, and the ITP, and all persons who are authorized to administer medication or supervise self-medication shall be alerted.

(e) All medications shall be stored in a locked safe when not being administered or selfadministered.

(f) Medication orders and dosage changes shall be written, printed, or provided electronically, on a form which clearly displays the program provider’s signature. The Facility shall maintain an accurate, perpetual inventory at all times. Every dose shall be recorded in the service recipient’s individual medication record at the time the dose is dispensed or administered. The perpetual inventory shall be totaled and recorded in milligrams daily. Any inventory variances shall be documented, including the reason for the variance and any follow-up actions, and be made available for inspection by the SOTA office.

(g) No standardized routines or schedules of increases or decreases of medications may be established or used.

(h) Computer-Based Recording.

Any such computerized system shall have the capability of producing a hardcopy printout of any medical or dosing order data which the Facility is responsible for maintaining under the laws and/or regulations of this state and/or the federal government. Any computerized system shall, upon the request of the SOTA, send or provide such a printout within forty-eight (48) hours, excluding weekends.
In the event a Facility experiences system down-time, the Facility must have a written or readily retrievable auxiliary policy and procedure for documentation of all medical and dosing orders. The auxiliary procedure shall ensure that each medical or dosing order is authorized, and that all appropriate data are retained for on-line data entry as soon as the computer system is available for use again.

(i) Guest Dosing.

Guest dosing shall be provided for a maximum of fourteen (14) days. Anything beyond fourteen (14) days shall be approved by the SOTA before dosing occurs.
Service recipients shall have been enrolled at the home clinic for a minimum of thirty (30) days before being eligible for a guest dose. Service recipients enrolled less than thirty (30) days at the home clinic shall be eligible for guest dosing only if approved by the SOTA.
Service recipients shall have two (2) consecutive favorable drug screens before being eligible for a guest dose unless the program provider determines that the benefits of guest dosing outweigh the risks and documents the justification for granting guest dosing privileges in the service recipient’s medical record.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.16 PHARMACOTHERAPY GUIDELINES

(1) The Facility shall develop pharmacotherapy guidelines for service recipients covering the Facility’s own prescribing and the review of prescriptions from other providers. These shall minimally include:

(a) Procedures to ensure that service recipients’ prescriptions from outside providers will be reported to the medical staff and reviewed by the program provider at admission and annually thereafter;

(b) Procedures describing the Facility’s response when information about prescriptions from outside providers is not reported including, but not limited to, the loss of takehome privileges, to ensure compliance with this rule; and (c) If a Facility is unable to acquire information about a service recipient’s prescriptions, the Facility shall document efforts made to obtain information about prescriptions from outside providers or pharmacies in the service recipient’s medical record.

(2) The Facility shall query the PMP when clinically indicated at the program provider’s discretion and at a minimum:

(a) Upon admission of a service recipient; and (b) Every three (3) months for the first one (1) year of treatment, and every six (6) months thereafter. The service recipient’s medical record shall include documentation of the check of the PMP database, the date upon which it occurred, the results of the PMP check, and any follow-up actions from the results. If the PMP report yields a result that the service recipient is receiving other controlled prescription medication(s), appropriate documentation of the prescription(s) must be in the service recipient’s medical record.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-302, and 33-2-404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.17 DRUG SCREENS

(1) Random urine drug screening or other adequately tested toxicological procedures shall be used for the purposes of assessing the service recipient’s progress in treatment.

(2) Drug screening procedures shall be individualized and shall include at least an initial observed drug screen for newly admitted service recipients, then a weekly drug screen during the first thirty (30) days of treatment, and at least eight (8) drug screens annually thereafter. In addition to the initial observed drug screen, the patient shall receive at least one (1) random observed drug screen annually.

(3) Service recipients whose drug screen results are unfavorable, or otherwise indicate treatment instability, shall be notified of the drug screen result within seventy-two (72) hours and receive a randomized drug screen at least every two (2) weeks, for a minimum of twentyeight (28) days from the date of receiving the result of most recent unfavorable drug screen.

(4) Each sample collected shall be screened to include, but not be limited to:

(a) Opioids, including synthetic opioids;

(b) Methadone, buprenorphine, or any other treatment medication used by the Facility’s program, as applicable;

(d) Cocaine;

(e) Methamphetamine/amphetamines; and (f) Other drugs as indicated by individual service recipient use patterns, community standards, regional variation, or clinical indication (e.g., THC, carisoprodol, barbiturates) or as directed by the SOTA.

(5) Collection and testing shall be done in a manner that assures that specimens collected from service recipients are unadulterated. In the case of urine collection, such collection and testing shall include random direct observation conducted professionally, ethically, and in a manner which respects the service recipients’ privacy.

(6) A drug screen is considered unfavorable when the results indicate the presence of any drug or substances listed in Paragraph (4) of this rule that is illegal or for which the service recipient cannot provide a valid prescription or any drug or substance prohibited by the Facility or SOTA; the presence of medication which is documented as part of the service recipient’s treatment plan shall not be considered an unfavorable screen. Any refusal to participate in a random drug screen shall be considered an unfavorable screen.

(7) Unfavorable drug screen results after the first six (6) months in a Facility shall result in the following:

(a) Upon the first unfavorable drug screen result, the Facility shall contact the service recipient within seventy-two (72) hours of receiving the drug screen result and provide mandatory and documented weekly counseling, which shall include weekly meetings with a qualified counseling provider, either in person or via telehealth platforms, for a minimum of twenty-eight (28) days.

(b) Upon a second unfavorable drug screen result within six (6) months of the first unfavorable drug screen result, the Facility shall:

Contact the service recipient within seventy-two (72) hours of receiving the drug screen result, provide mandatory and documented weekly counseling which shall include weekly meetings with a qualified counseling provider, either in person or via telehealth platforms, for a minimum of twenty-eight (28) days; and 2. Provide mandatory, in-person, documented treatment team meetings with the service recipient and review the service recipient’s ITP to ensure it is addressing the service recipient’s needs;

(c) Upon a third unfavorable drug screen result within six (6) months of the second unfavorable drug screen result, the Facility shall:

Contact the service recipient within seventy-two (72) hours of receiving the drug screen result and provide mandatory and documented weekly counseling, which shall include weekly meetings with a qualified counseling provider, in-person, for a minimum of twenty-eight (28) days; and 2. Provide mandatory, in-person, and documented treatment team meetings with the service recipient, which shall include, at a minimum: a review of the ITP, a discussion related to the need for continuing treatment; a discussion of other treatment alternatives; and documentation on whether a referral to a higher level of care is appropriate.

(8) The Facility shall document both the results of drug screens and the follow-up therapeutic action taken in the service recipient’s medical record.

(9) The Facility shall work carefully with toxicology laboratories to ensure valid, appropriate results of toxicological screens.

(10) The Facility shall ensure that program providers demonstrate competence in recognizing factors that may contribute to “false negative” and “false positive” laboratory results.

(11) Absence of methadone or other medications ordered by the Facility for the service recipient shall be considered evidence of possible medication diversion and evaluated by the program provider accordingly.

(12) Nothing contained in this rule shall preclude any Facility from administering any additional drug screens it determines necessary.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.18 MEDICALLY SUPERVISED WITHDRAWAL

(1) In the event the service recipient becomes unable to pay for treatment, the Facility shall develop procedures for administrative withdrawal or medically supervised withdrawal, including an appropriate time frame over which the procedure would take place. The schedule of withdrawal may be brief, less than thirty (30) days if necessary. Such procedures shall include documentation of referral of the service recipient to alternative treatment resources.

(a) The Facility shall develop policies and procedures clearly describing under what circumstances a service recipient may be subject to administrative withdrawal.

Administrative withdrawal may result from:

Non-payment of fees. The Facility shall make every effort to consider all clinical data including service recipient participation and compliance with treatment prior to initiating administrative withdrawal for non-payment. If the service recipient has a history of compliance and cooperation with treatment, the Facility shall document every effort to explore alternatives to administrative withdrawal with the service recipient prior to initiation of administrative withdrawal;
Disruptive conduct or behavior considered to have an adverse effect on the Facility, staff, or service recipient population to justify the involuntary withdrawal and discharge of a service recipient; or 3. Other reasons as determined by the Facility and approved by the SOTA.

(b) Medically supervised withdrawal occurs as a voluntary and therapeutic withdrawal agreed upon by staff and service recipient. In some cases, the withdrawal may be against the advice of clinical staff (against medical advice).

The Facility shall supply an individualized schedule of dose reduction well tolerated by the service recipient.
The Facility shall offer supportive treatment, including increased counseling sessions and referral to a self-help group or another counseling provider as appropriate.
If the service recipient leaves the Facility’s program abruptly against medical advice, the Facility may readmit the service recipient within thirty (30) days without having to complete a new Initial or Comprehensive Assessment referred to in Paragraphs 0940-05-42-.06(7) and (8). The Facility shall document attempting to assist the service recipient in any issues which may have precipitated their abrupt departure.
The Facility shall make provisions for continuing care for each service recipient following the last dose of medication and for re-entry to maintenance treatment if the service recipient experiences a return to drug use or if the service recipient should reconsider medically supervised withdrawal.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.19 DIVERSION CONTROL PLAN

(1) Each clinic shall develop policies and procedures for a Diversion Control Plan that contains specific measures to reduce the possibility of diversion of controlled substances and that assigns specific responsibility to the medical and administrative staff of the Facility for carrying out the diversion control functions described in the Diversion Control Plan. The Diversion Control Plan shall contain, at a minimum, a random call-back program with mandatory compliance.

(a) This call-back shall be in addition to the regular schedule of clinic visits.

(b) Each service recipient receiving three (3) or more consecutive take-home medications per week shall be called back randomly within the three (3)-month period immediately following the previous call-back.

(c) Upon call back a service recipient shall report to the clinic within twenty-four (24) hours of notification, with all take-home medications. If a service recipient call-back displays treatment instability, such as absence from the scheduled call-back, not having the appropriate quantity of take-homes, or the packaging shows signs of tampering, the service recipient shall be required to attend the clinic at least three (3) nonconsecutive days per week for a minimum of twenty-eight (28) days prior to returning to regular clinic attendance schedule, in accordance with Subpart 0940-05-42-.15(1)(c)1.(iii).

(d) Service recipients shall be informed of the above requirements and the Facility’s policies and procedures regarding call-backs and receiving take-homes, including follow-up actions for any call-back results that demonstrate treatment instability.

(e) The Facility shall document individual call-back results in the service recipient medical record.

(2) The Facility’s policies and procedures for the Diversion Control Plans shall include the method for which the Facility will prevent the diversion of controlled substances from within the Facility. The plan shall include, at a minimum: maintaining a perpetual inventory, procedures for ordering and receiving controlled substances, and conducting investigations if theft or diversion is suspected.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.20 CENTRAL REGISTRY

(1) All Facilities shall participate in the department’s Central Registry.

(2) Service recipients shall be informed of the Facility’s participation in the Central Registry; and, prior to initiating a Central Registry inquiry, the Facility shall obtain the service recipient’s written consent.

(3) To prevent multiple enrollment of a service recipient in more than one Facility, the Facility shall initiate a clearance inquiry by submitting to the approved Central Registry the name, date of birth, anticipated date of admission or discharge, and any other relevant information required for the clearance procedure or as required by the SOTA. If a multiple enrollment verification indicates that a service recipient may be enrolled at more than one (1) Facility, the Facility shall immediately attempt to contact the other Facility to coordinate care. This coordination of care shall be documented in the service recipient’s medical record.

(4) Reports received by the Central Registry shall be treated as confidential and shall not be released except to a licensed Facility or its designated legal representative or as approved by the SOTA, or as required by law. Information made available by the Central Registry to Facilities or their designated legal representatives or as approved by the SOTA shall also be treated as confidential.

(5) If a Facility operates within seventy-five (75) miles of another Facility in an adjoining state, the Facility shall share service recipient information with the service recipient’s written consent, with the Facility in the other state, or with the other state’s Central Registry, if applicable, to prevent multiple enrollment of persons in more than one (1) Facility.

(6) The Facility shall submit information to the Central Registry, as directed by the SOTA, for the purposes of outcome tracking and emergency preparedness. Information can include, but not be limited to: service recipient photo and contact information, service recipient dosing, and periodic assessments.

(7) The Facility shall verify that the information contained in the Central Registry is current and accurate at least monthly. This verification shall be documented by the Facility.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.21 REPORTING REQUIREMENTS

(1) The Facility shall submit to the SOTA all reports resulting from a survey, inspection, or complaint investigation from the DEA, SAMHSA, the Facility’s accrediting organization, and any other applicable agency or organization, either electronically or by mail, within five (5) business days of receiving such documents.

(2) The Facility shall report each case of communicable disease to the local county health officer in the manner provided by T.C.A. § 68-5-102 and Division 1200-14 of the Rules of the Tennessee Department of Health.

(3) The Facility shall report within twenty-four (24) hours to the Office of Licensure and the Office of the SOTA the abuse of a service recipient, an unexpected occurrence or accident that results in death or serious injury to a service recipient, or any action taken against the Facility by the DEA, accrediting body or other state, local or federal agency. Additionally, the following are examples of events that should be reported:

(a) Medication errors that caused or had the potential to cause harm to the service recipient;

(b) Criminal acts;

(d) Rape;

(e) Neglect of a service recipient;

(f) Service recipient altercations;

(g) Service recipient abuse;

(h) Misappropriation of service recipient funds, including any grant funding, if applicable;

(i) Restraint-related incidents;

(j) Overdose occurring within the Facility; or (k) Improper disclosure of a service recipient’s protected health information.

(4) Specific incidents that might result in a disruption of the delivery of health care services at the Facility shall be reported to the Office of Licensure and the Office of the SOTA within twentyfour (24) hours after the Facility learns of the incident. These specific incidents include the following:

(a) Strike by the staff at the Facility;

(b) External disaster impacting the Facility;

(c) Disruption of any service vital to the continuous, safe operation of the Facility or to the health and safety of its service recipients and personnel; and (d) Fires at the Facility which disrupt the provision of service recipient care services, cause harm to service recipients or staff, or which are reported by the Facility to any entity, including, but not limited to, a fire department or other local emergency services.

(5) Within seven (7) days of any event described in Paragraph (3), the Facility shall file a report with the Office of Licensure and the Office of the SOTA on the incident consisting of the following:

(a) The actions implemented to prevent the reoccurrence of the event;

(b) The time frames for the action(s) to be implemented;

(c) The person(s) designated to implement and monitor the action(s); and (d) The strategies for the measurements of effectiveness to be established.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.22 QUALITY OF CARE

(1) The Facility shall develop and implement a plan for continuous quality improvement. At a minimum, the plan shall include:

(a) Structured assessment of the program which addresses Facility program management, staffing, policies and procedures, and general operations;

(b) A service delivery assessment which, at a minimum, shall evaluate the appropriateness of the ITP development and clinical services delivered, completeness of documentation in service recipients’ medical records, and the quality of and participation in staff training programs, linkage to other community healthcare services, and availability of services and medications for other conditions (e.g. prenatal, tuberculosis, HIV);

(c) An assessment of the aggregate cost of services per service recipient per week for services rendered; and (d) An assessment of medication-related issues including take-home procedures, security, inventory and dosage issues.

(2) Such process shall serve to continuously monitor the Facility’s compliance with the requirements set forth in these rules. Responsibility for administering and coordinating the quality improvement process shall be delegated to a staff person who has been determined by the Facility to be qualified by education, training, and experience to perform such tasks.

The Facility’s medical director shall be actively involved in the process.

(3) A Facility shall participate in additional quality improvement outcome studies as directed by the SOTA.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.23 INFECTIOUS HAZARDOUS WASTE

(1) Each Facility shall develop, maintain and implement written policies and procedures for the definition and handling of its infectious wastes. These policies and procedures shall comply with the standards of this section and all other applicable state and federal regulations.

(2) Waste shall be packaged in a manner that will protect waste handlers and the public from possible injury and disease that may result from exposure to the waste. Such packaging shall provide for containment of the waste from the point of generation up to the point of proper treatment of disposal. Packaging shall be selected and utilized for the type of waste the package will contain, how the waste will be treated and disposed, and how it will be handled and transported, prior to treatment and disposal.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.24 INFECTION CONTROL

(1) The Facility shall have policies and procedures to be followed for infection control, including:

(a) Reporting all suspected or diagnosed cases of infectious disease including tuberculosis, AIDS, and sexually transmitted infections (STI) promptly to the regional health department in accordance with applicable local, state, and federal laws, rules, and regulations;

(b) Management of service recipients who are infected with Hepatitis B or C virus, HIV/AIDS, or other STI;

(d) Use of standard precautions for prevention of transmission of HIV/AIDS, Hepatitis B or C Virus, and other blood-borne pathogens;

(e) Infectious disease skin or blood testing will be made available on a voluntary

basis for any service recipient who requests it and be documented in appropriate records. If a clinic does not have the capacity to conduct pelvic exams, the clinic shall establish and document a relationship with a community health care provider so that referrals can be made and care can be coordinated;

(f) Assurance that a service recipient’s HIV, other STI, and tuberculosis status will be kept confidential in accordance with T.C.A. § 33-3-103; Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations at 45 C.F.R. Parts 160 and 164, Subparts A and E; and Confidentiality of Alcohol and Drug Abuse Service Recipient Records regulations at 42 C.F.R. Part 2;

(g) Documentation that details the Facility’s procedures for providing referrals and collaboration between the health department and the Facility to communicate appropriate information to assure that the service recipient receives appropriate care;

(h) Informed consent of service recipients before screening and treatment;

(i) Conducting case management activities to ensure that individuals receive appropriate treatment services for HIV/AIDS, Hepatitis B or C Virus, and other STIs;

(j) Ensuring that the Facility, either directly or through arrangements with other public or private non-profit entities, will make available tuberculosis services in accordance with current recommendations from the Tennessee Department of Health or Centers for Disease Control and Prevention; and (k) Responding to relevant public health crises that impact the Facility and the population it serves, including plans to collaborate with federal, state, and local health officials in the event of a declared public health emergency.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.25 MANAGING DISRUPTIVE BEHAVIOR

(1) The Facility shall develop policies and procedures that address the methods for managing disruptive behavior. If restrictive procedures are used to manage disruptive behaviors, written policies and procedures shall govern their use. At a minimum, any restrictive procedure shall be used by the Facility only after all less restrictive alternatives for dealing with the problem behavior have been tried or considered and have been determined to be inappropriate or ineffective.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.26 HOURS OF OPERATION

(1) A Facility’s hours of operation shall accommodate persons involved in activities such as school, homemaking, child care and variable shift work.

(2) The Facility shall provide comprehensive services, including dosing and counseling at least six (6) hours per day from Monday through Friday and at least three (3) hours on Saturday.

(3) Additionally, the Facility may close for six (6) nonconsecutive days for holidays. Facilities shall notify the SOTA and service recipients of the date of any holiday when the Facility will be closed at least fourteen (14) days in advance of the holiday.

(4) Any Facility may also be closed for one (1) mandatory training day, if required by the SOTA.

(5) Facilities shall provide the SOTA with at least fourteen (14) days notice prior to any change in Facility hours.

(6) A Facility that intends to voluntarily close shall notify TDMHSAS no later than ninety (90) days prior to closure. In order to assure continuity of care, any Facility which closes, either voluntarily or involuntarily, shall comply with all directions received from the TDMHSAS regarding the orderly transfer of service recipients and their records.

(7) Facilities shall notify the SOTA office of any closures due to unanticipated emergency conditions that prohibit the Facility from providing service to service recipients. Examples can include, but are not limited to: fires, floods, or damage to the Facility.

(8) Facilities shall obtain approval from the SOTA office for any Facility closures due to anticipated events. Examples can include, but are not limited to: anticipated severe weather, or planned Facility repairs.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.27 SERVICE RECIPIENTS’ RIGHTS

(1) All applications, certificates, records, reports and all legal documents, petitions and records made or information received pursuant to treatment in a Facility directly or indirectly identifying a service recipient shall be kept confidential and shall not be disclosed by any person except the individual identified.

(2) Nothing in this rule shall prohibit disclosure, upon proper inquiry, of information as to the current medical condition of a service recipient to any member of the Facility or to the service recipient’s relatives or friends in accordance with T.C.A. § 33-3-103; Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations at 45 C.F.R. Parts 160 and 164, Subparts A and E; and Confidentiality of Alcohol and Drug Abuse Service Recipient Records regulations at 42 C.F.R. Part 2.

(3) Service recipients shall not be abused or neglected.

(4) Facilities shall develop and implement written policies and procedures regarding the rights and responsibilities of service recipients under Rules 0940-05-06-.07 and 0940-05-06-.08 and the handling and resolution of complaints.

(5) Other service recipient rights include:

(a) Right to a humane treatment environment that affords reasonable protection from harm, exploitation, and coercion;

(b) Right to be informed about the ITP and to participate in the planning, as able;

(d) Right to accept or refuse treatment;

(e) Right to receive a written notice of the address and telephone number of the state licensing authority, the department; and (f) Right to obtain from the Facility, upon written request, a copy of the Facility’s most recent completed report of licensing compliance inspection. The Facility is not required to release a report until the Facility has had the opportunity to file a written plan of compliance for any violations as provided for in these rules.

(6) The written policies and procedures shall include provisions for service recipients and others to present complaints, either orally or in writing, and to have their complaints addressed and resolved as appropriate in a timely manner.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.28 COMMUNITY RELATIONS

(1) The Facility shall have policies and procedures for community relations, including identifying Facility personnel who is responsible for developing and implementing the plan.

(2) A Facility shall take proactive efforts to limit disruption outside of its Facility and that may be connected with patients it serves.

(3) Each Facility shall provide TDMHSAS, when requested, with a specific plan describing the efforts it will make to assure responsiveness to community needs.

(4) Each Facility shall document community relations efforts and community contacts, including the resolution of issues identified by community members or service recipients.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.29 PERSONNEL AND STAFFING REQUIREMENTS

(1) A personnel record for each staff member of a Facility shall include an application for employment and/or resume and a record of any disciplinary action taken. A licensee shall maintain written records for each employee and each individual file shall include:

(a) Identifying information including name, current address, current telephone number, and emergency contact person(s);

(b) A ten (10)-year employment history or a complete employment history if the person has not worked in ten (10) years;

(d) Date of employment;

(e) Documentation of training and orientation of the person’s duties and responsibilities;

(f) Any records relevant to the employee’s performance;

(g) Evidence that any professional license required as a condition of employment is current and in good standing;

(h) Annual verification of basic skills and annual evaluation of personnel performance.

Included shall be written verification that the employee has reviewed the evaluation and has had an opportunity to comment on it; and (i) Training and development activities designed to educate the staff in meeting the needs of the service recipients being served, including STI/HIV education.

(2) Tuberculosis.

(a) All new employees, including volunteers who have routine contact with service recipients, shall be tested within three (3) business days of employment for latent tuberculosis infection utilizing the two-step Mantoux method or a single interferongamma release blood assay (IGRA).

(b) Employees shall have a test for tuberculosis annually and at the time of exposure to active tuberculosis and three (3) months after exposure. Annual tuberculosis testing of previously TST-negative employees and volunteers shall be performed by the one-step Mantoux method.

(c) Employee records shall include the date and type of annual tuberculin tests given to the employee, date of tuberculin test results, and, if applicable, date and results of chest x-ray and any drug treatment for tuberculosis.

(3) Staffing.

(a) Program Director. The governing body of each Facility shall designate in writing a program director who is responsible for the operation of the Facility and overall compliance with federal, state, and local laws and regulations regarding the operation of opioid treatment programs, and for all employees including practitioners, agents, or other persons providing services at the Facility. Facilities shall notify the SOTA in writing within ten (10) calendar days whenever there is a change in program director.

(b) Medical Director. The governing body of each Facility shall designate in writing a medical director to be responsible for the administration of all medical services, including compliance with all federal, state, and local laws and regulations regarding the medical treatment of opioid use disorder. No physician may serve as medical director of more than two (2) Facilities without the prior written approval of the SOTA.

The medical director shall be physically present, or available for telehealth services and consultation, at the Facility the equivalent of twenty-five percent (25%) of the time the Facility is open to the public each month. Facilities shall notify the SOTA in writing within ten (10) calendar days whenever a temporary absence of the medical director may cause non-compliance with this staffing requirement, or whenever there is a change in medical director.

(c) Program Physician. Facilities are required to provide sufficient physician services to provide the medical treatment and oversight necessary to serve service recipient needs. Program physician services include, but are not limited to, performing medical

history and physical exams, determining a diagnosis under current DSM criteria, determination of opioid use disorder, ordering take-home privileges, discussing cases with the treatment team, and issuing any emergency orders.

(d) Physician Assistants and Advanced Practice Nurses. Licensed physician assistants and advanced practice nurses with a certificate of fitness with privileges to write and sign prescriptions and/or issue legend drugs may perform any functions under Tennessee law or regulations.

(e) Program Providers. The Facility shall provide on-site program provider services at least one (1) hour per week for every thirty-five (35) service recipients.

(f) Nurses. Facilities shall ensure that adequate nursing care is provided at all times the Facility is in operation and that a nurse is present at all times when medication is administered at the Facility. Facilities that do not employ a registered nurse to supervise the nursing staff shall ensure that licensed practical nurses adhere to written protocols and are properly supervised consistent with Division 1000-02 Rules and Regulations of Licensed Practical Nurses.

(g) Qualified Counseling Providers. There shall be sufficient group and individual counseling available to meet the requirements pursuant to Rule 0940-05-42-.14.

(h) Pharmacists. The Facility is encouraged to incorporate pharmacist-provided services in the Facility, including providing medication education, overseeing medication procurement and administration, being involved in the development of the Facility’s policies and procedures regarding the use of medications, and be available for consultation for Facility staff and patients.

(4) Staff Qualifications.

(a) Medical Director. All medical directors shall be licensed to practice medicine or osteopathy in Tennessee, shall maintain their licenses in good standing, and shall have the following experience and/or credentials:

Three (3) years of documented experience in the provision of services to persons with a substance use disorder, including the treatment of opioid use disorder;
Board eligibility in psychiatry and two (2) years of documented experience in the treatment of persons with a substance use disorder, including the treatment of opioid use disorder; or 3. Certification or actively engaged in a recognized course of study or another formal process for pursuing certification as an addiction medicine specialist and two (2) years of documented experience in the treatment of persons with a substance use disorder, including the treatment of opioid use disorder.

(b) Waiver from Medical Director Qualifications. Facilities that are unable to secure the services of a medical director who meets the requirements of subparagraph (a) above may apply to the TDMHSAS Office of Licensure for a waiver. The TDMHSAS Office of Licensure, in consultation with the SOTA, may grant such a waiver when there is showing that:

The Facility has made good faith efforts to secure a qualified medical director;
The Facility can secure the services of a licensed physician who is willing to serve as medical director and participate in the training plan;
A training plan has been developed which is acceptable to the SOTA and which consists of a combination of continuing education in addiction medicine and inservice training by a medical consultant who meets the qualifications specified in subparagraph (a) above; and 4. A medical consultant who meets the requirements of subparagraph (a) above shall be available, consistent with a training plan approved by the SOTA, to oversee the training of the medical director and the delivery of medical services at the Facility requesting the waiver.

(c) Program Provider. All program providers shall be licensed to practice in Tennessee, shall maintain their licenses in good standing, and shall have at least one (1) year of documented experience in the treatment of persons with a substance use disorder.

(d) Waiver from Program Provider Qualifications. Facilities seeking to employ a program provider, in addition to the medical director, but are unable to secure the services of a program provider who meets the requirements of subparagraph (c) above may apply to the TDMHSAS Office of Licensure for a waiver. The TDMHSAS Office of Licensure, in consultation with the SOTA, may grant such a waiver when there is a showing that:

The Facility has made good faith efforts to secure a qualified program physician;
The Facility can secure the services of a licensed physician who is willing to serve as program physician and participate in the training plan;
A training plan has been developed which is acceptable to the SOTA and which consists of a combination of continuing education in addiction medicine and inservice training by the Facility’s medical director; and 4. The Facility employs a qualified medical director who has the experience and credentials specified in subparagraph (a) above, has completed the training program specified in subparagraph (b) above or has completed the continuing education specified in subparagraph (f) below.

(e) Nurses. All registered nurses and licensed practical nurses shall be licensed to practice in Tennessee and shall maintain their license in good standing.

(f) Qualified Counseling Providers. All qualified counseling providers shall:

Meet one (1) of the following conditions; and (i) Licensed by the State of Tennessee as one (1) of the following (with experience or supervision as described, where specified): or (I) Alcohol and Drug Abuse Counselor I or II (commonly referred to as LADAC I or LADAC II);

(II) Psychologist;

(III) Psychological examiner;

(IV) Physician with experience or training in counseling;

(V) Physician assistant with experience or training in counseling;

(VI) Registered nurse with experience or training in counseling;

(VII) Social worker meeting one of the following;

I. If licensed as a bachelor’s-level social worker (LBSW) with training in counseling and direct supervision by a master’slevel social worker (LCSW or LMSW);

II. Licensed as a master’s-level social worker (LMSW); or III. Licensed as a clinical social worker (LCSW).

(VIII) Professional Counselor; or (IX) Marriage and Family Therapist.

(ii) Actively engaged in a recognized course of study or another formal process for pursuing licensure of a discipline described in subpart (i) above. Supervision shall be in accordance with the respective laws, rules, and regulations governing the professional licensure pursued.

Be qualified by education and/or experience for the specific duties of their position and only perform those duties within the scope of their applicable professional practice acts and Tennessee license.

(g) Pharmacist. All pharmacists shall be licensed to practice in Tennessee and shall maintain their license in good standing.

(h) Program Directors. All Facility program directors shall have at least one (1) year of supervisory or administrative experience in the field of mental health or substance use disorder treatment, or a minimum of six (6) months of experience with approval from the SOTA.

(i) Professional Practice. All professional staff, including, but not limited to, physicians, physician assistants, nurses, pharmacists, and counselors, may perform only those duties that are within the scope of their applicable professional practice acts and Tennessee licenses.

(5) Staff Training and Orientation. Prior to working with service recipients, all staff providing treatment or services shall be oriented in accordance with these rules and shall thereafter receive additional training with these rules.

(a) Orientation shall include instruction in:

The Facility’s written policies and procedures regarding its purposes and description; service recipient rights, responsibilities, and complaints; confidentiality; and other policies and procedures that are relevant to the employee’s range of duties and responsibilities;
The employee’s assigned duties and responsibilities; and 3. Reporting service recipient progress and problems to supervisory personnel and procedures for handling medical emergencies or other incidents that affect the delivery of treatment or services.

(b) Additional training consisting of a minimum of eight (8) hours of training or instruction shall be provided annually for each staff member who provides treatment or services to service recipients. Such training shall be in subjects that relate to the employee’s assigned duties and responsibilities, and in subjects about current clinical practice guidelines for medication-assisted treatment. In-house training for staff may be substituted for external training with the approval of the SOTA. The following areas shall receive emphasis during training:

Dosage level as determined through a provider’s clinical decision-making and the individual service recipient’s needs;
Counseling;
Drug screens;
Treatment stability;
Treating multiple substance use disorders;
Opioid treatment during pregnancy and chronic diseases;
HIV and other infectious diseases;
Co-morbid psychiatric conditions;
FDA-approved drugs for the treatment of opioid use disorder;
Take-home medication practices;
Chronic pain and pain management; and 12. Referring service recipients for primary care or other specialized services.

(c) The SOTA may require Facilities to attend mandatory training in addition to any other training required by these rules.

(d) Facilities shall maintain records documenting that each staff member has received the required annual training.

(6) Employee Drug Screening. Facilities shall establish and implement written policies and procedures for pre-employment and ongoing random drug screening of all Facility employees. Each sample collected shall be screened for opioids, methadone, amphetamines, cocaine, benzodiazepines, and other drugs as indicated by the SOTA.

(7) A minimum of one (1) on-duty staff member certified in cardiopulmonary resuscitation (CPR) and trained in the Abdominal Thrust Technique and First Aid shall be maintained.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: Original rule filed September 20, 2012; effective December 19, 2012. Amendments filed June 6, 2025; effective September 4, 2025.

Tenn. Comp. R. & Regs. 0940-05-42-.30 MOBILE UNITS

(1) Facilities that plan to operate a mobile unit must also comply with Title 21 of the C.F.R. Parts 1300, 1301, and 1304.

(2) Procedure for Initiation of Mobile Unit Services.

(a) The Facility shall provide written notification of intent to provide mobile unit services to the SOTA and the Office of Licensure along with a Certificate of Need (CON), if required by the Tennessee Health Facilities Commission or any other applicable state agency. The OTP must receive written approval from the SOTA and Office of Licensure prior to providing services via the mobile unit.

(b) At a minimum of thirty (30) days prior to operating the mobile unit, a schedule of locations where the unit will provide services shall be submitted to the SOTA.

(c) The SOTA shall be notified of changes to the declared scheduled fourteen (14) days in advance of operating at the alternative locations. Should it be required by the Tennessee Health Facilities Commission (or any other applicable state agency), the appropriate CON for the alternative location shall be provided with the notification of change.

(3) Policy and Procedures.

(a) Registration. All required DEA and vehicle registrations shall be maintained at the Facility and available for inspection, upon request.

(b) Operations. The Facility shall develop and implement policies and procedures for the operation of the mobile unit, including but not limited to:

The transfer and use of medications;
Security of the mobile unit and staff;
Staffing;
Downtime procedures and emergencies; and 5. Regulatory compliance.

History

Authority: T.C.A. §§ 4-3-1601, 4-4-103, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2- 404.
Administrative History: New rule filed June 6, 2025; effective September 4, 2025.

Chapter 0940-05-43 Minimum Program Requirements for Alcohol and Drug Non-Residential Rehabilitation Treatment Facilities

Tenn. Comp. R. & Regs. 0940-05-43-.01 DEFINITION

(1) “Alcohol and Drug Non-Residential Rehabilitation Treatment Facility” means an outpatient facility which offers treatment services to service recipients with alcohol and/or drug abuse or dependency disorders that can include but not be limited to assessment, referral, counseling, and education.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed February 23, 2007; effective May 9, 2007. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-43-.02 APPLICATION OF RULES

(1) The governing body of alcohol and drug non-residential rehabilitation treatment facilities must provide services and facilities which comply with the following rules:

(a) Chapter 0940-05-04-.04(2) Life Safety Business Occupancies rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(d) Chapter 0940-05-43 Minimum Program Requirements for Alcohol and Drug Non- Residential Treatment Facilities; and (e) If services are to be provided to one (1) or more mobile non-ambulatory service recipient, Chapter 0940-05-04-.09 Mobile Non-Ambulatory Rule.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed February 23, 2007; effective May 9, 2007. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-43-.03 POLICIES AND PROCEDURES

(1) The facility must maintain a written policy and procedure manual which includes the following:

(a) A description of the intake, assessment and treatment process;

(b) A description of its aftercare services;

(d) Requirements that each employee or volunteer comply with procedures for detection, prevention, and reporting of communicable diseases according to procedures of the Tennessee Department of Health;

(e) A policy ensuring that employees and volunteers practice infection control procedures and standard precautions that will protect the service recipient from infectious diseases;

(f) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure appropriate treatment has been delivered according to clinical practice;

(g) Drug testing procedures, if any, used by the facility;

(h) Policies and procedures which address the methods for managing disruptive behavior.

If restrictive procedures are used to manage disruptive behaviors, these policies and procedures must govern their use and minimally ensure the following:

Any restrictive procedure must be used by the facility only after all less-restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective;
The service recipient must have given written consent to any restrictive measures taken with him/her by the staff;
The restrictive procedure(s) must be documented in the individual program plan, be justifiable as part of the plan, and meet all requirements that govern the development and review of the plan;
Only qualified personnel may use restrictive procedures and must be adequately trained in their use; and 5. The adaptive or desirable behavior must be taught to the service recipient in conjunction with the implementation of the restrictive procedures.

(i) A policy which states physical holding must be implemented in such a way as to minimize any physical harm to the service recipient and may only be used when the service recipient poses an immediate threat under the following conditions:

The service recipient poses an immediate danger to self or others; and/or 2. To prevent the service recipient from causing substantial property damage.

(j) Procedures to ensure that the facility, either directly or through arrangements with other public or private nonprofit entities, will make available tuberculosis (TB) services in accordance with current TB Guidelines for Alcohol and Drug Treatment Facilities (TB Guidelines), established by the Department of Health TB Elimination Program and the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse, including:

Counseling the service recipients about TB;
Screening all service recipients for TB, and if applicable, testing service recipients at high risk for TB to determine whether service recipients have been infected with TB;
Providing for or referring the service recipients infected by TB for appropriate medical evaluation and treatment; and 4. Conducting case management activities to ensure that service recipients receive such services;

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed March 1, 2007; effective May 15, 2007. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-43-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) Direct treatment and/or rehabilitation services must be provided by qualified alcohol and drug abuse personnel.

(2) A physician must be employed or retained by written agreement to serve as medical consultant to the program.

(3) At least two (2) staff members must be on-duty at all times who are certified in cardiopulmonary resuscitation (CPR) and trained in first aid, the abdominal thrust, and standard precautions for infection control as specified by the Centers for Disease Control (CDC).

(4) The facility must provide STD/HIV education to all direct care staff.

(5) The facility must follow current TB Guidelines for screening and testing employees for TB infection.

(6) Employee records must include date and results of TB screening and, if applicable, tuberculin skin test or equivalent used, date and results of tuberculin skin test, date and results of chest x-ray, and any drug treatment for tuberculosis.

(7) The facility must provide annual training to personnel responsible for counseling, screening, and providing case management services to service recipients to prevent the transmission of TB.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed February 23, 2007; effective May 9, 2007. Amendment filed July 18, 2007; effective October 1, 2007. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-43-.05 SERVICE RECIPIENT ASSESSMENT REQUIREMENTS

(a) Assessment of current functioning according to presenting problem, including history of the presenting problem;

(b) Basic medical history, including drug usage, a determination of the necessity of a medical evaluation, and a copy, where applicable, of the results of the medical evaluation;

(c) Screening to identify service recipients who are at high risk for infection with TB according to TB Guidelines, including documentation of the service recipient’s risk level, and, if applicable, a tuberculin skin test or equivalent, the results of the tuberculin skin test, the date and result of a chest x-ray, and any drug treatment for TB;

(d) Assessment information, including employment and educational skills; financial status; emotional and psychological health; social, family, and peer interaction; physical health; legal issues; community living skills and housing needs; and the impact of alcohol and/or drug abuse or dependency in each area of the service recipient’s life functioning; and (e) A six (6) month history of prescribed medications, over-the-counter medications used frequently, and alcohol or other drugs, including patterns of specific usage for the past thirty (30) days.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-43-.06 INDIVIDUAL PROGRAM PLAN REQUIREMENTS

(1) An Individual Program Plan (IPP) must be developed and documented for each service recipient within thirty (30) days of admission or by the end of the third face-to-face treatment contact with qualified alcohol and drug abuse personnel, whichever occurs first, and must include:

(a) The service recipient’s name;

(b) The date of the IPP’s development;

(c) Standardized diagnostic formulation(s) including, but not limited to, the current Diagnostic and Statistical Manual (DSM) and/or the International Statistical Classification of Diseases and Related Health Problems (ICD), and ASAM PPC;

(d) Specified service recipient problems which are to be addressed within the particular service/program component;

(e) Service recipient goals which are related to specified problems and which are to be addressed within the particular service/program component;

(f) Interventions addressing goals;

(g) Planned frequency of contact;

(h) Signatures of appropriate staff; and (i) Documentation of the service recipient’s participation in the treatment planning process.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 30, 2003; effective July 14, 2003. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-43-.07 INDIVIDUAL PROGRAM PLAN MONITORING

(1) Progress notes which include written documentation of progress or changes occurring within the IPP must be made in the individual service recipient record for each treatment contact.

(2) The facility must review and, if indicated, revise the IPP at least every ninety (90) days. The revision shall document any of the following which apply:

(a) Change in goals and objectives based upon service recipient’s documented progress or identification of any new problems;

(b) Change in primary counselor assignment;

(c) Change in frequency and types of services provided; and (d) A statement documenting review and explanation if no changes are made in the IPP.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed June 21, 2007; effective September 4, 2007. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-43-.08 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The individual service recipient record must include the following:

(a) Documentation of all drugs prescribed or administered to the service recipient as part of the plan of care indicating the date prescribed, type, dosage, frequency, amount, and reason;

(b) Narrative summary review at least every ninety (90) days of all medications prescribed which includes specific reasons for prescribing and continuation of each medication;

(c) A discharge summary which states the date of discharge, reasons for discharge, and referral for other services, if appropriate;

(d) An aftercare plan which specifies the type of contact, planned frequency of contact, and responsible staff; or documentation that the service recipient was offered aftercare but decided not to participate; or documentation that the service recipient dropped out of treatment and is therefore not available for aftercare planning; or verification that the service recipient is admitted for further alcohol and drug treatment services; and (e) Documentation of any instance of restraint or restriction with documented justification and authorization.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed June 21, 2007; effective September 4, 2007. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-43-.09 PROFESSIONAL SERVICES

(1) In addition to the alcohol and drug treatment services provided, the facility must provide a continuum of services to service recipients to address their needs as indicated in the assessment/history in the areas of social, family and peer interactions; employment and educational needs; financial status; emotional and psychological health; physical health; legal issues; and community living skills and housing needs. Such services may be provided directly by the agency or indirectly by referral to other service providers. Referral agreements with frequently used providers must be documented. The provision of such services to individual service recipients must be documented in the service recipient record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. On May 15, 2008, rule was transferred from 1200-08-18 per Executive Order 44 (February 23, 2007). Repeal and new rule filed July 31, 2008; effective October 14, 2008.

Chapter 0940-05-44 Minimum Program Requirements for Alcohol and Drug Residential Detoxification Treatment Facilities

Tenn. Comp. R. & Regs. 0940-05-44-.01 DEFINITION

(1) “Alcohol and Drug Residential Detoxification Treatment Facilities” means intensive twentyfour (24) hour residential treatment for service recipients to systematically reduce or eliminate the amount of a toxic agent in the body until the signs and symptoms of withdrawal are resolved. The two levels of residential detoxification treatment are (a) clinically managed detoxification treatment and (b) medically monitored detoxification treatment. Clinically managed detoxification treatment emphasizes social and peer support and relies on established clinical protocols to determine whether service recipients need a higher level of care to manage withdrawal. Medically monitored residential detoxification treatment uses medical and nursing professionals to manage withdrawal signs and symptoms without the full resources of an acute care or psychiatric hospital. Both levels of residential detoxification services can be offered in a community setting or a specialty unit within a hospital. The American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC) is used to determine the level of residential detoxification treatment that will best meet a service recipient’s needs.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendments filed January 4, 2006; effective March 20, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.02 APPLICATION OF RULES

(1) The governing body of a facility providing alcohol and drug residential detoxification treatment services must comply with the following rules:

(a) Applicable occupancy rules found in Chapter 0940-05-04 Life Safety Licensure Rules:

Rule 0940-05-04-.02 Health Care Occupancies for facilities providing services to four (4) or more service recipients who are not capable of self-preservation; or 2. Rule 0940-05-04-.06 Residential Occupancies – Board and Care for facilities providing services to four (4) or more service recipients who are capable of selfpreservation; or 3. Rule 0940-05-04-.07 Residential Occupancies – One- and Two-Family Dwellings (Two or Three Clients) for facilities providing services to two (2) or three (3) service recipients;

(b) Rule 0940-05-04-.09(2) Mobile Non-Ambulatory Rule if services are provided to one (1) or more mobile non-ambulatory service recipients in facilities meeting the requirements for Rule 0940-05-04-.06 Residential Occupancies – Board and Care or Rule 0940-05- 04-.07 Residential Occupancies – One- and Two-Family Dwelling Occupancy;

(d) Minimum Program Requirements for All Facilities found in Chapter 0940-05-06;

(e) Minimum Program Requirements for Alcohol and Drug Residential Detoxification Treatment Facilities found in Chapter 0940-05-44; and (f) Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities found in Chapter 0940-03-09.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.03 POLICIES AND PROCEDURES

(1) The facility must maintain a written policy and procedures manual which includes the following:

(a) Intake and assessment process;

(b) A description of the aftercare service;

(c) Requirements that each employee or volunteer comply with procedures for detection, prevention, and reporting of communicable diseases according to procedures of the Tennessee Department of Health;

(d) Policies and procedures to ensure employees and volunteers practice standard precautions for infection control, as defined by the Centers for Disease Control (CDC);

(e) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure appropriate treatment has been delivered according to acceptable clinical practice;

(f) Drug testing procedures if used by the facility;

(g) Exclusion and inclusion criteria for service recipients seeking the facility’s services;

(h) Written admission protocols to screen for potentially aggressive or violent service recipients;

(i) Policies and procedures which address the methods for managing disruptive behavior including techniques to de-escalate anger and aggression;

(j) If restrictive procedures are used to manage disruptive behaviors, the written policies and procedures governing this use must comply with the Tennessee Department of Mental Health and Substance Abuse Services rules in Chapter 0940-03-09 Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities;

(k) For facilities providing clinically managed detoxification, procedures to ensure an assessment on admission by trained staff using a physician-approved protocol to determine if detoxification can safely occur in a clinically managed setting;

(l) For facilities providing clinically managed detoxification with self-administered detoxification medications, procedures for a physical examination by a physician, physician assistant or nurse practitioner as part of the initial assessment;

(m) For facilities providing medically monitored detoxification, procedures to ensure an assessment by a licensed nurse using a physician-approved protocol, or a physician, physician assistant or nurse practitioner, to determine whether services can be safely provided in a medically monitored residential treatment setting;

(n) For facilities providing medically monitored detoxification, procedures for a physical examination within twenty-four (24) hours of admission by a physician, physician assistant or nurse practitioner;

(o) Procedures for referring service recipients whose needs cannot be met to an appropriate level of care at another facility or an acute care hospital;

(p) Program admission criteria related to the results of the physical assessment;

(q) Physician-approved protocols for service recipient observation, supervision, and determination of appropriate level of care;

(r) Procedures and criteria for more extensive medical intervention and/or transfer to a more intensive service including an acute care hospital if a service recipient has, at a minimum, any of the following conditions:

A history of severe withdrawal, multiple withdrawals, delirium tremens, or seizures;
Sustained extremes in heart rate;
Cardiac arrhythmia; and/or 4. Unstable medical conditions including hypertension, diabetes, or pregnancy;

(s) Procedures to ensure that the facility, either directly or through arrangements with other public or private non-profit entities, will make available tuberculosis (TB) services in accordance with current Tennessee TB Guidelines for Alcohol and Drug Treatment Facilities (TB Guidelines), established by the Department of Health TB Elimination Program and the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse, including:

Counseling the service recipients about TB;
Screening all service recipients for TB and, if applicable, testing service recipients at high risk for TB to determine whether the service recipients have been infected with TB; and 3. Providing for or referring the service recipients infected by TB for appropriate medical evaluation, treatment, and case management activities;

(t) Procedures to ensure that service recipients under age eighteen (18) will be treated separately from service recipients eighteen (18) years of age or older;

(u) Procedures to ensure implementation of physician-approved protocols for service recipient observation and supervision and documentation of any concerns indicated by the protocol that need to be reviewed by a physician; and (v) A requirement that the facility provide to the service recipient, upon admission, a written statement outlining in simple, non-technical language all rights of service recipients under Title 33. These rights must include provisions to prohibit:

Denial to the service recipient of adequate food, treatment/rehabilitation activities, religious activities, mail or other contacts with family as punishment; and 2. Confinement of the service recipient to his/her room or other place of isolation as punishment. This does not preclude requesting service recipients to remove themselves from potentially harmful situations in order to regain self-control.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed March 1, 2007; effective May 15, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-44-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) Direct services must be provided by qualified alcohol and drug abuse personnel.

(2) All medical staff in facilities providing medically monitored detoxification and all direct service staff in facilities providing clinically managed detoxification must receive documented training before having unsupervised direct contact with service recipients. Training topics must include implementing physician-approved protocols for the signs and symptoms of alcohol and other drug intoxification and withdrawal; monitoring withdrawal; assessing appropriate levels of care; supportive care; preparing service recipients for ongoing treatment; and facilitating entry into ongoing care.

(3) Facilities providing clinically managed detoxification must provide annual training to all direct service staff on supervising the self-administration of medications.

(4) The facility must employ or retain a physician with training or experience in addiction medicine by written agreement to serve as medical consultant to the program.

(5) The facility must have a physician, physician assistant, or nurse practitioner available twentyfour (24) hours a day by telephone for medical evaluation and consultation.

(6) The facility providing medically monitored detoxification must make available hourly or more frequent monitoring if needed by a licensed nurse.

(7) All on-duty and on-site direct care staff must be certified in cardiopulmonary resuscitation (CPR) and trained in first aid, the abdominal thrust and standard precautions for infection control as defined by the Centers for Disease Control (CDC).

(8) The facility must provide annual education about sexually transmitted diseases (STD), human immunodeficiency virus (HIV), and acquired immunodefi ciency syndrome (AIDS) to all direct care staff.

(9) The facility must provide direct care staff with annual training in techniques to screen for potentially aggressive or violent service recipients and training in techniques to de-escalate anger and aggression in service recipients.

(10) The facility must maintain a direct-care awake staff to service recipient ratio on-duty and onsite of at least one (1) to twelve (12).

(11) The facility must follow current TB Guidelines for screening and testing employees for TB infection.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.05 SERVICE RECIPIENT ASSESSMENT REQUIREMENTS

(1) The facility must document that the following assessments are completed at the time of admission; re-admission assessments must document the following information from the date of last service:

(a) Assessment of current functioning by trained staff according to presenting problem including addiction-focused history of the presenting problem;

(b) Assessment of any special needs such as co-occurring psychiatric and medical conditions, physical limitations, cognitive impairments, and support system issues;

(c) Basic medical history information and determination of the necessity of a medical evaluation and a copy, where applicable, of the results of the medical evaluation, as deemed necessary by the program physician;

(d) A physical examination by a physician, physician assistant or nurse practitioner: within twenty-four (24) hours of admission if a facility is providing medically monitored detoxification; or as part of the initial assessment if a facility is providing clinically managed detoxification with the self-administration of detoxification medications; and (e) A history of prescribed medications, frequently used over-the-counter medications, and alcohol or other drugs, including patterns of specific usage for the past thirty (30) days prior to admission.

(2) If the facility provides medically monitored detoxification services, then the facility must document that the following additional assessments are completed at the time of admission; re-admission assessments must document the following information from the date of last service:

(a) An assessment on admission by a licensed nurse;

(b) Appropriate laboratory and toxicology tests; and (c) If the medically monitored detoxification services are step-down services from medically managed detoxification in an acute care hospital (ASAM Level IV-D), an evaluation within twenty-four (24) hours of admission by a physician of records of a physical examination within the preceding seven (7) days.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 20, 2006; effective July 4, 2006. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.06 INDIVIDUAL PROGRAM PLAN REQUIREMENTS

(1) An Individual Program Plan (IPP) developed within twenty-four (24) hours of admission must meet the following requirements and document for each service recipient:

(a) The service recipient’s name;

(b) The date of the development;

(c) Standardized diagnostic formulation(s) including, but not limited to, the current editions of the Diagnostic and Statistical Manual (DSM) and/or the International Statistical Classification of Diseases and Related Health Problems (ICD); and the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders (ASAM PPC).

(d) Treatment priorities and goals with treatment objectives to, and activities designed to, meet those objectives;

(e) Discharge plans for making referrals to address a service recipient’s goals and needs;

(f) Daily, seven (7) days per week, assessment of the service recipient’s progress through detoxification and any treatment changes; and (g) Signatures of staff involved in treatment planning and documentation of service recipients’ participation in the treatment planning process.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.07 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The individual service recipient record must include the following:

(a) Documentation on a medications log sheet of all medications prescribed or administered including date, type, dosage, frequency, amount, and reason;

(b) A list of each individual article of each service recipient’s personal property valued at $100.00 or more including its disposition, if no longer in use;

(d) Reports of medical problems, accidents, seizures, and illnesses and treatments for such accidents, seizures, and illnesses;

(e) Reports of significant behavior incidents;

(f) Reports of any instance of physical holding, restrictive procedures, or restraint with documented justification and authorization;

(g) A discharge summary which states the date of discharge, status at discharge, reasons for discharge, and referrals of service recipients and their families or significant others to the appropriate treatment resource upon completion of detoxification as appropriate; and (h) Documentation of a treatment protocol for detoxification and daily notes, seven (7) days per week, by qualified alcohol and drug or medical personnel that the protocol is being followed or exceptions to the protocol.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed April 30, 2003; effective July 14, 2003. Repeal and new rule filed January 4, 2006; effective March 20, 2006. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.08 PROFESSIONAL SERVICES

(1) The facility must offer daily treatment services necessary to assess needs, help the service recipient understand addiction and support the completion of the detoxification process.

(2) The facility must plan for discharge to address service recipient needs as indicated in the assessment/history in the following areas: vocational, educational skills and academic performance; financial issues; cognitive, socio-emotional, and psychological issues; social, family, and peer interactions; physical health; community living skills and housing information.

Such services may be provided directly by the agency or indirectly by referral to other service providers. Referral agreements with frequently used providers must be documented. The provision of such services to individual service recipients must be documented in the service recipient record at the facility.

(3) The facility must document either by written agreements or by program services access to an interdisciplinary team of appropriately trained clinicians (such as physicians, registered nurses, licensed practical nurses, counselors, social workers and psychologists) to assess, obtain, and interpret information regarding service recipient needs. The number and disciplines of team members must be appropriate to the range and severity of the service recipient’s problem.

(4) The facility must document, either by written agreements or by program services, the provision of twenty-four (24) hours per day, seven (7) days per week availability of immediate medical evaluation and care.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Repeal and new rule filed January 4, 2006; effective March 20, 2006. Amendment filed June 21, 2007; effective September 4, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.09 SERVICE RECIPIENT MEDICATION ADMINISTRATION REQUIREMENTS

(1) Facilities providing medically monitored detoxification services must provide a licensed nurse to oversee medication administration twenty-four (24) hours per day.

(2) When supervising the self-administration of medication, the facility must consider the service recipient’s self-management skills and ability.

(3) The facility must ensure that prescription medications are taken only by service recipients for whom they are prescribed and in accordance with the directions of a qualified prescriber.

(4) Discontinued and outdated drugs and containers with worn, illegible, or missing labels must be disposed.

(5) All medication errors, drug reactions, or suspected inappropriate medication use must be reported to the Medical Director of the facility who will report to the prescriber, if known.

(6) Evidence of the current prescription of each medication taken by a service recipient must be maintained by the facility.

(7) All direct service staff must be trained about medications used by the service recipient. This training must include information about the purpose and function of the medications, their major side effects and contraindications, and ways to recognize signs that medication is not being taken or is ineffective for its prescribed purposes.

(8) Staff must have access to medications at all times.

(9) For any service recipient incapable of self-administration, all medications must be administered by personnel licensed to administer medication.

(10) Schedule II drugs must be stored in a locked container within a locked compartment at all times and be accessible only to staff in charge of administering medicine.

(11) All medications and other medical preparations intended for internal or external human use must be stored in sanitary and secure medicine cabinets or drug rooms. Such cabinets or drug rooms must be kept securely locked when not in use and the key must be in the possession of the supervising nurse or other authorized staff. Locks in doors to medicine cabinets and drug rooms must be such that they require an action on the part of staff to lock and unlock.

(12) For facilities providing clinically managed detoxification services, staff must document each time a service recipient self-administers medication or refuses a medication, including overthe-counter medication. This documentation must include the date, time, medication name, and dosage and be entered on the medication log sheet in the service recipient’s record.

(13) Before discharge, service recipients must be given instruction about dosages, appropriate use, and self-administration of medications after detoxification is complete and the service recipient leaves the residential detoxification facility.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-8-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.10 RECREATIONAL ACTIVITY PROVISIONS

(1) The facility must provide opportunities for recreational activities appropriate to and adapted to the needs, interests, and ages of the service recipients being served.

History

Authority: T. C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.11 SERVICE RECIPIENT HEALTH, HYGIENE, AND GROOMING PROVISIONS

(1) The facility must have provisions that address the following health issues while the service recipient is at the facility:

(a) Nutritional needs;

(b) Exercise;

(d) Adequate, uninterrupted sleep; and (e) Designated smoking areas outside the building.

(2) The facility must assist service recipients in independent exercise of health, hygiene, and grooming practices.

(3) The facility must encourage the use of dental appliances, eyeglasses, and hearing aids, if used by service recipients.

(4) The facility must encourage each service recipient to maintain a well-groomed and clean appearance that is age and activity appropriate and within reason of current acceptable styles of grooming, dressing, and appearance.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal and new rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.12 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed January 4, 2006; effective March 20, 2006. Amendment filed February 7, 2007; effective April 23, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08- 23 on May 15, 2008. Repeal filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.13 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-44-.14 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. Per Executive Order 44 (February 23, 2007), rule was transferred from 1200-08-23 on May 15, 2008. Repeal filed January 7, 2009; effective March 23, 2009.

Chapter 0940-05-45 Minimum Program Requirements for Alcohol and Drug Residential Rehabilitation Treatment Facilities

Tenn. Comp. R. & Regs. 0940-05-45-.01 DEFINITION

(1) “Alcohol and Drug Residential Rehabilitation Treatment Facility” means a residential program for service recipients at least eighteen (18) years of age, which offers highly structured services to service recipients with the primary purpose of restoring service recipients with alcohol and/or drug abuse or dependency disorders to levels of positive functioning and abstinence appropriate to the service recipient. A primary goal of these services is to move the service recipient into less intensive levels of care and/or reintegration into the community as appropriate. Services include counseling contacts, lectures/seminars, and other services necessary to meet the service recipients’ assessed needs.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 11, 2003; effective June 25, 2003. Amendment filed April 28, 2003; effective July 12, 2003. Amendments filed January 3, 2006; effective March 19, 2006. Amendment filed February 7, 2007; effective April 23, 2007. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.02 APPLICATION OF RULES

(1) The governing body of a residential rehabilitation treatment program must comply with the following rules:

(a) Applicable occupancy rules found in Chapter 0940-05-04-.04 Life Safety Health Care Occupancies for facilities providing services for four (4) or more service recipients who are not capable of self-preservation; Life Safety Board and Care Occupancies for facilities providing services to four (4) or more service recipients; or Life Safety One- and Two-Family Dwellings Occupancies for facilities providing services to two (2) or three (3) service recipients;

(b) If services are to be provided in a facility meeting the requirements for Board and Care or One- and Two-Family Dwelling Occupancy and services are provided to one (1) or more mobile non-ambulatory service recipients, then Rule 0940-05-04- .09(2) Mobile Non-Ambulatory rule;

(d) Minimum Program Requirements for All Facilities found in Chapter 0940-05-06;

(e) Minimum Program Requirements for Alcohol and Drug Residential Rehabilitation Treatment Facilities found in Chapter 0940-05-45; and (f) Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities found in Chapter 0940-03-09.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.03 POLICIES AND PROCEDURES

(1) The facility must maintain a written policy and procedure manual which includes the following:

(a) A description of the intake, assessment and treatment process;

(b) A description of its aftercare service;

(e) A policy ensuring that employees and volunteers practice infection control procedures and standard precautions that will protect the service recipient from infectious diseases;

(f) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure appropriate treatment has been delivered according to clinical practice;

(g) Drug testing procedures if used by the facility;

(h) Procedures to ensure that the facility, either directly or through arrangements with other public or private non-profit entities, will make available tuberculosis (TB) services in accordance with current Tennessee TB Guidelines for Alcohol and Drug Treatment Facilities (TB Guidelines), established by the Department of Health TB Elimination Program and the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse, including:

Counseling the service recipients about TB;
Screening all service recipients for TB and, if applicable, testing service recipients at high risk for TB to determine whether the service recipients have been infected with TB;
Providing for or referring the service recipients infected by TB for appropriate medical evaluation and treatment; and 4. Conducting case management activities to ensure that service recipients receive such services.

(i) Appropriate protocols which guide delivery of treatment and support across a continuum of residential services and reflect the varying severity of illnesses treated and the intensity of services required;

(j) Policy and procedures which address the methods for managing disruptive behavior. If restrictive procedures are used to manage disruptive behaviors, these policies and procedures must comply with Chapter 0940-3-9 Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed March 1, 2007; effective May 15, 2007. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-45-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) Direct treatment and/or rehabilitation services must be provided by qualified alcohol and drug abuse personnel.

(2) A physician must be employed or retained by written agreement to serve as medical consultant to the program.

(3) At least two (2) staff members must be on-duty at all times who are certified in cardiopulmonary resuscitation (CPR) and trained in first aid, the abdominal thrust technique, and standard precautions for infection control.

(4) The facility must have a written weekly schedule of all program services and service recipient activities for each day specifying the type of service/activities and scheduled times.

(5) The facility must maintain an on-duty and on-site staff-to-service recipient ratio of at least one (1) to sixteen (16) at each building at all times.

(6) The facility must provide STD/HIV education and counseling as it relates to service recipient care to all direct care staff.

(7) The facility must provide annual training to personnel responsible for counseling, screening, and providing case management services to service recipients to prevent the transmission of TB.

(8) The facility must follow current TB Guidelines for screening and testing employees for TB infection.

(9) Employee records must include date and results of TB screening and, if applicable, tuberculin skin test or equivalent used, date and results of tuberculin skin test, date and results of chest x-ray, and any drug treatment for tuberculosis.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 30, 2003; effective July 14, 2003. Amendment filed April 20, 2006; effective July 4, 2006. Amendment filed July 18, 2007; effective October 1, 2007. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.05 SERVICE RECIPIENT ASSESSMENT REQUIREMENTS

(a) Assessment of current functioning according to presenting problem, including history of the presenting problem;

(b) Basic medical history, a determination of the necessity of a medical evaluation, and a copy, where applicable, of the results of the medical evaluation if deemed necessary by the program physician;

(c) Screening to identify service recipients who are at high risk for infection with TB according to TB Guidelines, including documentation of the service recipient’s risk level and, if applicable, a tuberculin skin test or equivalent, the results of the tuberculin skin test, the date and result of a chest x-ray, and any drug treatment for TB;

(d) Assessment information, including employment and educational skills; financial status; emotional and psychological health; community living skills and housing needs; and the impact of alcohol and/or drug abuse or dependency on each area of the service recipient’s life functioning; and (e) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol or other drugs, including patterns of specific usage for the past thirty (30) days.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 20, 2006; effective July 4, 2006. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.06 INDIVIDUAL PROGRAM PLAN REQUIREMENTS

(1) An Individual Program Plan (IPP) must be developed and documented for each service recipient within seven (7) days of admission and must include:

(a) The service recipient’s name;

(b) The date of the IPP’s development;

(c) Standardized diagnostic formulation(s) including, but not limited to the current editions of the Diagnostic and Statistical Manual (DSM) and/or the International Statistical Classification of Diseases and Related Health Problems (ICD), and the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders (ASAM PPC);

(d) Specified service recipient problems which are to be addressed within the particular service/program component;

(e) Service recipient goals which are related to specified problems and which are to be addressed within the particular service/program component;

(f) Interventions addressing goals;

(g) Planned frequency of contact;

(h) Signatures of appropriate staff; and (i) Documentation of the service recipient’s participation in the treatment planning process.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 30, 2003; effective July 14, 2003. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.07 INDIVIDUAL PROGRAM PLAN MONITORING

(2) The facility must review and, if indicated, revise the IPP at least every thirty (30) days.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed February 18, 2003; effective May 4, 2003. Amendment filed April 30, 2003; effective July 14, 2003. Repeal and new rule filed January 3, 2006; effective March 19, 2006. Amendment filed June 21, 2007; effective September 4, 2007. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.08 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The service recipient record must include the following:

(a) Documentation on a medications log sheet of all medications prescribed or administered with the date of the prescription, date of administration, type, dosage, frequency, amount, and reason;

(b) Narrative summary review at least every thirty (30) days of all medications prescribed which includes specific reasons for prescribing and continuing each medication;

(c) A list of each individual article of each service recipient’s personal property valued at $100.00 or more including disposition, if no longer in use;

(d) Written accounts of all monies received and disbursed on behalf of the service recipient;

(e) Reports of health history, past and current;

(f) Reports of aggressive and/or disruptive behavior incidents;

(g) Reports of any instance of physical holding or restriction with documented justification and authorization;

(h) A discharge summary which states the date of discharge, reasons for discharge, status of the service recipient at the time of discharge and referral for other services, if appropriate; and (i) An aftercare plan which specifies the type of contact, planned frequency of contact, and responsible staff; or documentation that the service recipient was offered aftercare but decided not to participate; or documentation that the service recipient dropped out of treatment and is therefore not available for aftercare planning; or verification that the service recipient is referred for further alcohol and drug treatment services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Repeal and new rule filed January 3, 2006; effective March 19, 2006. Amendment filed June 21, 2007; effective September 4, 2007. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.09 PROFESSIONAL SERVICES

(1) In addition to the alcohol and drug treatment services provided, the facility must provide services to service recipients to address their needs as indicated in the assessment/history in the areas of social, family, and peer interactions; employment and educational needs; financial status; emotional and psychological health; physical health; and community living skills and housing needs. Such services may be provided directly by the agency or indirectly by referral to other service providers. Referral agreements with frequently used providers must be documented. The provision of such services to individual service recipient must be documented in the service recipient record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.10 SERVICE RECIPIENT MEDICATION ADMINISTRATION REQUIREMENTS

(1) When supervising the administration of medication, the facility must consider the service recipient’s self-management skills and ability.

(2) The facility must ensure that prescription medications are taken only by service recipients for whom they are prescribed and in accordance with the directions of a qualified prescriber.

(3) Discontinued and outdated medication and containers with worn, illegible, or missing labels must be disposed.

(4) All medication errors, drug reactions, or suspected inappropriate medication use must be reported to the Medical Director of the facility who will report to the prescriber, if known.

(5) Evidence of the current prescription of each medication taken by a service recipient must be maintained by the facility.

(7) Staff must have access to medications at all times.

(8) For any service recipient incapable of self-administration, all medications must be administered by personnel licensed to administer medication.

(9) Schedule II drugs must be stored within two (2) separated locked compartments at all times and be accessible only to staff in charge of administering medication.

(10) All medications and other medical preparations intended for internal or external human use must be stored in sanitary and secure medicine cabinets or drug rooms. Such cabinet or drug rooms must be kept securely locked when not in use and the key must be in the possession of the supervising nurse or other authorized staff. Locks in doors to medicine cabinets and drug rooms must be such that they require an action on the part of staff to lock and unlock.

(11) Staff must document each time a service recipient self-administers medication or refuses a medication. This documentation must include the date, time, medication name, and dosage, as well as over the counter medication. This documentation must be made on the medication log sheet in the service recipient’s record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 11, 2003; effective June 25, 2003. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.11 HEALTH, HYGIENE, AND GROOMING PROVISIONS FOR SERVICE RECIPIENTS

(1) The facility must have provisions that address the following health issues while the service recipient is at the facility;

(a) Nutritional needs;

(b) Exercise;

(d) Adequate, uninterrupted sleep; and (e) Designated smoking areas outside the building.

(2) The facility must assist service recipients in independent exercise of health, hygiene, and grooming practices.

(3) The facility must encourage the use of dental appliances, eyeglasses, and hearing aids, if used by service recipients.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.12 SERVICE RECIPIENT’S RIGHTS PROVISIONS

(1) Service recipients must not be denied adequate food, treatment/rehabilitation activities, religious activities, mail or other contacts with families as punishment.

(2) A service recipient must not be confined to his/her room or other place of isolation as punishment. This does not preclude requesting service recipients to remove themselves from potentially harmful situations in order to regain self-control.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. Amendment filed April 28, 2003; effective July 12, 2003. Repeal and new rule filed January 3, 2006; effective March 19, 2006. Amendment filed February 7, 2007; effective April 23, 2007. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal and new rule filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.13 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed April 27, 2000; effective July 11, 2000. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal filed August 27, 2008; effective November 10, 2008.

Tenn. Comp. R. & Regs. 0940-05-45-.14 REPEALED

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-404 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed February 16, 2007; effective May 2, 2007. On May 15, 2008, rule was transferred from 1200-08-17 per Executive Order 44 (February 23, 2007). Repeal filed August 27, 2008; effective November 10, 2008.

Chapter 0940-05-46 Minimum Program Requirements for Alcohol and Drug Residential Treatment Facilities for Children and Youth

Tenn. Comp. R. & Regs. 0940-05-46-.01 DEFINITION

(1) “Alcohol and Drug Residential Treatment Facilities for Children and Youth” means a residential program which offers twenty-four (24) hour treatment to service recipients under eighteen (18) years of age with the primary purpose of restoring service recipients with alcohol and/or drug abuse or dependency disorders to abstinence and levels of positive functioning appropriate to the service recipient. An important goal of these services is to move the service recipient into less intensive levels of care and/or reintegration in to the community. The program must provide or arrange for an education component in compliance with the Rules, Regulations, and Minimum Standards of the Tennessee State Board of Education.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.02 APPLICATION OF RULES

(1) The governing body of a residential treatment program must comply with the following rules:

(a) Applicable occupancy rules found in Chapter 0940-05-04: Life Safety Health Care Occupancies for facilities providing services to four (4) or more service recipients who are not capable of self-preservation; Life Safety Board and Care Occupancies for facilities providing services to four (4) or more service recipients; or Life Safety Oneand Two-Family Dwellings Occupancies for facilities providing services to two (2) or three (3) service recipients;

(d) Minimum Program Requirements for All Facilities found in Chapter 0940-05-06;

(e) Minimum Program Requirements for Alcohol and Drug Residential Treatment Facilities for Children and Youth found in Chapter 0940-05-46; and (f) Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities found in Chapter 0940-03-09.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.03 POLICIES AND PROCEDURES

(1) The facility must maintain a written policy and procedure manual which includes the following:

(a) The intake and assessment process;

(b) A description of its aftercare service;

(d) A policy ensuring that employees and volunteers practice standard precautions for infection control as specified by the Centers for Disease Control;

(e) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure appropriate treatment has been delivered according to clinical practice;

(f) Drug testing procedures if used by the facility;

(g) Eligibility criteria including exclusion criteria for service recipients not appropriate for the facility’s services;

(h) Policies and procedures which address the methods for managing disruptive behavior.

If restrictive procedures are used to manage disruptive behaviors, these policies and procedures must comply with Chapter 0940-3-9 Use of Isolation, Mechanical Restraint, and Physical Holding Restraint in Mental Health Residential Treatment Facilities;

(i) A procedure for notifying the Office of Licensure upon the eighteenth birthday of the service recipient with a plan that targets discharge within ninety (90) days. If the treatment extends beyond ninety (90) days past the service recipient’s eighteenth birthday, a waiver must be sought from the Department;

(j) A requirement that the facility provide to the service recipient, upon admission, a written statement outlining in simple, non-technical language all rights of service recipients under Title 33. These rights must include provisions to prohibit:

Denial to the service recipient of adequate food, treatment/rehabilitation activities, religious activities, mail or other contacts with family as punishment;
Confinement of the service recipient to his/her room or other place of isolation as punishment. This does not preclude requesting service recipients to remove themselves from potentially harmful situations in order to regain self-control; and (k) Procedures to ensure that the facility, either directly or through arrangements with other public or private non-profit entities, will make available tuberculosis (TB) services in accordance with current Tennessee TB Guidelines for Alcohol and Drug Treatment Facilities (TB Guidelines), established by the Department of Health TB Elimination Program and the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse, including:
Counseling the service recipients about TB;
Screening all service recipients for TB and, if applicable, testing service recipients at high risk for TB to determine whether the service recipients have been infected with TB;
Providing for or referring the service recipients infected by TB for appropriate medical evaluation and treatment; and 4. Conducting case management activities to ensure that service recipients receive such services.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-46-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) Direct treatment and/or rehabilitation services must be provided by qualified alcohol and drug abuse personnel.

(2) A physician or a nurse with training and/or experience in child and adolescent development and addiction must be employed or retained by written agreement to serve as medical consultant to the program.

(3) If the consulting physician is not a psychiatrist, then the facility must arrange for the regular, consultative, and emergency services of a licensed psychiatrist.

(4) Specialized training will be provided to staff on symptoms of addiction, sexuality, reproductive health, and sexually transmitted diseases.

(5) At least two (2) staff members must be on-duty at all times who are certified in cardiopulmonary resuscitation (CPR) and trained in first aid, the abdominal thrust technique, and standard precautions for infection control as specified by the Centers for Disease Control (CDC).

(6) The facility must provide annual training to all direct care staff on how to manage medical and psychiatric crises.

(7) The facility must provide annual training to all direct care staff on issues pertinent to childhood and adolescence such as treatment approaches specific to adolescents and families, family dynamics and family therapy, adolescent growth and development, sexual and physical abuse, gender issues, mental health problems, different cultural and ethical values, psychopharmacology, referral and community resources, cognitive impairments and legal matters.

(8) The facility must provide at least three (3) hours of training annually on ethics related to children and adolescents.

(9) The facility must have a written weekly schedule of all program services and service recipient activities for each day specifying the type of service/activities and scheduled times.

(10) During normal waking hours the program must provide at least one (1) staff person on-duty and on-site for each ten (10) service recipients present. Staff persons counted in the staff-toservice recipient ratio may only be persons who are assigned to provide direct program services as described by written job description. During normal sleeping hours the program must provide two (2) awake direct care staff on-site in each building, or physically separated unit of a building, in which service recipients are housed. Support staff, such as clerical, housekeeping, van and bus driver staff, or students involved in an on-site practicum for academic credit may not be counted in the staff-to-service recipient ratio.

(11) Service recipients must be adequately supervised at all times based on environment, circumstance, the service recipient’s treatment plan or other specific needs or risks.

(12) The facility must provide STD/HIV education to all direct care staff.

(13) All new employees, including volunteers, who have routine contact with service recipients, must have a current tuberculosis test prior to direct patient contact.

(14) The facility must follow current TB Guidelines for screening and testing employees for TB infection;

(15) Employee records must include date and results of TB screening and, if applicable, tuberculin skin test or equivalent used, date and results of tuberculin skin test, date and results of chest x-ray, and any drug treatment for tuberculosis; and (16) The facility must provide annual training to personnel responsible for counseling, screening, and providing case management service to service recipients to prevent the transmission of TB.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.05 ASSESSMENT REQUIREMENTS

(1) The facility must document that the following assessments have been completed prior to development of the Individual Program Plan (IPP); re-admission assessments must document the following information from the date of last service:

(a) Assessment of current functioning according to presenting problem, including history of the presenting problem;

(b) Basic medical history; a determination of the necessity of a medical evaluation; and a copy, where applicable, of the results of the medical evaluation if deemed necessary by the program physician;

(c) Screening to identify service recipients who are at high risk for infection with TB according to TB Guidelines, including documentation of the service recipient’s risk level and, if applicable, a tuberculin skin test or equivalent, the results of the tuberculin skin test, the date and result of a chest x-ray, and any drug treatment for TB;

(d) Assessment information, including vocational, educational skills and academic performance; financial issues; socio-emotional, cognitive, and psychological issues; social, family, and peer interactions; physical health; legal; community living skills and housing information; and the impact of alcohol and/or drug abuse or dependency on each area of the service recipient’s life functioning and development;

(e) A six (6) month history of prescribed medications, frequently used over-the-counter medications, and alcohol or other drugs, including patterns of specific usage for the past thirty (30) days; and (f) Assessment of whether the service recipient is currently eligible for special education services in accordance with the State Board of Education Rules, Regulations and Minimum Standards.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.06 INDIVIDUAL PROGRAM PLAN (IPP) AND REVIEW REQUIREMENTS

(1) An IPP which includes the following requirements must be developed and documented for each service recipient within seven (7) days of admission:

(a) The service recipient’s name;

(b) The date of development;

(c) Standardized diagnostic formulation(s) including but not limited to the current Diagnostic and Statistical Manual (DSM) and/or the International Statistical Classification of Diseases and Related Health Problems (ICD), and another appropriate measure for adolescent alcohol and/or drug abuse or dependency;

(d) Specific service recipient and family problems (such as substance use, psychosocial, medical, sexual, reproductive, and possible psychiatric issues) to be addressed within the particular service/program component;

(e) Specific strengths and resources of the service recipient and family and ways to apply them to reach treatment goals;

(f) Service recipient’s goals that are related to specific problems and that are to be addressed within the particular service/program component;

(g) Interventions addressing goals, including helping them recognize their involvement in substance use and acknowledge responsibility for the problems resulting from substance use; and the staff responsible for implementing the interventions;

(h) Planned frequency of contact;

(i) Signatures of appropriate staff;

(j) Documentation of participation of service recipient and parent/guardian/legal custodian or conservator, where appropriate, in the treatment planning process or, if any of the parties refuse to participate, reasons for their refusal; and (k) A plan for family members’ involvement in the service recipient’s treatment, if appropriate.

(2) Progress notes which include written documentation of progress or changes occurring within the IPP must be made in the individual service recipient record for each treatment contact or on a weekly basis.

(3) The facility must review and, if indicated, revise the IPP at least every thirty (30) days.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.07 RECORD REQUIREMENTS

(1) The service recipient’s record must contain the following information:

(a) Documentation of the IPP and the Individualized Education Program (IEP), if required, and their implementation;

(b) Daily progress notes which include written documentation of service recipient progress and changes which have occurred within the IPP. The progress notes must be dated and include the signature, title or degree of the person who provided the service;

(c) Documentation on a medications log sheet of all drugs prescribed and/or administered by the facility with date prescribed, type, dosage, frequency, amount, and reason;

(d) Narrative summary review at least every thirty (30) days of all medications prescribed which includes specific reasons for prescribing and continuation of each medication;

(e) Documentation of significant behavior and actions taken by staff;

(f) A list of each article of the service recipient’s personal property valued at one hundred dollars ($100.00) or more, and its disposition if no longer in use;

(g) Documentation of abuse, medical problems, accidents, seizures, and illnesses and treatment for such abuse, medical problems, accidents, seizures, and illnesses, and any reports generated as the result;

(h) Results of assessments required by this Rule;

(i) Discharge summary which states the date of discharge, reasons for discharge, service recipient’s condition at the time of discharge, referral for other services, if appropriate, and signature of person preparing the summary;

(j) Documentation of an education plan developed for each service recipient that conforms to the Rules, Regulations, and Minimum Standards of the State Board of Education and the IEP test being developed by an appropriately constituted IEP-Team for all “qualified students with disabilities.” The education plan may include education services provided either by the facility or by the local education agency;

(k) An aftercare plan which specifies the type of contact, planned frequency of contact, and responsible staff; or documentation that the service recipient was offered aftercare but declined to participate; or documentation that the service recipient dropped out of treatment and is therefore not available for aftercare planning; or verification that the service recipient is admitted for further alcohol and drug treatment services;

(l) Appropriate authorizations for the release and obtaining of information about the service recipient; and (m) Contact person and means of contact in case of emergency.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.08 PROFESSIONAL SERVICES

(1) In addition to the alcohol and drug treatment services provided, the facility must provide services to service recipients to address their needs as indicated in the assessment/history in the areas of vocational, educational skills and academic performance; financial issues; cognitive, socio-emotional, and psychological issues; social, family, and peer interactions; physical health; legal; community living skills and housing information. Such services may be provided directly by the agency or indirectly by referral to other service providers. Referral agreements with frequently used providers must be documented. The provision of such services to the individual service recipient must be documented in the service recipient record at the facility.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.09 EMERGENCY SERVICES

(1) In case of medical or other type of emergency, the facility must secure emergency services and immediate access to relevant information for treatment in the service recipient’s record.

(2) The program must provide immediate notification to the parent, guardian, or legal custodian in case of emergency.

(3) The program must secure emergency services for service recipients who pose an imminent physical danger to themselves or others as provided in T.C.A. § 33-6-401.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.10 MEDICATION ADMINISTRATION REQUIREMENTS

(1) Medications must be administered by licensed medical or licensed nursing personnel or other qualified staff under a protocol approved by medical staff. Qualified personnel under these rules means a certified or registered respiratory therapist, a radiological technologist, or certified physician assistant practicing within the scope of their professional license or certification.

(2) Qualified personnel must have access to medications at all times.

(3) Evidence of the current prescription of each medication taken by a service recipient must be maintained by the facility.

(4) The facility must ensure that prescription medications are taken only by service recipients for whom they are prescribed, and in accordance with the directions of a physician.

(5) All medication errors, medication reactions, or suspected inappropriate medication use must be reported to the Medical Director of the facility who will then report to the prescriber, if known.

(7) Discontinued and outdated medications and containers with worn, illegible, or missing labels must be disposed of according to law.

(8) Schedule II medications must be stored in two (2) separately locked compartments at all times and be accessible only to staff in charge of administering medication.

(9) All medications and other medical preparations intended for internal or external human use must be stored in sanitary and secure medicine cabinets or drug rooms. Such cabinet or drug rooms must be kept securely locked when not in use and the key must be in the possession of the supervising nurse or other authorized staff. Locks in doors to medicine cabinets and drug rooms must be such that they require an action on the part of staff to lock and unlock.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule fil ed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.11 RECREATIONAL ACTIVITY

(1) The facility must provide opportunities for recreational activities appropriate to and adapted to the needs, interests, and ages of the service recipients.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Tenn. Comp. R. & Regs. 0940-05-46-.12 HEALTH, HYGIENE, AND GROOMING PROVISIONS FOR SERVICE RECIPIENTS

(1) The facility must have provisions that address the following health issues while the service recipient is at the facility:

(a) Nutritional needs;

(b) Exercise;

(2) The facility must educate and encourage the independent exercise of health, hygiene, and grooming practices, as appropriate.

(3) The facility must encourage the use of, including but not limited to, dental appliances, eyeglasses, and hearing aids, if used by the service recipient.

(4) The facility must encourage each service recipient to maintain a well-groomed and clean appearance that is age and activity appropriate.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, 33-2-403, and 33-2-404 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed July 31, 2008; effective October 14, 2008.

Chapter 0940-05-47 Minimum Program Requirements for Alcohol and Drug Outpatient Detoxification Treatment Facilities

Tenn. Comp. R. & Regs. 0940-05-47-.01 DEFINITIONS

(1) “Alcohol and Drug Outpatient Detoxification Treatment Facilities” means organized outpatient services for service recipients to systematically reduce or eliminate the amount of a toxic agent in the body until the signs and symptoms of withdrawal are resolved. Outpatient detoxification treatment services are provided in regularly scheduled sessions in an office setting, health care or addiction treatment facility. The American Society of Addiction Medicine Patient Placement Criteria (ASAM PPC) is used to determine the level of outpatient detoxification services that will best meet a service recipient’s needs.

(2) “Level II-D services with extended on-site monitoring” means outpatient services with daily assessment of progress during detoxification including serial nursing assessments using appropriate measures of withdrawal. This level of service is appropriate for service recipients at moderate risk of severe withdrawal syndrome who would safely respond to several hours of monitoring, medication and treatment.

(3) “Level II-D services without extended on-site monitoring” means outpatient services that may be provided daily or less frequently to service recipients with a minimal risk of severe withdrawal syndrome.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-47-.02 APPLICATION OF RULES

(1) The governing body of alcohol and drug outpatient detoxification treatment facilities must provide services and facilities which comply with the following rules:

(a) Chapter 0940-05-04-.04(2) Life Safety Business Occupancies Rule;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(d) Chapter 0940-05-47 Minimum Program Requirements for Alcohol and Drug Outpatient Detoxification Treatment Facilities; and (e) Chapter 0940-05-04-.09 Mobile Non-Ambulatory Rule if services are to be provided to one (1) or more mobile non-ambulatory service recipient.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-47-.03 POLICIES AND PROCEDURES

(1) The facility must maintain a written policy and procedure manual which includes the following:

(a) A description of the intake, assessment, and treatment process;

(b) A description of the aftercare service;

(d) Policies and procedures to ensure employees and volunteers practice standard precautions for infection control, as defined by the Centers for Disease Control (CDC);

(e) A quality assurance procedure which assesses the quality of care at the facility. This procedure must ensure appropriate treatment has been delivered according to acceptable clinical practice;

(f) Drug testing procedures if used by the facility;

(g) Exclusion and inclusion criteria for service recipients seeking the facility’s services;

(h) Program admission criteria related to the results of the physical assessment;

(i) Written admission protocols to screen for potentially aggressive or violent service recipients;

(j) Policies and procedures which address the methods for managing disruptive behavior including techniques to deescalate anger and aggression;

(k) If restrictive procedures are used to manage disruptive behaviors, policies and procedures that govern their use and minimally ensure the following:

Any restrictive procedure must be used by the facility only after all less-restrictive alternatives for dealing with the problem behavior have been systematically tried or considered and have been determined to be inappropriate or ineffective;
The service recipient must have given written consent to any restrictive measures taken with him/her by the staff;
The restrictive procedure(s) must be documented in the individual program plan, be justifiable as part of the plan, and meet all requirements that govern the development and review of the plan;
Only qualified personnel may use restrictive procedures and must be adequately trained in their use; and 5. The adaptive or desirable behavior must be taught to the service recipient in conjunction with the implementation of the restrictive procedures.

(l) If physical holding is used, a policy that requires it to be implemented in such a way as to minimize any physical harm to the service recipient and may only be used when the service recipient poses an immediate threat under the following conditions:

The service recipient poses an immediate danger to self or others; and/or 2. To prevent the service recipient from causing significant property damage.

(m) Procedures for a physical examination by a physician, physician assistant or nurse practitioner as part of the initial assessment to determine the safety of providing detoxification services in an outpatient setting in accordance with Rule 0940-05-47-.05 Service Recipient Assessment Requirements.

(n) Physician-approved protocols for service recipient observation, supervision, determination of appropriate level of care, and documentation of any concerns indicated by the protocol that need to be reviewed by a physician.

(o) Procedures and criteria for more extensive medical intervention and/or transfer to a more intensive service, including an acute care hospital, if a service recipient has, at a minimum, any of the following conditions:

A history of severe withdrawal, multiple withdrawals, delirium tremens, or seizures;
Sustained extremes in heart rate;
Cardiac arrhythmia;
Sustained extremes in blood pressure;
Unstable medical conditions including hypertension, diabetes or pregnancy.

(p) Procedures to ensure that service recipients under age eighteen (18) will be treated separately from service recipients eighteen (18) years of age or older; and (q) Procedures to ensure that the facility, either directly or through arrangements with other public or private non-profit entities, will make available tuberculosis (TB) services in accordance with current Tennessee TB Guidelines for Alcohol and Drug Treatment Facilities (TB Guidelines), established by the Department of Health TB Elimination Program and the Tennessee Department of Mental Health and Substance Abuse Services Division of Alcohol and Drug Abuse Services, including:

Counseling the service recipients about TB;
Screening all service recipients for TB and, if applicable, testing service recipients at high risk for TB to determine whether the service recipients have been infected with TB; and 3. Providing for or referring the service recipients infected by TB for appropriate medical evaluation, treatment, and case management activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-05-47-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) Direct services must be provided by qualified alcohol and drug abuse personnel.

(2) All direct service staff in facilities providing alcohol and drug outpatient treatment detoxification services must receive documented training before having unsupervised direct contact with service recipients. Training topics must include implementing physicianapproved protocols for the signs and symptoms of alcohol and other drug intoxification and withdrawal; monitoring withdrawal; assessing appropriate levels of care; supportive care; preparing service recipients for ongoing treatment; and facilitating entry into ongoing care.

(3) Facilities must provide annual training to all direct service staff on supervising the selfadministration of medications.

(4) The facility must employ or retain a physician with training or experience in addiction medicine by written agreement to serve as medical consultant to the program.

(5) The facility must have a physician, physician assistant, or nurse practitioner available twentyfour (24) hours a day by telephone for medical evaluation and consultation.

(6) The facility must have medical or nursing personnel to conduct a medical screening of service recipients to evaluate and confirm that detoxification in an outpatient setting is relatively safe for that service recipient.

(7) Facilities providing Level II-D services with extended on-site monitoring must have medical or nursing personnel available for daily (seven days per week) monitoring, assessment, and management of symptoms of withdrawal and intoxification.

(8) The facility must provide at least two (2) on-duty and on-site staff members certified in cardiopulmonary resuscitation (CPR), and trained in first aid, the abdominal thrust and standard precautions for infection control as defined by the Centers for Disease Control (CDC).

(9) The facility must provide annual education about sexually transmitted diseases (STD), human immunodeficiency virus (HIV), and acquired immunodeficiency syndrome (AIDS) to all direct care staff (10) The facility must provide direct care staff with annual training in techniques to screen for potentially aggressive or violent service recipients and training in techniques to deescalate anger and aggression in service recipients.

(11) The facility must follow current TB Guidelines for screening and testing employees for TB infection.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-47-.05 SERVICE RECIPIENT ASSESSMENT REQUIREMENTS

(1) The facility must document that the following assessments are completed at the time of admission; re-admission assessments must document the following information from the date of last service:

(a) Assessment of current functioning by trained staff according to presenting problem including addiction-focused history of the presenting problem;

(b) An assessment of any special needs such as co-occurring psychiatric and medical conditions, physical limitations, cognitive impairments, and support system issues;

(c) Basic medical history information and medical assessment to determine the necessity of a medical evaluation; and a copy, where applicable, of the results of the medical evaluation;

(d) A physical examination by a physician, physician assistant or nurse practitioner within twenty-four (24) hours of admission; and (e) A history prior to admission of prescribed medications, frequently used over-thecounter medications, and alcohol or other drugs including patterns of specific usage for the past thirty (30) days prior to admission.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-47-.06 INDIVIDUAL PROGRAM PLAN REQUIREMENTS

(1) An Individual Program Plan (IPP) must be developed and documented for each service recipient within twenty-four (24) hours of admission and must include the following requirements:

(a) The service recipient’s name;

(b) The date of development;

(d) Treatment priorities and goals with treatment objectives and activities designed to meet those objectives;

(e) Discharge plans for making referrals to address a service recipient’s goals and needs;

(f) Assessment of progress through detoxification and any treatment changes; and (g) Signatures of staff involved in treatment planning and documentation of service recipients’ participation in the treatment planning process.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-47-.07 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The individual’s service recipient record must include the following:

(a) Documentation on a medications log sheet of all medications prescribed or administered including date, type, dosage, frequency, amount, and reason;

(b) Documentation of a treatment protocol and schedule for detoxification and notes by qualified alcohol and drug or medical personnel that the protocol and schedule is being followed or exceptions to the protocol and schedule;

(c) For facilities providing Level II-D extended on-site monitoring, documentation of daily (seven days per week) nursing assessments of withdrawal, progress during detoxification, and any treatment changes;

(d) Reports of medical problems, accidents, seizures, illnesses and treatments for such accidents, seizures, and illnesses;

(e) Reports of significant behavior incidents;

(f) Reports of any instance of physical holding or restrictive procedures with documented justification and authorization; and (g) A discharge plan which states the date of discharge, status at discharge, reasons for discharge, and referral of the service recipient and their family or significant others to other services, as appropriate.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-47-.08 PROFESSIONAL SERVICES

(1) The facility must provide outpatient treatment services necessary to assess needs, help the service recipient understand addiction and support the completion of the detoxification process.

(2) Service recipients must be given instruction about dosages, appropriate use, and selfadministration of medications.

(3) The facility must plan for discharge to address service recipient needs as indicated in the assessment/history in the areas vocational, educational skills and academic performance; financial issues; cognitive, socio-emotional, and psychological issues; social, family, and peer interactions; physical health; community living skills and housing information. Such services may be provided directly by the agency or indirectly by referral to other service providers.

Referral agreements with frequently used providers must be documented. The provision of such services to individual service recipients must be documented in the service recipient record at the facility.

(4) The facility must document either by written agreements or by program services access to an interdisciplinary team of appropriately trained clinicians (such as physicians, registered nurses, licensed practical nurses, counselors, social workers and psychologists) to assess, obtain, and interpret information regarding service recipient needs. The number and disciplines of team members must be appropriate to the range and severity of the service recipient’s problem.

(5) The facility must document, either by written agreements or by program services, the provision of twenty-four (24) hour a day, seven (7) day a week availability of immediate medical evaluation and care.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Tenn. Comp. R. & Regs. 0940-05-47-.09 SERVICE RECIPIENT MEDICATION ADMINISTRATION REQUIREMENTS

(1) When supervising the self -administration of medication, the facility must consider the service recipient’s self-management skills and ability.

(2) The facility must ensure that prescription medications are taken only by service recipients for whom they are prescribed and in accordance with the directions of a qualified prescriber.

(3) Discontinued and outdated medication and containers with worn, illegible, or missing labels must be disposed.

(4) All medication errors, drug reactions, or suspected inappropriate medication, use must be reported to the Medical Director of the facility who will report to the prescriber, if known.

(5) Evidence of the current prescription of each medication taken by a service recipient must be maintained by the facility.

(7) Staff must have access to medications at all times.

(8) Schedule II drugs must be stored in a locked container within a locked compartment at all times and be accessible only to staff in charge of administering medication.

(9) Staff must document each time a service recipient self-administers medication or refuses a medication. This documentation must include the date, time, medication name, and dosage, as well as over-the-counter medication. This documentation must be made on the medication log sheet in the service recipient’s record.

(10) For any service recipient incapable of self-administration, all medications must be administered by personnel licensed to administer medication.

(11) All medications and other medical preparations intended for internal or external use must be stored in sanitary and secure medicine cabinets or drug rooms. Such cabinet or drug rooms must be kept securely locked when not in use and the key must be in the possession of the supervising nurse or other authorized staff. Locks in doors to medicine cabinets and drug rooms must be such that they require an action on the part of staff to lock and unlock.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-302, and 33-2-403 and Executive Order Number 44 (February 23, 2007).
Administrative History: Original rule filed January 7, 2009; effective March 23, 2009.

Chapter 0940-05-48 Reserved

Tenn. Comp. R. & Regs. 0940-05-48 Reserved

December, 2022 1 RULES OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

Chapter 0940-05-49 Reserved

Tenn. Comp. R. & Regs. 0940-05-49 Reserved

December, 2022 1 RULES OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

Chapter 0940-05-50 Reserved

Tenn. Comp. R. & Regs. 0940-05-50 Reserved

December, 2022 1 RULES OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

Chapter 0940-05-51 Minimum Program Requirements for Adult Supportive Residential Facilities

Tenn. Comp. R. & Regs. 0940-05-51-.01 DEFINITION

(1) “Adult Supportive Residential Facility” means a mental health residential program that provides twenty-four (24) hours residential care with a treatment and rehabilitation component less intensive than required in a Residential Treatment Facility. Coordinated and structured services are provided for adult service recipients that include personal care services, training in community living skills, vocational skills, and/or socialization. Access to medical services, social services, and mental health services are insured and are usually provided off-site, although limited mental health treatment and rehabilitation may be provided on site.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.02 APPLICATION OF RULES

(1) The governing body of an adult supportive residential facility shall comply with the following rules:

(a) Rule 0940-05-04-.06(2) Life Safety Board and Care Occupancy;

(b) Chapter 0940-05-05 Adequacy of Facility Environment and Ancillary Services;

(c) Chapter 0940-05-06 Minimum Program Requirements for All Facilities; and (d) Chapter 0940-05-51 Minimum Program Requirements for Adult Supportive Residential Facilities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.03 POLICIES AND PROCEDURES

(1) The facility shall maintain a written policies and procedures manual which contains the following elements:

(a) A policy and procedures only allowing the admittance of persons who are:

Able to perform basic self-help activities including eating and bathing;
Able to care for their own possessions and to maintain their bedroom or living area in a reasonable state of orderliness and cleanliness;
Able to recognize danger or threat to personal safety;
Able to live comfortably within any limitations in the structure of the facility; and 5. Generally able to maintain appropriate behaviors tolerable to the community.

(b) A policy and procedures addressing the method for managing disruptive behavior; and (c) A policy and procedures stating that physical holding shall be implemented in such a way as to minimize any physical harm to the service recipient and may only be used when the service recipient poses an immediate threat under the following conditions:

The service recipient poses an immediate harm to self or others; and/or 2. To prevent the service recipient from causing substantial property damage.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.04 PERSONNEL AND STAFFING REQUIREMENTS

(1) All mental health personnel shall be under the supervision of a licensed mental health professional.

(2) All direct care staff shall be under the supervision of a mental health professional.

(3) The facility shall provide adequate supervision by an adult who is knowledgeable of rules, policies and procedures relevant to the facility’s operation.

(4) During normal waking hours, all facilities shall provide at least one (1) direct-care staff person on-duty/on-site for every twelve (12) service recipients present in the facility. During normal sleeping hours, all facilities shall provide at least one (1) direct-care staff person on-site in each building where service recipients are housed.

(5) All direct care staff at the facility shall have at least four (4) hours training annually in areas relevant to the care provided as evidenced in the facility’s record.

(6) Service recipients shall not be left unattended in the facility at any time.

(7) Mental health treatment and rehabilitation services may be provided on-site for up to fifteen (15) hours per week, if the services are provided by a licensed mental health outpatient facility.

(8) The program shall provide back-up coverage by staff trained to handle acute psychiatric problems on a twenty-four (24) hours per day, seven (7) days per week, on-call basis.

(9) The program shall arrange for the regular, consultative, and emergency services of a licensed psychiatrist.

(10) The program shall provide at all times at least one (1) on-duty staff member certified in cardiopulmonary resuscitation (CPR) and trained in First Aid and the Abdominal Thrust Maneuver. The provision of training shall be evidenced by documentation in the facility’s record.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.05 PROFESSIONAL SERVICES FOR SERVICE RECIPIENTS

(1) The facility shall make arrangements for qualified dental, medical, nursing and pharmaceutical care for service recipients of the facility including care for emergencies on twenty-four (24) hours per day and seven (7) days per week basis; and allow service recipients or their families to have the option of choosing a personal professional for routine services. Such services may be provided directly by the facility or indirectly by referral to other service providers.

(2) The facility shall provide or procure for each service recipient a physical examination, which includes routine screening and special studies as determined by the examining physician, within thirty (30) days of admission unless the service recipient has had a physical examination within ninety (90) days prior to admission. Subsequently physical examinations shall be provided or procured as determined by the service recipient’s examining physician.

The documentation of required physical examinations shall be provided in the service recipient’s record and shall include exact name of the examining physician, clinic, or hospital.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.06 SERVICE RECIPIENT RECORD REQUIREMENTS

(1) The individual record maintained for each service recipient shall contain the following information:

(a) Marital status;

(b) Social security number;

(d) Legal competency status, if available;

(e) Source of financial support and financial arrangements for residing in the facility. This information shall be updated when the service recipient’s financial status changes;

(f) Name, address and telephone number of the physician or health agency providing medical services;

(g) A list of each individual article of the service recipient’s personal property valued at fifty dollars ($50.00) or more including its disposition, if no longer in use;

(h) Written accounts of all monies received and disbursed on behalf of the service recipient;

(i) Report of medical problems, accidents, seizures and illnesses and treatments for such accidents, seizures and illnesses;

(j) Report of significant behavior incidents;

(k) Notes made on a weekly basis which minimally include a brief statement of the service recipient’s progress while residing at the facility. The notes shall include the date that the note was written and the signature of the person making the note;

(l) Current diagnosis and DSM axis, summary of mental health service plan and crisis plan;

(m) Medication log; and (n) Housing transition plan.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.07 SERVICE RECIPIENT RIGHTS

(1) Upon admission to the facility, each service recipient shall be provided an orientation which minimally includes minimally the following:

(a) Explanation of the facility’s services, activities, performance expectations, any rules and regulations and program descriptions;

(b) Familiarizing the service recipient with the facility’s premises, the neighborhood and public transportation systems; and (c) Explanation of service recipient rights and grievance procedures.

(2) Service recipients shall not be denied adequate food, treatment/rehabilitative activities, religious activities, mail or other contacts with families as punishment.

(3) A service recipient shall not be confined to his/her room or other place of isolation as punishment. This does not preclude requesting individuals to remove themselves from a potentially harmful situation in order to regain self-control.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.08 MEDICATION ADMINISTRATION

(1) When supervising the self-administration of medication, the facility shall consider the service recipient’s self-management skills and ability.

(2) The facility shall ensure that prescription medications are taken only by service recipients for whom they are prescribed and in accordance with the directions of a qualified prescriber.

(3) Medications shall be stored in a locked container which ensures proper conditions of security and sanitation and prevents accessibility to any unauthorized person.

(4) Discontinued and outdated medications and containers with worn, illegible, or missing labels shall be disposed.

(5) All medication errors, drugs reactions, or suspected overmedication shall be reported to the practitioner who prescribed the medication.

(6) Evidence of the current prescription of each medication taken by a service recipient shall be maintained by the facility.

(7) All direct-service staff shall be trained about medications used by service recipients. This training shall include information about the purpose and function of the medications, their major side effects and contraindications, and ways to recognize signs that medication is not being taken or is ineffective.

(8) Staff shall have access to medications at all times.

(9) For any service recipient incapable of self-administration or supervised self-administration, all medications shall be administered by personnel authorized to do so under Tennessee law.

(10) Qualified personnel administering medication may only administer medication within the scope of an established protocol approved by medical staff.

(11) Staff shall document each time a service recipient receives medication including over-thecounter medication or refuses a prescribed medication. This documentation shall include the date, time, medication, name, and dosage. This documentation shall be made on the medication log sheets in the service recipient’s chart.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.09 RECREATIONAL PROVISIONS FOR SERVICE RECIPIENTS

(1) The facility shall provide opportunities for recreational activities, including off-site activities at least once a week unless otherwise indicated by the service recipient’s behavior, that are appropriate to and adapted to the needs, interests and ages of the service recipients being served. These opportunities and the participation of the residents will be documented in records available at the facility.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.10 HEALTH, HYGIENE AND GROOMING PROVISIONS FOR SERVICE RECIPIENTS

(1) The facility shall assist service recipients in the independent exercise of health, hygiene and grooming practices.

(2) The facility shall encourage the use of dental appliances, eyeglasses and hearing aids if used by service recipients.

(3) The facility shall encourage each service recipient to maintain a well groomed and clean appearance that is age and activity appropriate and within reason of currently acceptable styles of grooming, dressing and appearance.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.11 CLOTHING PROVISIONS FOR SERVICE RECIPIENTS

(1) The facility shall provide indirect supervision of service recipients in the selection and purchase of their clothes and in the selection of dressing manner and change of clothes.

(2) Any marking of service recipients’ clothes for identification purposes shall be done in an inconspicuous manner.

(3) The facility shall allow service recipients to select and purchase their clothes and to dress themselves at appropriate times.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Tenn. Comp. R. & Regs. 0940-05-51-.12 DAY ACTIVITIES FOR SERVICE RECIPIENTS

The facility shall assist service recipients in making use of daily activities according to the age levels, interests and abilities of the service recipients. Such day services may include, but are not limited to, parttime and full-time employment, attendance at a day center, participation in a vocational rehabilitation program, senior citizens involvement and regularly scheduled recreational activities.

History

Authority: T.C.A. §§ 4-4-103, 4-5-204, 33-1-302, 33-1-305, 33-1-309, 33-2-301, 33-2-403, and 33-2-404.
Administrative History: Original rule filed November 9, 2009; effective February 7, 2010.

Chapter 0940-06-01 Controlled Substances

Tenn. Comp. R. & Regs. 0940-06-01-.01 CONTROLLED SUBSTANCES IN SCHEDULE I

(1) Schedule I consists of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this rule. Each drug or substance bears the federal controlled substance code number assigned to it by the Drug Enforcement Administration.

(2) Opiates. Unless specifically excepted or unless listed in another schedule, any of the following opiates, including their isomers, esters, ethers, salts and salts of isomers, esters, and ethers, whenever the existence of such isomers, esters, ethers, and salts is possible within the specific chemical designation. For the purposes of subparagraph (kkk)2.(xxxi), 3- Methylfentanyl, only, the term isomer includes the optical and geometric isomers.

(a) Acetylmethadol........................................................................................ 9601 (b) AH-7921 (3,4-dichloro-N-[(1-dimethylamino)cyclohexylmethyl]benzamide)........... 9551 (c) Allylprodine............................................................................................. 9602 (d) Alphacetylmethadol (except levo-alphacetylmethadol also known as levo-alphaacetylmethadol; levomethadyl acetate; or LAAM).............................................. 9603 (e) Alphameprodine....................................................................................... 9604 (f) Alphamethadol......................................................................................... 9605 (g) Benzethidine........................................................................................... 9606 (h) Betacetylmethadol.................................................................................... 9607 (i) Betameprodine........................................................................................ 9608 (j) Betamethadol.......................................................................................... 9609 (k) Betaprodine............................................................................................ 9611 (l) Brorphine................................................................................................ 9098 (m) Butonitazene .......................................................................................... 9751 (n) Clonitazene............................................................................................. 9612 (o) Dextromoramide...................................................................................... 9613 (p) Diampromide.......................................................................................... 9615 (q) Diethylthiambutene................................................................................... 9616 (r) Difenoxin................................................................................................ 9168 (s) Dimenoxadol........................................................................................... 9617 (t) Dimepheptanol........................................................................................ 9618 (u) Dimethylthiambutene................................................................................ 9619 (v) Dioxaphetyl butyrate................................................................................. 9621 (w) Dipipanone............................................................................................. 9622 (x) Ethylmethylthiambutene............................................................................. 9623 (y) Etodesnitazene........................................................................................ 9765 (z) Etonitazepipne N-piperidinyl etonitazene (2-(4-ethoxybenzyl)-5-nitro-1-(2-(piperidin-1yl)ethyl-1H-benzimidazole)......................................................................... 9761 (aa) Etonitazene............................................................................................. 9624 (bb) Etoxeridine............................................................................................... 9625 (cc) Flunitazene............................................................................................. 9756 (dd) Furethidine.............................................................................................. 9626 (ee) Hydroxypethidine...................................................................................... 9627 (ff) Isotonitazene............................................................................................ 9614 (gg) Ketobemidone.......................................................................................... 9628 (hh) Levomoramide......................................................................................... 9629 (ii) Levophenacylmorphan.............................................................................. 9631 (jj) 2-methyl AP-237 (1-(2-methyl-4-(3-phenylprop-2-en-1-yl)piperazin-1-yl) butan-1one)....................................................................................................... 9664 (kk) Metodesnitazene..................................................................................... 9764 (ll) Metonitazene........................................................................................... 9757 (mm) Morpheridine........................................................................................... 9632 (nn) MPPP (1-methyl-4-phenyl-4-propionoxypiperidine).......................................... 9661 (oo) MT-45 (1-cyclohexyl-4-(1,2-diphenylethyl)piperazine)....................................... 9560 (pp) N-desethyl isotonitazene (N-ethyl-2-(2-(4-isopropoxylbenzyl)-5-nitro-1H-benzimidazol- 1-yl)ethan-1-amin).................................................................................... 9760 (qq) N-pyrrolidino etonitazene............................................................................ 9758 (rr) Noracymethadol....................................................................................... 9633 (ss) Norlevorphanol........................................................................................ 9634 (tt) Normethadone......................................................................................... 9635 (uu) Norpipanone........................................................................................... 9636 (vv) PEPAP (1-(2-phenylethyl)-4-phenyl-4-acetoxypiperidine).................................. 9663 (ww) Phenadoxone.......................................................................................... 9637 (xx) Phenampromide...................................................................................... 9638 (yy) Phenomorphan........................................................................................ 9647 (zz) Phenoperidine......................................................................................... 9641 (aaa) Piritramide.............................................................................................. 9642 (bbb) Proheptazine........................................................................................... 9643 (ccc) Properidine............................................................................................ 9644 (ddd) Propiram................................................................................................ 9649 (eee) Protonitazene.......................................................................................... 9759 (fff) Racemoramide........................................................................................ 9645 (ggg) Tilidine.................................................................................................. 9750 (hhh) Trimeperidine.......................................................................................... 9646 (iii) U-47700................................................................................................. 9547 (jjj) Zipeprol.................................................................................................. 9873 (kkk) Fentanyl Derivatives and Analogues.

Unless specifically excepted, listed in another schedule, or contained within a pharmaceutical product approved by the United States Food and Drug Administration, any material, compound, mixture, or preparation, including its salts, isomers, esters, or ethers, and salts of isomers, esters, or ethers, whenever the existence of such salts is possible within any of the following specific chemical designations containing a 4-anilidopiperidine structure:

(i) With or without substitution at the carbonyl of the aniline moiety with alkyl, alkenyl, carboalkoxy, cycloalkyl, methoxyalkyl, cyanoalkyl, or aryl groups, or furanyl, dihydrofuranyl, benzyl moiety, or rings containing heteroatoms sulfur, oxygen, or nitrogen;

(ii) With or without substitution at the piperidine amino moiety with a phenethyl, benzyl, alkylaryl (including heteroaromatics), alkyltetrazolyl ring, or an alkyl or carbomethoxy group, whether or not further substituted in the ring or group;

(iii) With or without substitution or addition to the piperidine ring to any extent with one or more methyl, carbomethoxy, methoxy, methoxymethyl, aryl, allyl, or ester groups;

(iv) With or without substitution of one or more hydrogen atoms for halogens, or methyl, alkyl, or methoxy groups, in the aromatic ring of the anilide moiety;

(v) With or without substitution at the alpha or beta position of the piperidine ring with alkyl, hydroxyl, or methoxy groups;

(vi) With or without substitution of the benzene ring of the anilide moiety for an aromatic heterocycle; and (vii) With or without substitution of the piperidine ring for a pyrrolidine ring, perhydroazepine ring, or azepine ring;

Excluding, Alfentanil, Carfentanil, Fentanyl, and Sufentanil; including, but not limited to:

(i) Acetylfentanyl (N-(1-phenethylpiperidin-4-yl) -N-phenylacetamide)...... 9821 (ii) Acetyl-alpha-methylfentanyl (N-[1-(1-methyl-2-phenethyl)-4-piperidnyl]-Nphenyl-acetamide).......................................................................9815 (iii) Acryl fentanyl (N-(1-phenethylpiperidin-4-yl) -Nphenylacrylamide).................................................................... 9811 (iv) Alpha’methyl butyryl fentanyl (2-methyl-N-(1-phenethylpiperidin-4-yl) -Nphenylbutanamide)................................................................... 9864 (v) Alpha-methylfentanyl (N-[1-(alpha-methyl-beta-phenyl)ethyl-4piperidyl]propionanilide; 1-(1-methyl-2-phenylethyl)-4-(Npropanilido)piperidine)............................................................... 9814 (vi) Alpha-methylthiofentanyl (N-[1-methyl-2-(2-thienyl)ethyl-4-piperidinyl]-Nphenylpropanamide) ................................................................ 9832 (vii) Benzodioxolefentanyl (viii) Beta-hydroxyfentanyl (N-[1-(2-hydroxy-2-phenethyl)-4-piperidinyl]-Nphenylpropanamide)................................................................. 9830 (ix) Beta-hydroxythiofentanyl (N-[1-[2-hydroxy-2-(thiophen-2-yl) ethyl]piperidin- 4-yl] -N-phenylpropionamide; N-[1-[2-hydroxy-2-(2-thienyl)ethyl]-4piperidinyl]-N-phenylpropanamide)................................................... 9836 (x) Beta-hydroxy-3-methylfentanyl (N-[1-(2-hydroxy-2-phenethyl)-3-methyl-4piperidinyl]-N-phenylpropanamide)............................................... 9831 (xi) Beta-methylacetyl fentanyl (N-phenyl-N-(1-(2- phenylpropyl)piperidin-4yl)acetamide).......................................................................... 9868 (xii) Beta-Methyl fentanyl (N-phenyl-N-(1-(2-phenylpropyl)piperidin-4yl)propionamide....................................................................... 9856 (xiii) Beta’-phenyl fentanyl (N-(1-phenethylpiperidin-4-yl) -N,3diphenylpropanamide) .................................................................... 9842 (xiv) Butyrylfentanyl (N-(1-phenethylpiperidin-4-yl) -N-phenylbutyramide, N-(1phenethylpiperidin-4-yl) -N-phenylbutanamide)................................. 9822 (xv) Crotonyl fentanyl ((E)-N-(1-phenethylpiperidin-4-yl) -N-phenylbut-2enamide) ............................................................................... 9844 (xvi) Cyclopentyl fentanyl (N-(1-phenethylpiperidin-4-yl) -Nphenylcyclopentanecarboxamide)................................................ 9847 (xvii) Cyclopropyl fentanyl (N-(1-phenethylpiperidin-4-yl) -Nphenylcyclopropanecarboxamide)................................................ 9845 (xviii) 2’,5’-Dimethoxyfentanyl (N-(1-(2,5-dimethoxyphenethyl)piperidin-4-yl) -Nphenylpropionamide)................................................................ 9861 (xix) Fentanyl carbamate (ethyl (1-phenethylpiperidin-4yl)(phenyl)carbamate)............................................................... 9851 (xx) 2’-Fluoro ortho-fluorofentanyl (N-(1-(2-fluorophenethyl)piperidin-4-yl) -N-(2fluorophenyl)propionamide) ....................................................... 9855 (xxi) Furanyl fentanyl (N-(1-phenethylpiperidin-4-yl) -N-phenylfuran-2carboxamide).......................................................................... 9834 (xxii) 3-Furanyl fentanyl (N-(1-phenethylpiperidin-4-yl) -N-phenylfuran-3carboxamide).......................................................................... 9860 (xxiii) Isobutyryl fentanyl (N-(1-phenethylpiperidin-4yl)-Nphenylisobutyramide)............................................................... 9827 (xxiv) Isovaleryl fentanyl (3-methyl-N-(1-phenethylpiperidin-4-yl) -Nphenylbutanamide)................................................................... 9862 (xxv) Lofentanil (xxvi) Meta-fluorofentanyl (N-(3-fluorophenyl)-N-(1-phenethylpiperidin-4-yl) propionamide).......................................................................... 9857 (xxvii) Meta-fluorofuranyl fentanyl (N-(3-fluorophenyl)-N-(1-phenethylpiperidin-4yl)furan-2-carboxamide)................................................................ 9871 (xxviii) Meta-fluoroisobutyryl fentanyl (N-(3-fluorophenyl)-N-(1-phenethylpiperidin- 4-yl)isobutyramide)........................................................................ 9858 (xxix) Methoxyacetyl fentanyl (2-methoxy-N-(1-phenethylpiperidin-4-yl) -Nphenylacetamide)..................................................................... 9825 (xxx) 4’-Methyl acetyl fentanyl (N-(1-(4-methylphenethyl)piperidin-4-yl) -Nphenylacetamide.................................................................................... 9819 (xxxi) 3-Methylfentanyl (N-[3-methyl-1-(2-phenylethyl)-4-piperidyl]-Nphenylpropanamide).................................................................. 9813 (xxxii) 3-Methylthiofentanyl (N-[(3-methyl-1-(2-thienyl)ethyl-4-piperidinyl]-Nphenylpropanamide)................................................................. 9833 (xxxiii) Ocfentanil (N-(2-fluorophenyl)-2-methoxy-N-(1-phenethylpiperidin-4yl)acetamide)........................................................................... 9838 (xxxiv) Ohmefentanyl (xxxv) Ortho-chlorofentanyl (N-(2-chlorophenyl)-N-(1- phenethylpiperidin-4yl)propionamide).......................................................................9828 (xxxvi) Ortho-fluoroacryl fentanyl (N-(2-fluorophenyl)-N-(1-phenethylpiperidin-4yl)acrylamide)......................................................................................... 9852 (xxxvii) Ortho-fluorobutyryl fentanyl (N-(2-fluorophenyl)-N-(1-phenethylpiperidin- 4-yl)butyramide)............................................................................ 9846 (xxxviii) Ortho-fluorofentanyl (2-fluorofentanyl; N-(2-fluorophenyl)-N-(1phenethylpiperidin-4-yl)propionamide)............................................... 9816 (xxxix) Ortho-fluorofuranyl fentanyl (N-(2-fluorophenyl)-N-(1-phenethylpiperidin-4yl)furan-2-carboxamide).................................................................. 9863 (xl) Ortho-fluoroisobutyryl fentanyl (N-(2-fluorophenyl)-N-(1-phenethylpiperidin- 4-yl)isobutyramide)............................................................................9853 (xli) Ortho-methyl acetylfentanyl (N-(2-methylphenyl)-N-(1-phenethylpiperidin-4yl)acetamide)................................................................................. 9848 (xlii) Ortho-methylcyclopropylfentanyl (N-(2-methylphenyl)-N-(1phenethylpiperidin-4-yl)cyclopropanecarboxamide).......................... 9849 (xliii) Ortho-methyl methoxyacetyl fentanyl (2-methoxy-N-(2-methylphenyl)-N-(1phenethylpiperidin-4-yl)acetamide..................................................... 9820 (xliv) Para-chlorofentanyl (N-(4-chlorophenyl)-N-(1-phenethylpiperidin-4yl)propionamide) ..................................................................... 9818 (xlv) Para-chloroisobutyryl fentanyl (N-(4-chloropenyl)-N-(1-phenethylpiperidin- 4-yl)isobutyramide)................................................................... 9826 (xlvi) Para-fluorobutyryl fentanyl (N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4yl)butyramide)........................................................................... 9823 (xlvii) Para-fluorofentanyl (N-(4-fluorophenyl)-N-[1-(2-phenethyl)-4-piperidinyl] propanamide) .......................................................................... 9812 (xlviii) Para-fluoro furanyl fentanyl (N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4yl)furan-2-carboxamide)......................................................................... 9854 (xlix) Para-fluoroisobutyryl fentanyl (N-(4-fluorophenyl)-N-(1-phenethylpiperidin- 4-yl)isobutyramide; 4-fluoroisobutyryl fentanyl..................................... 9824 (l) Para-fluoro valeryl fentanyl (N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4yl)pentanamide) ....................................................................... 9870 (li) Para-methoxybutyryl fentanyl (N-(4-methoxyphenyl)-N-(1phenethylpiperidin-4-yl)butyramide).............................................. 9837 (lii) Para-methoxyfuranyl fentanyl (N-(4-methoxyphenyl)-N-(1phenethylpiperidin-4-yl)furan-2-carboxamide....................................... 9859 (liii) Para-methylcyclopropyl fentanyl (N-(4-methylphenyl)-N-(1phenethylpiperidin-4-yl)cyclopropanecarboxamide)........................... 9865 (liv) Para-methylfentanyl (N-(4-methylphenyl)-N-(1-phenethylpiperidin-4yl)propionamide).................................................................................... 9817 (lv) Phenyl fentanyl (N-(1-phenethylpiperidin-4-yl) -N-phenylbenzamide)... 9841 (lvi) Pentanoyl fentanyl (lvii) Tetrahydrofuranyl fentanyl (N-(1-phenethylpiperidin-4-yl) -Nphenyltetrahydrofuran-2-carboxamide.................................................. 9843 (lviii) Tetrahydrothiofuranyl fentanyl (N-(1-phenethylpiperidin-4-yl) -Nphenyltetrahydrothiophene-2-carboxamide) ...................................... 9869 (lix) Thiofentanyl............................................................................. 9835 (lx) Thiofuranyl fentanyl (N-(1-phenethylpiperidin-4-yl) -N-phenylthiophene-2carboxamide........................................................................................... 9839 (lxi) Valeryl fentanyl (N-(1-phenethylpiperidin-4-yl) -Nphenylpentanamide).................................................................. 9840 (3) Opium derivatives. Unless specifically excepted or unless listed in another schedule, any of the following opium derivatives, its salts, isomers, and salts of isomers, whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation:

(a) Acetorphine............................................................................................ 9319 (b) Acetyldihydrocodeine................................................................................ 9051 (c) Benzylmorphine....................................................................................... 9052 (d) Codeine methylbromide............................................................................. 9070 (e) Codeine-N-Oxide..................................................................................... 9053 (f) Cyprenorphine......................................................................................... 9054 (g) Desomorphine......................................................................................... 9055 (h) Dihydromorphine..................................................................................... 9145 (i) Drotebanol............................................................................................. 9335 (j) Etorphine (except hydrochloride salt)........................................................... 9056 (k) Heroin................................................................................................... 9200 (l) Hydromorphinol....................................................................................... 9301 (m) Methyldesorphine.................................................................................... 9302 (n) Methyldihydromorphine............................................................................. 9304 (o) Morphine methylbromide........................................................................... 9305 (p) Morphine methylsulfonate......................................................................... 9306 (q) Morphine-N-Oxide................................................................................... 9307 (r) Myrophine.............................................................................................. 9308 (s) Nicocodeine............................................................................................ 9309 (t) Nicomorphine........................................................................................... 9312 (u) Normorphine........................................................................................... 9313 (v) Pholcodine............................................................................................. 9314 (w) Thebacon............................................................................................... 9315 (4) Hallucinogenic substances. Unless specifically excepted or unless listed in another schedule, any material, compound mixture, or preparation, which contains any quantity of the following hallucinogenic substances, or which contains any of its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers, is possible within the specified chemical designation (for purposes of this paragraph only, the term “isomer” includes the optical, position and geometric isomers):

(a) Alpha-ethyltryptamine................................................................................ 7249 Other names: etryptamine; Monase; [alpha]-ethyl-1H-indole-3-ethanamine; 3-(2aminobutyl) indole; [alpha]-ET; and AET; ET; Trip (b) Alpha-methyltryptamine ............................................................................. 7432 Other name: AMT (c) Alpha-pyrrolidinobutiophenone...................................................................... 7546 Other names: [alpha]-PBP; 1-phenyl-2-(pyrrolidin-1-yl)butan-1-one (d) Alpha-pyrrolidinopentiophenone................................................................... 7545 Other names: [alpha]-PVP; [alpha]-pyrrolidinovalerophenone; 1-phenyl-2-(pyrrolidin-1yl)pentan-1-one (e) 4-Bromo-2,5-dimethoxyamphetamine........................................................... 7391 Other names: 4-Bromo-2,5-dimethoxy-[alpha]-methylphenethylamine; 4-bromo-2,5- DMA (f) 4-Bromo-2,5-dimethoxyphenethylamine......................................................... 7392 Other names: 2-(4-bromo-2,5-dimethoxyphenyl)-1-aminoethane; alpha-desmethyl DOB; 2C-B; Nexus (g) 2-(4-Bromo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine................... 7536 Other names: 25B-NBOMe; 2C-B-NBOMe; 25B; Cimbi-36 (h) Bufotenine............................................................................................... 7433 Other names: 3-([beta]-Dimethylaminoethyl)-5-hydroxyindole; 3-(2dimethylaminoethyl)-5-indolol; N,N-dimethylserotonin; 5-hydroxy-N,Ndimethyltryptamine; mappine (i) Butylone................................................................................................. 7541 Other names: bk-MBDB; 1-(1,3-benzodioxol-5-yl) -2-(methylamino)butan-1-one (j) 2-(4-Chloro-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine.................... 7537 Other names: 25C-NBOMe; 2C-C-NBOMe; 25C; Cimbi-82 (k) Diethyltryptamine...................................................................................... 7434 Other names: N,N-Diethyltryptamine; DET (l) 2,5-Dimethoxyamphetamine........................................................................ 7396 Other names: 2,5-Dimethoxy-[alpha]-methylphenethylamine; 2,5-DMA (m) 2,5-Dimethoxy-4-ethylamphetamine.............................................................. 7399 Other name: DOET (n) 2,5 Dimethoxy-4-propylthiophenethylamine.................................................... 7348 Other name: 2C-T-7 (o) Dimethyltryptamine.................................................................................... 7435 Other name: DMT (p) Ethylamine analogue of phencyclidine........................................................... 7455 Other names: N-Ethyl-1-phenylcyclohexylamine; (1-phenylcyclohexyl)ethylamine; N-(1phenylcyclohexyl)ethylamine; cyclohexamine; PCE (q) 2-(ethylamino)-2-(3-methoxyphenyl)cyclohexan-1-one...................................... 7286 Other names: MXE; methoxetamine (r) Ethylone.................................................................................................. 7547 Other names: 1-(1,3-benzodioxol-5-yl) -2-(ethylamino)propan-1-one; 3,4methylenedioxy-N-ethylcathinone; bk-MDEA; MDEC (s) Ethyl 2-[[1-(5-fluoropentyl)indole-3-carbonyl]amino]-3,3-dimethyl-butanoate.......... 7094 Other names: 5F-EDMB-PICA; 5F-EDMB-2201 (t) Ethyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate...... 7036 Other name: 5F-EDMB-PINACA (u) (1-(4-fluorobenzyl)-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone........ 7014 Other name: FUB-144 (v) 3-Fluoro-N-methylcathinone......................................................................... 1233 Other names: 3-FMC; 1-(3-fluorophenyl)-2-(methylamino)propan-1-one (w) 4-Fluoro-N-methylcathinone......................................................................... 1238 Other names: 4-FMC; flephedrone; 1-(4-fluorophenyl)-2-(methylamino)propan-1-one (x) 1-(5-fluoropentyl)-N-(2-phenylpropan-2-yl) -1H-indazole-3-carboxamide ................ 7083 Other names: 5F-CUMYL-PINACA, SGT-25 (y) Ibogaine.................................................................................................. 7260 Other names: 7-Ethyl-6,6[beta],7,8,9,10,12,13-octahydro-2-methoxy-6,9-methano-5Hpyrido [1’,2’:1,2] azepino [5,4-b] indole; Tabenanthe iboga.

(z) 2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine........................ 7538 Other names: 25I-NBOMe; 2C-I-NBOMe; 25I; Cimbi-5 (aa) Lysergic acid diethylamide.......................................................................... 7315 Other name: LSD (bb) Mescaline................................................................................................ 7381 Other name: Constituent of “Peyote” cacti (cc) 4-Methoxyamphetamine............................................................................. 7411 Other names: 4-methoxy-[alpha]-methylphenethylamine; paramethoxyamphetamine;

PMA (dd) 5-Methoxy-3,4-methylenedioxyamphetamine.................................................. 7401 (ee) 5-Methoxy-N,N-diisopropyltryptamine............................................................ 7439 Other name: 5-MeO-DIPT (ff) 5-methoxy-N,N-dimethyltryptamine .............................................................. 7431 Other names: 5-methoxy-3-[2-(dimethylamino)ethyl]indole; 5-MeO-DMT (gg) 4-Methyl-N-ethylcathinone........................................................................... 1249 Other names: 4-MEC; 2-(ethylamino)-1-(4-methylphenyl)propan-1-one (hh) 4-Methyl-alpha-pyrrolidinopropiophenone...................................................... 7498 Other names: 4-MePPP; MePPP; 4-methyl-[alpha]-pyrrolidinopropiophenone; 1-(4methylphenyl)-2-(pyrrolidin-1-yl) -propan-1-one (ii) Methyl 2-(1-(cyclohexylmethyl)-1h-indole-3-carboxamido)-3,3-dimethylbutanoate... 7042 Other names: MDMB-CHMICA, MMB-CHMINACA (jj) 4-Methyl-2,5-dimethoxyamphetamine........................................................... 7395 Other names: 4-methyl-2,5-dimethoxy-[alpha]-methylphenethylamine; DOM; STP (kk) 4-Methyl-1-phenyl-2-(pyrrolidin-1-yl)pentan-1-one............................................ 7551 Other names: α-PiHP; alpha-PiHP (ll) 3,4-Methylenedioxyamphetamine................................................................. 7400 (mm) 3,4-Methylenedioxymethamphetamine.......................................................... 7405 Other name: MDMA (nn) 3,4-Methylenedioxy-N-ethylamphetamine...................................................... 7404 Other names: N-ethyl-alpha-methyl-3,4(methylenedioxy)phenethylamine; N-ethyl MDA;

MDE; MDEA

(oo) 3,4-Methylenedioxy-N-methylcathinone.........................................................7540 Other names: Methylone (pp) Methyl 3,3-dimethyl-2-(1-(pent-4-en-1-yl) -1H-indazole-3-carboxamido)butanoate... 7090 Other name: MDMB-4en-PINACA (qq) Methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate... 7020 Other names: MDMB-FUBINACA (rr) Methyl 2-[[1-(4-fluorobutyl)indole-3-carbonyl]amino]-3,3-dimethyl-butanoate......... 7091 Other names: 4F-MDMB-BUTICA; 4F-MDMB-BICA (ss) Methyl 2-(1-(4-fluorobutyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate..... 7043 Other name: 4F-MDMB-BINACA (tt) Methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate.... 7034 Other names: 5F-ADB; 5F-MDMB-PINACA (uu) Methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3-methylbutanoate........ 7033 Other name: 5F-AMB (vv) Methyl 2-(1-(5-fluoropentyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate....... 7041 Other name: 5F-MDMB-PICA (ww) N-(adamantan-1-yl) -1-(4-fluorobenzyl)-1H-indazole-3-carboxamide..................... 7047 Other names: FUB-AKB48, FUB-APINACA, AKB48 N-(4-FLUOROBENZYL)

(xx) N-(adamantan-1-yl) -1-(5-fluoropentyl)-1H-indazole-3-carboxamide...................... 7049 Other names: 5F-APINACA, 5F-AKB48 (yy) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl) -1-(4-fluorobenzyl)1H-indazole-3carboxamide............................................................................................. 7010 Other name: ADB-FUBINACA (zz) Naphyrone............................................................................................... 1258 Other names: naphthylpyrovalerone; 1-(naphthalen-2-yl) -2-(pyrrolidin-1-yl)pentan-1one (aaa) Naphthalen-1-yl 1-(5-fluoropentyl)-1 h-indole-3-carboxylate............................... 7221 Other names: NM2201; CBL2201 (bbb) N-Ethyl-3-piperidyl benzilate........................................................................ 7482 (ccc) N-Hydroxy-3,4-methylenedioxyamphetamine.................................................. 7402 Other names: N-hydroxy-alpha-methyl-3,4(methylenedioxy)phenethylamine; N-hydroxy MDA (ddd) N-methyl-3-piperidyl benzilate.......................................................................... 7484 (eee) Parahexyl................................................................................................ 7374 Other names: 3-Hexyl-1-hydroxy-7,8,9,10-tetrahydro-6,6,9-trimethyl-6H-dibenzo[b, d]pyran; Synhexyl (fff) Para-methoxymethamphetamine.................................................................. 1245 Other names: PMMA, 1-(4-methoxyphenyl)-N-methylpropan-2-amine (ggg) Pentedrone,............................................................................................. 1246 Other names: [alpha]-methylaminovalerophenone; 2-(methylamino)-1-phenylpentan-1one (hhh) Pentylone............................................................................................... 7542 Other names: bk-MBDP; 1-(1,3-benzodioxol-5-yl) -2-(methylamino)pentan-1-one (iii) Peyote................................................................................................... 7415 Meaning all parts of the plant presently classified botanically as Lophophora williamsii Lamaire, whether growing or not, the seeds thereof, any extract from any part of such plant, and every compound, manufacture, salts, derivative, mixture, or preparation of such plant its seeds or extracts. (Interprets 21 USC 812(c), Schedule 1 (c)(12))

(jjj) Psilocybin (constituent of magic mushrooms).................................................. 7437 (kkk) Psilocyn (constituent of magic mushrooms) ....................................................7438 (lll) Pyrrolidine analogue of phencyclidine (1-(1-phenylcyclohexyl)-pyrrolidine)............ 7458 Other names: PCPy; PHP (mmm) 1-[1-(2-Thienyl)cyclohexyl]pyrrolidine...........................................................7473 Other name: TCPy (nnn) 4-Methylmethcathinone ............................................................................. 1248 Other names: mephedrone; methpadrone; 4-MMC (ooo) 3-Methylmethcathinone (2-(methylamino)-1-(3-methylphenyl)propan-1-one)......... 1259 Other names: 3-MMC; 3-methylmethcathinone (ppp) 3,4-Methylenedioxypyrovalerone.................................................................. 7535 Other name: MDPV (qqq) 2-(2,5-Dimethoxy-4-ethylphenyl)ethanamine (2C-E)......................................... 7509 (rrr) 2-(2,5-Dimethoxy-4-methylphenyl)ethanamine (2C-D)....................................... 7508 (sss) 2-(4-Chloro-2,5-dimethoxyphenyl)ethanamine (2C-C)...................................... 7519 (ttt) 2-(4-Iodo-2,5-dimethoxyphenyl)ethanamine (2C-I)........................................... 7518 (uuu) 2-[4-Ethylthio-2,5-dimethoxyphenyl]ethanamine (2C-T-2).................................. 7385 (vvv) 2-[4-(Isopropylthio)-2,5-dimethoxyphenyl]ethanamine (2C-T-4) .......................... 7532 (www) 2-(2,5-Dimethoxyphenyl)ethanamine (2C-H)...................................................7517 (xxx) 2-(2,5-Dimethoxy-4-nitro-phenyl)ethanamine (2C-N) ....................................... 7521 (yyy) 2-(2,5-Dimethoxy-4-(n)-propylphenyl)ethanamine (2C-P) .................................. 7524 (zzz) Thiophene analogue of phencyclidine............................................................ 7470 Other names: 1-[1-(2-thienyl)cyclohexyl]-piperidine; 2-thienylanalog of phencyclidine;

TPCP; TCP

(aaaa) 3,4,5-Trimethoxyamphetamine.................................................................... 7390 (bbbb) (1-Pentyl-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone ....................7144 Other names: UR-144; 1-pentyl-3-(2,2,3,3-tetramethylcyclopropoyl)indole (cccc) 5-Pentyl-2-(2-phenylpropan-2-yl)pyrido[4,3-b]indol-1-one................................ 7093 Other names: CUMYL-PEGACLONE; SGT-151 (dddd) 1-(5-Fluoro-pentyl)-1H-indol-3-yl](2,2,3,3-tetramethylcyclopropyl)methanone........ 7011 Other names: 5-fluoro-UR-144; 5-F-UR-144; XLR11; 1-(5-fluoro-pentyl)-3-(2,2,3,3tetramethylcyclopropoyl)indole (eeee) (1-(5-Fluoropentyl)-1H-indazol-3-yl)methanone...................... 7024 Other name: THJ-2201 (ffff) 5F-CUMYL-P7AICA................................................................................... 7085 Other names: 1-(5-fluoropentyl)-n-(2-phenylpropan-2-yl) -1H-pyrrolo[2,3-b]pyridine-3carboxamide (gggg) MMB-CHMICA......................................................................................... 7044 Other names: methyl-2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3methylbutanoate; AMB-CHMICA (hhhh) MMB-FUBICA......................................................................................... 7095 Other name: (methyl 2-(1-(4-fluorobenzyl)-1H-indole-3-carboxamido)-3-methyl butanoate (iiii) 4-CN-CUMYL-BUTINACA............................................................................... 7089 Other names: 1-(4-cyanobutyl)-N-(2-phenylpropan-2-yl) -1H-indazole-3-carboxamide; 4cyano-CUMYL-BUTINACA; 4-CN-CUMYL BINACA; CUMYL-4CN-BINACA; SGT-78 (jjjj) 5F-AB-PINACA......................................................................................... 7025 Other names: N-(1-amino-3-methyl-1-oxobutan-2-yl) -1-(5-fluoropentyl)-1H-indazole-3carboxamide (kkkk) N-(1-amino-3-methyl-1-oxobutan-2-yl) -1(cyclohexylmethyl)-1H-indazole-3carboxamide............................................................................................ 7031 Other name: AB-CHMINACA (llll) N-(1-amino-3-methyl-1-oxobutan-2-yl) -1-(4-fluorobenzyl)-1H-indazole-3carboxamide............................................................................................ 7012 Other name: AB-FUBINACA (mmmm) N-(1-adamantyl)-1-pentyl-1H-indazole-3-carboxamide................................... 7048 Other names: APINACA; AKB48 (nnnn) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl) -1-butyl-1H-indazole-3carboxamide.............................................................................................................. 7027 Other name: ADB–BUTINACA (oooo) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl) -1-(pent-4-en-1-yl) -1H-indazole-3carboxamide............................................................................................ 7092 Other name: ADB-4en-PINACA (pppp) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl) -1-pentyl-1H-indazole-3carboxamide............................................................................................ 7035 Other name: ADB-PINACA (qqqq) N-(1-amino-3-methyl-1-oxobutan-2-yl) -1-pentyl-1H-indazole-3carboxamide........................................................................................... 7023 Other name: AB-PINACA (rrrr) Quinolin-8-yl 1-(5-fluoropentyl)-1H-indole-3-carboxylate .................................... 7225 Other names: 5-fluoro-PB-22; 5F-PB-22 (ssss) Quinolin-8-yl 1-pentyl-1H-indole-3-carboxylate ............................................... 7222 Other names: PB-22; QUPIC (tttt) N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl) -1-(cyclohexylmethyl)-1H-indazole-3carboxamide, its optical, positional, and geometric isomers, salts and salts of isomers................................................................................................... 7032 Other names: MAB-CHMINACA; ADB-CHMINACA (uuuu) Methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3-methylbutanoate....... 7021 Other names: FUB-AMB, MMB-FUBINACA, AMB-FUBINACA (5) Depressants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a depressant effect on the central nervous system, including its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specified chemical designation:

(a) Clonazolam (6-(2-chlorophenyl)-1-methyl-8-nitro-4H-benzo[f][1,2,4]triazolo[4,3a][1,4]diazepine)....................................................................................... 2786 (b) Diclazepam (7-chloro-5-(2-chlorophenyl)-1-methyl-1,3-dihydro-2Hbenzo[e][1,4]diazepin-2-one)............................................................................. 2789 (c) Etizolam ................................................................................................. 2780 Other names; Etilaam, Etizola, Sedekopan, Pasaden, Depas (d) Flualprazolam (8-chloro-6-(2-fluorophenyl)-1-methyl-4H-benzo[f][1,2,4]triazolo[4,3a][1,4]diazepine)....................................................................................... 2785 (e) Flubromazolam (8-bromo-6-(2-fluorophenyl)-1-methyl-4H-benzo[f][1,2,4]triazolo[4,3a][1,4]diazepine)....................................................................................... 2788 (f) Gamma-hydroxybutyric acid........................................................................ 2010 Other names: GHB; gamma-hydroxybutyrate; 4-hydroxybutyrate; 4-hydroxybutanoic acid; sodium oxybate; sodium oxybutyrate (g) Mecloqualone.......................................................................................... 2572 (h) Methaqualone.......................................................................................... 2565 (6) Stimulants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a stimulant effect on the central nervous system, including its salts, isomers, and salts of isomers:

(a) Amineptine.................................................................................................... 1219 Other names: 7-[(10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5-yl)amino]heptanoic acid (b) Alpha-Pyrrolidinoheptaphenone.................................................................... 7548 Other names: PV8, 1-phenyl-2-(pyrrolidin-1-yl)heptan-1-one (c) Alpha-Pyrrolidinohexanophenone................................................................. 7544 Other names: α-PHP, alpha-pyrrolidinohexiophenone, 1-phenyl-2-(pyrrolidin-1yl)hexan-1-one (d) Aminorex................................................................................................. 1585 Other names: aminoxaphen; 2-amino-5-phenyl-2-oxazoline; or 4,5-dihydro-5-phenyl-2oxazolamine (e) Cathinone................................................................................................ 1235 Other names: 2-amino-1-phenyl-1-propanone; alpha-aminopropiophenone; 2aminopropiophenone; norphedrone; constituent of catha edulis or “Khat” plant (f) 4′-Chloro-alpha-pyrrolidinovalerophenone...................................................... 7443 Other names: 4-chloro-α-PVP, 4′-chloro-alpha-pyrrolidinopentiophenone, 1-(4chlorophenyl)-2-(pyrrolidin-1-yl)pentan-1-one (g) 4,4′-Dimethylaminorex............................................................................... 1595 Other names: 4,4′-DMAR; 4,5-dihydro-4-methyl-5-(4-methylphenyl)-2-oxazolamine (h) Ephylone................................................................................................. 7543 Other names: N-ethylpentylone; 1-(1,3-benzodioxol-5-yl) -2-(ethylamino)-pentan-1-one (i) Ethylphenidate (ethyl 2-phenyl-2-(piperidin-2-yl)acetate)...................................1727 (j) Eutylone.................................................................................................. 7549 Other names: 1-(1,3-benzodioxol-5-yl) -2-(ethylamino)butan-1-one; bk-EBDB (k) Fenethylline............................................................................................. 1503 (l) Mesocarb................................................................................................. 1227 Other names: N-phenyl-N’-(3-(1-phenylpropan-2-yl) -1,2,3-oxadiazol-3-ium-5-yl) carbamimidate (m) Methcathinone.......................................................................................... 1237 Other names: 2-(methylamino)-propiophenone; alpha-(methylamino) propiophenone; 2- (methylamino)-1-phenylpropan-1-one; alpha-N-methylaminopropiophenone; monomethylpropion; ephedrone; N-methylcathinone; methylcathinone; AL-464; AL- 422; AL-463; and UR1432 (n) Methiopropamine....................................................................................... 1478 Other names: N-methyl-1-(thiophen-2-yl)propan-2-amine (o) 4-Methyl-alpha-ethylaminopentiophenone...................................................... 7245 Other names: 4-MEAP, 2-(ethylamino)-1-(4-methylphenyl)pentan-1-one (p) 4′-Methyl-alpha-pyrrolidinohexiophenone........................................................ 7446 Other names: MPHP, 4′-methyl-alpha-pyrrolidinohexanophenone, 1-(4-methylphenyl)- 2-(pyrrolidin-1-yl)hexan-1-one (q) (+/-)cis-4-Methylaminorex (cis isomer).......................................................... 1590 Other name: (+/-)cis-4,5-dihydro-4-methyl-5-phenyl-2-oxazolamine (r) N-Benzylpiperazine................................................................................... 7493 Other names: BZP; 1-benzylpiperazine (s) N-Ethylamphetamine................................................................................. 1475 (t) N-Ethylhexedrone...................................................................................... 7246 Other name: 2-(ethylamino)-1-phenylhexan-1-one (u) N,N-Dimethylamphetamine.......................................................................... 1480 Other names: N,N-alpha-trimethyl-benzeneethanamine; N,N-alphatrimethylphenethylamine (7) Cannabimimetic agents. Unless specifically exempted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, or which contains their salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation:

(a) 5-(1,1-Dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (CP-47,497) ........ 7297 (b) 5-(1,1-Dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (cannabicyclohexanol or CP-47,497 C8-homolog) ............................................................................ 7298 (c) 1-Pentyl-3-(1-naphthoyl)indole (JWH-018 and AM678) .................................... 7118 (d) 1-Butyl-3-(1-naphthoyl)indole (JWH-073) ....................................................... 7173 (e) 1-Hexyl-3-(1-naphthoyl)indole (JWH-019) ...................................................... 7019 (f) 1-[2-(4-Morpholinyl)ethyl]-3-(1-naphthoyl)indole (JWH-200) .............................. 7200 (g) 1-Pentyl-3-(2-methoxyphenylacetyl)indole (JWH-250) ...................................... 6250 (h) 1-Pentyl-3-[1-(4-methoxynaphthoyl)]indole (JWH-081) ..................................... 7081 (i) 1-Pentyl-3-(4-methyl-1-naphthoyl)indole (JWH-122) ......................................... 7122 (j) 1-Pentyl-3-(4-chloro-1-naphthoyl)indole (JWH-398) ......................................... 7398 (k) 1-(5-Fluoropentyl)-3-(1-naphthoyl)indole (AM2201).......................................... 7201 (l) 1-(5-Fluoropentyl)-3-(2-iodobenzoyl)indole (AM694)......................................... 7694 (m) 1-Pentyl-3-[(4-methoxy)-benzoyl]indole (SR-19 and RCS-4) .............................. 7104 (n) 1-Cyclohexylethyl-3-(2-methoxyphenylacetyl)indole (SR-18 and RCS-8) .............. 7008 (o) 1-Pentyl-3-(2-chlorophenylacetyl)indole (JWH-203) .......................................... 7203

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Amendment filed July 10, 1997; effective September 23, 1997. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Repeal and new rules filed October 1, 2019; effective December 30, 2019. Amendments filed October 1, 2020; effective December 30, 2020. Amendments filed September 24, 2021; effective December 23, 2021. Amendments filed October 3, 2022; effective January 1, 2023. Amendments filed March 1, 2024; effective May 30, 2024. Amendments filed September 19, 2024; effective December 18, 2024. Amendments filed September 16, 2025; effective December 15, 2025.

Tenn. Comp. R. & Regs. 0940-06-01-.02 CONTROLLED SUBSTANCES IN SCHEDULE II

(1) Schedule II consists of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this rule. Each drug or substance bears the federal controlled substance code number assigned to it by the Drug Enforcement Administration.

(2) Substances, vegetable origin or chemical synthesis. Unless specifically excepted or unless listed in another schedule, any of the following substances whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis:

(a) Opium and opiate, and any salt, compound, derivative, or preparation of opium or opiate, excluding apomorphine, dextrorphan, thebaine-derived butorphanol, naldemedine, nalmefene, nalbuphine, naloxegol, naloxone, 6β-naltrexol and naltrexone, and their respective salts, but including the following:

Codeine.......................................................................................... 9050 2. Dihydroetorphine.............................................................................. 9334 3. Ethylmorphine................................................................................. 9190 4. Etorphine hydrochloride..................................................................... 9059 5. Granulated opium............................................................................. 9640 6. Hydrocodone.................................................................................. 9193 7. Hydromorphone.............................................................................. 9150 8. Metopon........................................................................................ 9260 9. Morphine....................................................................................... 9300 10. Noroxymorphone.............................................................................. 9668 11. Opium extracts................................................................................ 9610 12. Opium fluid..................................................................................... 9620 13. Oripavine........................................................................................ 9330 14. Oxycodone...................................................................................... 9143 15. Oxymorphone.................................................................................. 9652 16. Powdered opium.............................................................................. 9639 17. Raw opium..................................................................................... 9600 18. Thebaine........................................................................................ 9333 19. Tincture of opium............................................................................ 9630 (b) Any salt, compound, derivative, or preparation thereof which is chemically equivalent or identical with any of the substances referred to in paragraph (2)(a) of this rule, except that these substances shall not include the isoquinoline alkaloids of opium.

(d) Coca leaves (9040) and any salt, compound, derivative or preparation of coca leaves (including cocaine (9041) and ecgonine (9180) and their salts, isomers, derivatives and salts of isomers and derivatives), and any salt, compound, derivative, or preparation thereof which is chemically equivalent or identical with any of these substances, except that the substances shall not include decocainized coca leaves or extraction of coca leaves, which extractions do not contain cocaine or ecgonine.

(e) Concentrate of poppy straw (the crude extract of poppy straw in either liquid, solid or powder form which contains the phenanthrene alkaloids of the opium poppy)........ 9670 (3) Opiates. Unless specifically excepted or unless in another schedule any of the following opiates, including its isomers, esters, ethers, salts and salts of isomers, esters and ethers whenever the existence of such isomers, esters, ethers, and salts is possible within the specific chemical designation, dextrorphan and levopropoxyphene excepted:

(a) Alfentanil................................................................................................. 9737 (b) Alphaprodine........................................................................................... 9010 (c) Anileridine............................................................................................... 9020 (d) Bezitramide ............................................................................................. 9800 (e) Carfentanil............................................................................................... 9743 (f) Dextropropoxyphene (bulk, non dosage forms)............................................... 9273 (g) Dihydrocodeine........................................................................................ 9120 (h) Diphenoxylate......................................................................................... 9170 (i) Fentanyl................................................................................................. 9801 (j) Isomethadone.......................................................................................... 9226 (k) Levo-alphacetylmethadol........................................................................... 9648 Other names: levo-alpha-acetylmethadol; levomethadyl acetate; LAAM (l) Levomethorphan...................................................................................... 9210 (m) Levorphanol........................................................................................... 9220 (n) Metazocine............................................................................................. 9240 (o) Methadone.............................................................................................. 9250 (p) Methadone-Intermediate; 4-cyano-2-dimethylamino-4,4-diphenyl butane.............. 9254 (q) Moramide-Intermediate; 2-methyl-3-morpholino-1,1-diphenylpropane-caboxylic acid........................................................................................................ 9802 (r) Oliceridine. ............................................................................................. 9245 (s) Pethidine (meperidine) .............................................................................. 9230 (t) Pethidine-Intermediate-A; 4-cyano-1-methyl-4-phenylpiperidine......................... 9232 (u) Pethidine-Intermediate-B; ethyl-4-phenylpiperidine-4-carboxylate....................... 9233 (v) Pethidine-Intermediate-C; 1-methyl-4-phenylpiperidine-4-carboxylic acid.............. 9234 (w) Phenazocine........................................................................................... 9715 (x) Piminodine.............................................................................................. 9730 (y) Racemethorphan..................................................................................... 9732 (z) Racemorphan.......................................................................................... 9733 (aa) Remifentanil........................................................................................... 9739 (bb) Sufentanil............................................................................................... 9740 (cc) Tapentadol.............................................................................................. 9780 (dd) Thiafentanil............................................................................................. 9729 (4) Stimulants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a stimulant effect on the central nervous system:

(a) Amphetamine, its salts, optical isomers, and salts of its optical isomers................1100 (b) Methamphetamine, its salts, isomers, and salts of its isomers............................ 1105 (c) Phenmetrazine and its salts........................................................................ 1631 (d) Methylphenidate....................................................................................... 1724 (e) Lisdexamfetamine, its salts, isomers, and salts of its isomers............................. 1205 (5) Depressants. Unless specifically excepted or unless listed in another schedule any material, compound, mixture, or preparation which contains any quantity of the following substances having a depressant effect on the central nervous system, including its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation:

(a) Amobarbital ............................................................................................ 2125 (b) Glutethimide............................................................................................ 2550 (c) Pentobarbital........................................................................................... 2270 (d) Phencyclidine.......................................................................................... 7471 (e) Secobarbital........................................................................................... 2315 (6) Hallucinogenic substances.

(a) Nabilone................................................................................................ 7379 Other names: (+/-)-trans-3-(1,1-dimethylheptyl)-6,6a,7,8,10,10a-hexahydro-1-hydroxy- 6, 6-dimethyl-9H-dibenzo[b,d]pyran-9-one (b) Dronabinol in oral solution in drug product approved for marketing by United States Food and Drug Administration..................................................................... 7365 Other name: Syndros (7) Immediate precursors. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture or preparation which contains any quantity of the following substances:

(a) Immediate precursor to amphetamine and methamphetamine:

Phenylacetone................................................................................. 8501 Other names: phenyl-2-propanone; P2P; benzyl methyl ketone; methyl benzyl ketone (b) Immediate precursors to phencyclidine (PCP):
1-phenylcyclohexylamine.................................................................... 7460 2. 1-piperidinocyclohexanecarbonitrile (PCC) ............................................ 8603 (c) Immediate precursor to fentanyl:
4-anilino-N-phenethyl-4-piperidine (ANPP) ............................................ 8333 2. N-phenyl-N-(piperidin-4-yl)propionamide (norfentanyl) ............................. 8366 (8) Tianeptine and any salt, sulfate, free acid, or other preparation of tianeptine, and any salt, sulfate, free acid, compound, derivative, precursor, or other preparation thereof that is substantially chemically equivalent or identical with tianeptine.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309 and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Amendment filed July 10, 1997; effective September 23, 1997. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed October 1, 2020; effective December 30, 2020. Amendments filed September 24, 2021; effective December 23, 2021. Amendments filed October 3, 2022; effective January 1, 2023. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.03 CONTROLLED SUBSTANCES IN SCHEDULE III

(1) Schedule III consists of the drugs and other substances by whatever official name, common or usual name, chemical name, or brand name designated, listed in this rule. Each drug or substance bears the federal controlled substance code number assigned to it by the Drug Enforcement Administration.

(2) Stimulants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a stimulant effect on the central nervous system, including its salts, isomers (whether optical, position or geometric), and salts of such isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation:

(a) Those compounds, mixtures, or preparations in dosage unit form containing any stimulant substances listed in Schedule II which compounds, mixtures, or preparations were listed on August 25, 1971, as excepted compounds under 21 C.F.R. 1308.32, and any other drug of the quantitative composition shown in that list for those drugs or which is the same except that it contains a lesser quantity of controlled substances...... .............................................................................................................1405 (b) Benzphetamine ..................................................................................... 1228 (c) Clorphentermine .....................................................................................1645 (d) Clortermine ............................................................................................. 1647 (e) Phendimetrazine .....................................................................................1615 (3) Depressants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a depressant effect in the central nervous system:

(a) Any compound, mixture, or preparation containing:

Amobarbital .................................................................................... 2126 2. Secobarbital.................................................................................... 2316 3. Pentobarbital.................................................................................... 2271 Or any salt thereof and one or more other active medicinal ingredients which are not listed in any schedule.

(b) Any suppository dosage form containing:

Amobarbital .................................................................................... 2126 2. Secobarbital.................................................................................... 2316 3. Pentobarbital.................................................................................... 2271 Or any salt of these drugs and approved by the Food and Drug Administration for marketing only as a suppository.

(c) Any substance which contains any quantity of a derivative of barbituric acid or any salt thereof. Examples include the following drugs................................................ 2100 1. Aprobarbital ................................................................................... 2100 2. Butabarbital (secbutabarbital) ........................................................... 2100 3. Butalbital......................................................................................... 2100 4. Butobarbital (butethal) ....................................................................... 2100 5. Talbutal......................................................................................... 2100 6. Thiamylal....................................................................................... 2100 7. Thiopental....................................................................................... 2100 8. Vinbarbital....................................................................................... 2100 (d) Chlorhexadol......................................................................................... 2510 (e) Embutramide........................................................................................... 2020 (f) Gamma hydroxybutyric acid preparations. Any drug product containing gamma hydroxybutyric acid, including its salts, isomers, and salts of isomers, for which an application is approved under § 505 of the federal Food, Drug, and Cosmetic Act, codified in 21 U.S.C. §§ 301, et seq............................................................ 2012 (g) Ketamine, its salts, isomers, and salts of isomers ............................................7285 Other name: (±)-2-(2-chlorophenyl)-2-(methylamino)-cyclohexanone (h) Lysergic acid............................................................................................ 7300 (i) Lysergic acid amide.................................................................................. 7310 (j) Methyprylon............................................................................................. 2575 (k) Perampanel, and its salts, isomers, and salts of isomers................................... 2261 (l) Sulfondiethylmethane.................................................................................2600 (m) Sulfonethylmethane................................................................................... 2605 (n) Sulfonmethane....................................................................................... 2610 (o) Tiletamine and zolazepam or any salt of tiletamine or zolazepam...................... 7295 1. Other name for a tiletamine-zolazepam combination product: Telazol®.

Other name for tiletamine: 2-(ethylamino)-2-(2-thienyl)-cyclohexanone.
Other names for zolazepam: 4-(2-fluorophenyl)-6,8-dihydro-1,3,8trimethylpyrazolo[3,4-e],[1,4]-diazepin-7(1H)-one; flupyrazapon.

(4) Nalorphine....................................................................................................... 9400 (5) Narcotic Drugs.

(a) Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below:

Not more than 8 grams of codeine per 100 milliliters or not more than 90 milligrams per dosage unit, with an equal or greater quantity of an isoquinoline alkaloid of opium.............................................................................. 9803 2. Not more than 1.8 grams of codeine per 100 milliliters or not more than 90 milligrams per dosage unit, with one or more active, non-narcotic ingredients in recognized therapeutic amounts.......................................................... 9804 3. Not more than 1.8 grams of dihydrocodeine per 100 milliliters or not more than 90 milligrams per dosage unit with one or more active non-narcotic ingredients in recognized therapeutic amounts.......................................................... 9807 4. Not more than 300 milligrams of ethylmorphine per 100 milliliters or not more than 15 milligrams per dosage unit with one or more active non-narcotic ingredients in recognized therapeutic amounts....................................... 9808 5. Not more than 500 milligrams of opium per 100 milliliters or per 100 grams or not more than 25 milligrams per dosage unit, with one or more active, non-narcotic ingredients in recognized therapeutic amounts....................................... 9809 6. Not more than 50 milligrams of morphine per 100 milliliters or per 100 grams, with one or more active, non-narcotic ingredients in recognized therapeutic amounts......................................................................................... 9810 (b) Any material, compound, mixture, or preparation containing any of the following narcotic drugs or their salts:
Buprenorphine................................................................................. 9064 (6) Anabolic steroids. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation containing any quantity of the following substances, including its salts, esters and ethers:

(a) Anabolic steroids...................................................................................... 4000 1. 3[alpha],17[beta]-dihydroxy-5a-androstane 2. 17[alpha]-methyl-3[alpha],17[beta]-dihydroxy-5a-androstane 3. 17[alpha]-methyl-3[beta],17[beta]-dihydroxy-5a-androstane 4. 17[alpha]-methyl-3[beta],17[beta]-dihydroxyandrost-4-ene 5. 17[alpha]-methyl-[delta]1-dihydrotestosterone(17[beta]-hydroxy-17[alpha]-methyl- 5[alpha]- androst-1-en-3-one)

Other name: 17-[alpha]-methyl-1-testosterone 6. 17[alpha]-methyl-4-hydroxynandrolone(17[alpha]-methyl-4-hydroxy-17[beta]hydroxyestr-4-en-3-one)

1-Androstenediol (3[alpha],17[beta]-dihydroxy-5[alpha]-androst-1-ene)
1-Androstenediol (3[beta],17[beta]-dihydroxy-5[alpha]-androst-1-ene)
4-Androstenediol (3[beta],17[beta]-dihydroxy-androst-4-ene)
5-Androstenediol (3[beta],17[beta]-dihydroxy-androst-5-ene)
1-Androstenedione (5[alpha]-androst-1-en-3,17-dione)
4-Androstenedione (androst-4-en-3,17-dione)
5-Androstenedione (androst-5-en-3,17-dione)
3[Beta],17[Beta]-dihydroxy-5a-androstane 15. 13[Beta]-ethyl-17[beta]-hydroxygon-4-en-3-one 16. Androstanedione (5[alpha]-androstan-3,17-dione)
Bolasterone (7[alpha],17[alpha]-dimethyl-17[beta]-hydroxyandrost-4-en-3-one)
Boldenone (17[beta]-hydroxyandrost-1,4-diene-3-one)
Boldione (androsta-1,4-diene-3,17-dione)
Calusterone (7[beta],17[alpha]-dimethyl-17[beta]-hydroxyandrost-4-en-3-one)
Clostebol (4-chloro-17[beta]-hydroxyandrost-4-en-3-one)

Other name: 4-Chlorotestosterone 22. Dehydrochloromethyltestosterone (4-chloro-17[beta]-hydroxy-17[alpha]methylandrost-1,4-dien-3-one)

[Delta]1-dihydrotestosterone (a.k.a. ‘1-testosterone’) (17[Beta]-hydroxy-5[alpha]androst-1-en-3-one)
Desoxymethyltestosterone (17[alpha]-methyl-5[alpha]-androst-2-en-17[Beta]-ol)

Other name: madol 25. 4-Dihydrotestosterone (17[beta]-hydroxyandrostan-3-one)

Drostanolone (17[beta]-hydroxy-2[alpha]-methyl-5[alpha]-androstan-3-one)
Ethylestrenol (17[alpha]-ethyl-17[beta]-hydroxyestr-4-ene)
Fluoxymesterone (9-fluoro-17[alpha]-methyl-11[beta],17[beta]-dihydroxyandrost- 4-en-3-one)
Formebolone (2-formyl-17[alpha]-methyl-11[alpha],17[beta]-dihydroxyandrost- 1,4-dien-3-one)
Furazabol (17[alpha]-methyl-17[beta]-hydroxyandrostano[2,3-c]-furazan)
4-Hydroxy-19-nortestosterone (4,17[beta]-dihydroxyestr-4-en-3-one)
4-Hydroxytestosterone (4,17[beta]-dihydroxyandrost-4-en-3-one)
Mestanolone (17[alpha]-methyl-17[beta]-hydroxy-5[alpha]-androstan-3-one)
Mesterolone (1[alpha]-methyl-17[beta]-hydroxy-5[alpha]-androstan-3-one)
Methandienone (17[alpha]-methyl-17[beta]-hydroxyandrost-1,4-diene-3-one)
Methandriol (17[alpha]-methyl-3[beta],17[beta]-dihydroxyandrost-5-ene)
Methasterone (2[alpha],17[alpha]-dimethyl-5[alpha]-androstan-17[beta]-ol-3-one)
Methenolone (1-methyl-17[beta]-hydroxy-5[alpha]-androst-1-en-3-one)
Methyldienolone (17[alpha]-methyl-17[beta]-hydroxyestra-4,9(10)-dien-3-one)
Methyltestosterone (17[alpha]-methyl-17[beta]-hydroxyandrost-4-en-3-one)
Methyltrienolone (17[alpha]-methyl-17[beta]-hydroxyestra-4, 9,11-trien-3-one)
Mibolerone (7[alpha],17[alpha]-dimethyl-17[beta]-hydroxyestr-4-en-3-one)
Nandrolone (17[beta]-hydroxyestr-4-en-3-one)
19-Nor-4,9(10)-androstadienedione (estra-4,9(10)-diene-3,17-dione)
19-Nor-4-androstenediol (3[alpha],17[beta]-dihydroxyestr-4-ene)
19-Nor-4-androstenediol (3[beta],17[beta]-dihydroxyestr-4-ene)
19-Nor-5-androstenediol (3[alpha],17[beta]-dihydroxyestr-5-ene)
19-Nor-5-androstenediol (3[beta],17[beta]-dihydroxyestr-5-ene)
19-Nor-4-androstenedione (estr-4-en-3,17-dione)
19-Nor-5-androstenedione (estr-5-en-3,17-dione)
Norbolethone (13[beta],17[alpha]-diethyl-17[beta]-hydroxygon-4-en-3-one)
Norclostebol (4-chloro-17[beta]-hydroxyestr-4-en-3-one)
Norethandrolone (17[alpha]-ethyl-17[beta]-hydroxyestr-4-en-3-one)
Normethandrolone (17[alpha]-methyl-17[beta]-hydroxyestr-4-en-3-one)
Oxandrolone (17[alpha]-methyl-17[beta]-hydroxy-2-oxa-5[alpha]-androstan-3one)
Oxymesterone (17[alpha]-methyl-4,17[beta]-dihydroxyandrost-4-en-3-one)
Oxymetholone (17[alpha]-methyl-2-hydroxymethylene-17[beta]-hydroxy- [5[alpha]]-androstan-3-one)
Prostanozol (17[beta]-hydroxy-5[alpha]-androstano[3,2-c]pryazole)
Stanozolol (17[alpha]-methyl-17[beta]-hydroxy-[5[alpha]]-androst-2-eno[3,2-c]pyrazole)
Stenbolone (17[beta]-hydroxy-2-methyl-[5[alpha]]-androst-1-en-3-one)
Testolactone (13-hydroxy-3-oxo-13,17-secoandrosta-1, 4-dien-17-oic acid lactone)
Testosterone (17[beta]-hydroxyandrost-4-en-3-one)
Tetrahydrogestrinone (13[beta],17[alpha]-diethyl-17[beta]-hydroxygon-4, 9,11trien-3-one)
Trenbolone (17[beta]-hydroxyestr-4,9,11-trien-3-one)

(b) Any salt, ester, or isomer of a drug or substance described or listed in subparagraph (a), if such salt, ester, or isomer promotes muscle growth.

(c) Anabolic steroids intended for administration to cattle or other non-human species are exempt from this rule unless such steroids are prescribed, dispensed, or distributed for human use.

(d) Anabolic steroids with a combination of estrogens intended for administration to hormone deficient women are exempt from this rule unless such steroids are prescribed, dispensed, or distributed to women who are not hormone deficient.

(7) Hallucinogenic Substances (a) Dronabinol (synthetic) in sesame oil and encapsulated in a soft gelatin capsule in a United States Food and Drug Administration approved drug product.................. 7369 Other names: (6aR-trans)-6a,7,8,10a-tetrahydro-6,6,9-trimethyl-3-pentyl-6H-dibenzo [b,d]pyran-1-ol or (-)-delta-9-(trans) tetrahydrocannabinol

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Amendment filed July 10, 1997; effective September 23, 1997. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed September 24, 2021; effective December 23, 2021. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.04 CONTROLLED SUBSTANCES IN SCHEDULE IV

(1) Schedule IV consists of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this rule. Each drug or substance bears the federal controlled substance code number assigned to it by the Drug Enforcement Administration.

(2) Narcotic drugs. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below:

(a) Not more than 1 milligram of difenoxin and not less than 25 micrograms of atropine sulfate per dosage unit............................................................................... 9167 (b) Dextropropoxyphene dosage forms (alpha-(+)-4-dimethylamino-1,2-diphenyl-3-methyl- 2-propionoxybutane).................................................................................. 9278 (c) Tramadol, its salts, optical and geometric isomers, and salts of these isomers....... 9752 Other names: Ultram® and Ultracet® (3) Depressants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substance, including its salts, isomers, and salts of isomers whenever the existence of such salts, isomers, and salts of isomers is possible within the specific chemical designation:

(a) Alfaxalone .............................................................................................. 2731 (b) Alprazolam.............................................................................................. 2882 (c) Barbital................................................................................................... 2145 (d) Brexanolone............................................................................................. 2400 (e) Bromazepam........................................................................................... 2748 (f) Camazepam............................................................................................ 2749 (g) Carisoprodol............................................................................................. 8192 Other name: Soma® (h) Chloral betaine.......................................................................................... 2460 (i) Chloral hydrate......................................................................................... 2465 (j) Chlordiazepoxide...................................................................................... 2744 (k) Clobazam............................................................................................... 2751 (l) Clonazepam............................................................................................ 2737 (m) Clorazepate............................................................................................. 2768 (n) Clotiazepam............................................................................................ 2752 (o) Cloxazolam.............................................................................................. 2753 (p) Daridorexant ............................................................................................ 2410 (q) Delorazepam........................................................................................... 2754 (r) Diazepam................................................................................................ 2765 (s) Dichloralphenazone................................................................................... 2467 (t) Estazolam............................................................................................... 2756 (u) Eszopiclone............................................................................................... N/A (v) Ethchlorvynol............................................................................................ 2540 (w) Ethinamate............................................................................................... 2545 (x) Ethyl Loflazepate....................................................................................... 2758 (y) Fludiazepam............................................................................................. 2759 (z) Flunitrazepam.......................................................................................... 2763 (aa) Flurazepam.............................................................................................. 2767 (bb) Fospropofol.............................................................................................. 2138 (cc) Halazepam...............................................................................................2762 (dd) Haloxazolam............................................................................................ 2771 (ee) Ketazolam............................................................................................... 2772 (ff) Lemborexant.............................................................................................................. 2245 (gg) Loprazolam.............................................................................................. 2773 (hh) Lorazepam.............................................................................................. 2885 (ii) Lormetazepam.......................................................................................... 2774 (jj) Mebutamate............................................................................................. 2800 (kk) Medazepam............................................................................................. 2836 (ll) Meprobamate........................................................................................... 2820 (mm) Methohexital............................................................................................ 2264 (nn) Methylphenobarbital (mephobarbital) ............................................................ 2250 (oo) Midazolam.................................................................................................2884 (pp) Nimetazepam........................................................................................... 2837 (qq) Nitrazepam.............................................................................................. 2834 (rr) Nordiazepam........................................................................................... 2838 (ss) Oxazepam.............................................................................................. 2835 (tt) Oxazolam................................................................................................ 2839 (uu) Paraldehyde.............................................................................................2585 (vv) Petrichloral............................................................................................... 2591 (ww) Phenobarbital........................................................................................... 2285 (xx) Pinazepam............................................................................................... 2883 (yy) Prazepam................................................................................................ 2764 (zz) Quazepam............................................................................................... 2881 (aaa) Remimazolam........................................................................................................... 2846 (bbb) Suvorexant.............................................................................................. 2223 (ccc) Temazepam............................................................................................. 2925 (ddd) Tetrazepam.............................................................................................. 2886 (eee) Triazolam................................................................................................... 2887 (fff) Zaleplon ................................................................................................. 2781 (ggg) Zolpidem................................................................................................. 2783 (hhh) Zopiclone................................................................................................ 2784 (iii) Zuranolone.............................................................................................. 2420 (4) Lorcaserin. Any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts, isomers, and salts of such isomers, whenever the existence of such salts, isomers, and salts of isomers is possible:

(a) Lorcaserin............................................................................................... 1625 (5) Stimulants. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a stimulant effect on the central nervous system, including its salts, isomers and salts of isomers:

(a) Cathine ((+)-norpseudoephedrine)................................................................ 1230 (b) Diethylpropion............................................................................................. 1610 (c) Fencamfamin............................................................................................ 1760 (d) Fenproporex............................................................................................ 1575 (e) Mazindol.................................................................................................. 1605 (f) Mefenorex............................................................................................... 1580 (g) Modafinil.................................................................................................. 1680 (h) Pemoline (including organometallic complexes and chelates thereof)................... 1530 (i) Phentermine............................................................................................. 1640 (j) Pipradol.................................................................................................. 1750 (k) Serdexmethylphenidate............................................................................................ 1729 (l) Sibutramine............................................................................................. 1675 (m) Solriamfetol............................................................................................. 1650 (n) SPA ((-)-1-dimethylamino-1,2-diphenylethane) ................................................ 1635 (6) Other substances. Unless specifically excepted or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances, including its salts:

(a) Pentazocine............................................................................................. 9709 (b) Butorphanol (including its optical isomers)..................................................... 9720 (c) Eluxadoline (5-[[[(2S)-2-amino-3-[4-aminocarbonyl)-2,6-dimethylphenyl]-1oxopropyl][(1S)-1-(4-phenyl-1H-imidazol-2-yl)ethyl]amino]methyl]-2-methoxybenzoic acid) (including its optical isomers) and its salts, isomers, and salts of isomers...... 9725

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed October 1, 2020; effective December 30, 2020. Amendments filed September 24, 2021; effective December 23, 2021. Amendments filed October 3, 2022; effective January 1, 2023. Amendments filed March 1, 2024; effective May 30, 2024. Amendments filed September 19, 2024; effective December 18, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.05 CONTROLLED SUBSTANCES IN SCHEDULE V

(1) Schedule V consists of the drugs and other substances, by whatever official name, common or usual name, chemical name, or brand name designated, listed in this rule. Each drug or substance bears the federal controlled substance code number assigned to it by the Drug Enforcement Administration.

(2) Narcotic drugs containing non-narcotic active medicinal ingredients. Any compound, mixture, or preparation containing any of the following narcotic drugs, or their salts calculated as the free anhydrous base or alkaloid, in limited quantities as set forth below, which shall include one or more non-narcotic active medicinal ingredients in sufficient proportion to confer upon the compound, mixture, or preparation valuable medicinal qualities other than those possessed by narcotic drugs alone:

(a) Not more than 200 milligrams of codeine per 100 milliliters or per 100 grams.

(b) Not more than 100 milligrams of dihydrocodeine per 100 milliliters or per 100 grams.

(d) Not more than 2.5 milligrams of diphenoxylate and not less than 25 micrograms of atropine sulfate per dosage unit.

(e) Not more than 100 milligrams of opium per 100 milliliters or per 100 grams.

(f) Not more than 0.5 milligrams of difenoxin and not less than 25 micrograms of atropine sulfate per dosage unit.

(3) Stimulants. Unless specifically exempted or excluded, or unless listed in another schedule, any material, compound, mixture or preparation that contains any quantity of the following substances having a stimulant effect on the central nervous system, including its salts, isomers, and salts of the isomers:

(a) Pyrovalerone........................................................................................... 1485 (4) Depressants. Unless specifically exempted or excluded or unless listed in another schedule, any material, compound, mixture, or preparation which contains any quantity of the following substances having a depressant effect on the central nervous system, including its salts:

(a) Brivaracetam ((2S)-2-[(4R)-2-oxo-4-propylpyrrolidin-1-yl] butanamide)................ 2710 (b) Cenobamate ([(1R)-1-(2-chlorophenyl)-2-(tetrazol-2- yl)ethyl]carbamate)............. 2720 (c) Ezogabine [N-[2-amino-4-(4-fluorobenzylamino)-phenyl]-carbamic acid ethyl ester] ............................................................................................................. 2779 (d) Gabapentin [1-(aminomethyl)cyclohexaneacetic acid]

(e) Ganaxolone (3-alpha-hydroxy-3-beta-methyl-5-alpha-pregnan-20-one)................ 2401 (f) Lacosamide [(R)-2-acetoamido-N-benzyl-3-methoxy-propionamide].................... 2746 (g) Lasmiditan [2,4,6-trifluoro-N-(6-(1-methylpiperidine-4-carbonyl)pyridine-2yl)benzamide].......................................................................................... 2790 (h) Pregabalin [(S)-3-(aminomethyl)-5-methylhexonoic acid]................................... 2782

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Repeal and new rules filed October 1, 2019; effective December 30, 2019. Amendments filed October 1, 2020; effective December 30, 2020. Amendments filed September 24, 2021; effective December 23, 2021. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.06 CONTROLLED SUBSTANCES IN SCHEDULE VI

(1) Marijuana........................................................................................................ 7360 (2) Tetrahydrocannabinols....................................................................................... 7370 (3) Unless specifically excepted or unless listed in another schedule, synthetic equivalents of the substances contained in the plant, or in the resinous extractives of Cannabis, sp. and/or synthetic substances, derivatives, and their isomers with similar chemical structure and pharmacological activity. Examples include the following drugs or their compounds regardless of numerical designation of atomic positions covered:

(a) 1 cis or trans tetrahydrocannabinol, and its optical isomers.

(b) 6 cis or trans tetrahydrocannabinol, and its optical isomers.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.07 CONTROLLED SUBSTANCES IN SCHEDULE VII

(1) Butyl nitrite and any isomer of butyl nitrite.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.08 NON-NARCOTIC SUBSTANCES EXCLUDED FROM CONTROLLED SUBSTANCES

(1) Non-narcotic substances listed in the most current edition of 21 C.F.R. 1308.22, are excluded from all schedules.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed April 29, 1981; effective June 18, 1981. Repeal and new rule filed May 25, 1984; effective June 24, 1984. Repeal and new rule filed September 6, 1985; effective October 10, 1985. Repeal and new rule filed December 17, 1986; effective January 31, 1987. Amendment filed July 10, 1997; effective September 23, 1997. Repeal and new rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.09 CHEMICAL PREPARATIONS EXCLUDED FROM CONTROLLED SUBSTANCES

(1) Chemical preparations listed in the most current edition of 21 C.F.R. 1308.24, are excluded from all schedules.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.10 VETERINARY ANABOLIC STEROID IMPLANT PRODUCTS EXCLUDED FROM

CONTROLLED SUBSTANCES.

(1) Veterinary anabolic steroid implant products listed in the most current edition of 21 C.F.R. 1308.26, are excluded from all schedules.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.11 PRESCRIPTION PRODUCTS EXCLUDED FROM CONTROLLED SUBSTANCES

(1) Prescription products listed in the most current edition of 21 C.F.R. 1308.32, are excluded from all schedules.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed January 7, 2011; effective April 7, 2011. Repeal and new rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.12 ANABOLIC STEROID PRODUCTS EXCLUDED FROM CONTROLLED

SUBSTANCES.

(1) Anabolic steroid products listed in the most current edition of 21 C.F.R. 1308.34, are excluded from all schedules.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Tenn. Comp. R. & Regs. 0940-06-01-.13 CERTAIN CANNABIS PLANT MATERIAL, AND PRODUCTS MADE THEREFROM,

EXCLUDED FROM CONTROLLED SUBSTANCES.

(1) Certain cannabis plant material, and products made therefrom, that contain tetrahydrocannabinols listed in the most current edition of 21 C.F.R. 1308.35, are excluded from all schedules.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-303, 33-1-305, 33-1-309, and 39-17-403.
Administrative History: Original rule filed December 20, 2013; effective March 20, 2014. Repeal and new rule filed February 24, 2015; effective May 25, 2015. Repeal and new rule filed March 4, 2016; effective June 2, 2016. Repeal and new rules filed March 21, 2017; effective June 19, 2017. Repeal and new rules filed July 5, 2018; effective October 3, 2018. Amendments filed March 1, 2024; effective May 30, 2024.

Chapter 0940-06-02 Repealed

Tenn. Comp. R. & Regs. 0940-06-02 Repealed

RULES

OF THE TENNESSEE DEPARTMENT OF MENTAL HEALTH

AND SUBSTANCE ABUSE SERVICES

Chapter 0940-06-03 Drug Overdose by Student

Tenn. Comp. R. & Regs. 0940-06-03-.01 DEFINITIONS

“Drug”, as used in these rules, means any of the substances treated as controlled substances under T.C.A. Title 39, Chapter 17, Part 4.

History

Authority: T.C.A. §§ 4-5-202 and 68-24-301 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed August 17, 1997; effective October 27, 1997. Rule transferred from 1200-30-02 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007).

Tenn. Comp. R. & Regs. 0940-06-03-.02 REQUIRED DATA ELEMENTS

(1) Who must report:

(a) Every physician or other medical professional who makes a diagnosis of or treats a person, who is believed to be enrolled in school in a K through 12 grade, for a drug overdose.

(b) Every chief administrative officer of a hospital, clinic, or dispensary in which there is a case of drug overdose of such a person.

(2) Data to be reported: The following data for each reported overdose shall be provided to the appropriate public school superintendent on a form provided by the Tennessee Department of Health. Each report shall contain no other information.

(a) Type of drug (b) Name of school in which student is enrolled (c) Name and address of reporting authority

History

Authority: T.C.A. §§ 4-5-202 and 68-24-301301 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed August 7, 1997; effective October 27, 1997. Rule transferred from 1200-30-02 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007).

Tenn. Comp. R. & Regs. 0940-06-03-.03 SUBMISSION TIME LINE

All required data shall be submitted on the form provided by the Department of Health to the local school superintendent within seven (7) calendar days of the overdose.

History

Authority: T.C.A. §§ 4-5-202, 68-1-104(l), and 68-24-301301 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed August 7, 1997; effective October 27, 1997. Rule transferred from 1200-30-02 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007).

Tenn. Comp. R. & Regs. 0940-06-03-.04 PENALTY FOR FAILURE TO REPORT

Any person who fails to perform the duties imposed by T.C.A. § 68-24-301 is guilty of professional misconduct and for that failure is subject to professional discipline by the licensing agency or employment disciplinary action by the employer.

History

Authority: T.C.A. §§ 4-5-202 and 68-24-301 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed August 7, 1997; effective October 27, 1997. Rule transferred from 1200-30-02 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007).

Tenn. Comp. R. & Regs. 0940-06-03-.05 CONFIDENTIAL INFORMATION

(1) All information reported under this part is confidential.

(2) In no event may patient identifiers be collected.

History

Authority: T.C.A. §§ 4-5-202 and 68-24-301301 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed August 7, 1997; effective October 27, 1997. Rule transferred from 1200-30-02 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007).

Chapter 0940-06-04 Alcohol and Drug Addiction Treatment Fund Services for D.U.I. Offenders and People with Problem Gambling Disorders

Tenn. Comp. R. & Regs. 0940-06-04-.01 PURPOSE AND SCOPE

(1) The purpose of this chapter is to regulate specific services to Tennesseans who meet eligibility criteria for participation in the Tennessee Department of Mental Health and Substance Abuse Services’ (TDMHSAS) Alcohol and Drug Addiction Treatment (ADAT)

Program, including:

(a) Assessment and treatment for people convicted of a current D.U.I. offense; and (b) Prevention, early intervention, assessment or referral, and treatment services for individuals and their families who have experienced problems with compulsive gambling.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 40-33-211, 55-10-403, 55-50-504, 68-1-103, 68-24-101, and 68-24-201 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed June 14, 2006; effective August 28, 2006. Rule was transferred from 1200-30- 03 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007). Repeal and new rule filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-06-04-.02 DEFINITIONS

(1) “ADAT Funds for D.U.I. Offenders” means dollars statutorily allocated to the ADAT Fund for D.U.I. Offenders for alcohol and drug abuse or dependency assessment and treatment services targeted to offenders convicted of driving under the influence (D.U.I.) of alcohol and/or other drugs and who meet program eligibility criteria.

(2) “ADAT Program for D.U.I. Offenders” means the program established by TDMHSAS for the alcohol and drug abuse assessment and treatment of D.U.I. offenders who meet program eligibility criteria.

(3) “ADAT Problem Gambling Program” means the program established by TDMHSAS for the prevention, early intervention, assessment or referral, and evaluation services related to compulsive gambling disorder.

(4) “Alcohol and/or Drug Abuse or Dependency” means disorders characterized by the continuous or episodic use of alcohol and/or other drugs resulting in maladaptive patterns of use as defined in currently accepted diagnostic nomenclature for abuse or dependency.

(5) “ASAM PPCCR” means the most current version of the American Society of Addiction Medicine Patient Placement Criteria Case Review for assessing and reassessing the service recipient’s levels of care.

(6) “ASI” means Addiction Severity Index, a standardized multi-focused screening/assessment tool used to collect information regarding the nature and severity of problems of substance abusers.

(7) “Assessment” means a documented evaluation of a service recipient for the purpose of determining prevention, treatment and/or rehabilitation needs. An assessment may, but does not necessarily, include examinations and tests determined to be necessary by the service staff based on the presenting problems and symptoms of the individual service recipient.

(8) “Authorization List” means the list of approved service recipients eligible for participation in the TDMHSAS ADAT Program for D.U.I. Offenders.

(9) “Compulsive Gambling Disorder” or “Problem Gambling” means gambling behavior which causes disruptions in any major area of life: psychological, physical, social or vocational.

(10) “Current D.U.I. Conviction” means, for the purposes of this chapter:

(a) A person has been convicted of one (1) or more of the following offenses by a Tennessee Court of competent jurisdiction:

A first or subsequent D.U.I. offense under T.C.A. § 55-10-401; and/or 2. Driving with a cancelled, suspended or revoked license due to a D.U.I. conviction; and (b) As long as the person remains on probation for the D.U.I. offense, the conviction remains current.

(11) “Department” means the Tennessee Department of Mental Health and Substance Abuse Services.

(12) “D.U.I.” means driving under the influence of any intoxicant, marijuana, narcotic drug, or drug producing stimulating effects on the central nervous system as set forth in T.C.A. § 55-10- 401.

(13) “Ignition Interlock” means a breath alcohol analysis device which is connected to a vehicle’s ignition system. The driver must blow a breath sample into the device and obtain an acceptable breath alcohol reading before the vehicle will start.

(14) “Individualized Program Plan (treatment plan)” means a document developed by the treatment staff or team and the service recipient which identifies the service recipient’s problems and specifies goals to be addressed in treatment and the interventions used to accomplish these goals.

(15) “Resource Provider List” means the list of approved treatment providers with which TDMHSAS contracts for the treatment of service recipients who meet eligibility criteria for a program.

(16) “Service Recipient” means a Tennessean who meets the eligibility criteria for a program described in this chapter.

(17) “Treatment Provider” means any facility licensed by the Department to provide alcohol and drug abuse treatment services that meets eligibility criteria for participation in the ADAT program.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 40-33-211, 55-10-403, 55-50-504, 68-1-103, 68-24-101, and 68-24-201 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed June 14, 2006; effective August 28, 2006. Rule was transferred from 1200-30- 03 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007). Repeal and new rule filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-06-04-.03 ELIGIBILITY FOR PARTICIPATION IN THE TDMHSAS ADAT PROGRAM FOR D.U.I

OFFENDERS.

(1) A person is eligible to become a service recipient in the TDMHSAS ADAT Program for D.U.I.

Offenders when that person has:

(a) One (1) or more current D.U.I. convictions as defined in Rule 0940-06-04-.02(10);

(b) Been ordered by the court, as a result of the above current conviction(s), to participate in an alcohol or drug treatment program; and (c) Been deemed indigent under T.C.A. § 55-10-403(a)(4)(B) by the court.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 40-33-211, 55-10-403, 55-50-504, 68-1-103, 68-24-101, and 68-24-201 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed June 14, 2006; effective August 28, 2006. Rule was transferred from 1200-30- 03 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007). Repeal and new rule filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-06-04-.04 ADMITTING SERVICE RECIPIENTS TO THE TDMHSAS ADAT PROGRAM FOR

D.U.I. OFFENDERS.

(1) Once a service recipient becomes eligible to participate in the TDMHSAS ADAT Program for D.U.I. Offenders according to the criteria set forth in rule 0940-06-04-.03, the following shall occur, subject to the availability of funding and resources:

(a) The court shall cause to be provided to the Department copies of the following:

The court order;
The judgment or guilty plea; and 3. The determination and documentation of indigence as specified by T.C.A. § 55- 10-403(a)(4)(B).

(2) Once the Department receives from the court a copy of the order authorizing treatment for a service recipient and certifying that such service recipient is eligible for the TDMHSAS ADAT Program for D.U.I. Offenders, the Department shall add the service recipient’s name to its Authorization List, and it shall provide the service recipient or authorized party making such request on the service recipient’s behalf with its Resource Provider List and with instructions for contacting a treatment provider; and (a) The service recipient, or an authorized party acting on the service recipient’s behalf, shall contact a treatment provider included on the Resource Provider List; and (b) The Department shall send the service recipient, other authorized party acting on the service recipient’s behalf, and the treatment provider, a written letter authorizing the service recipient to be admitted to the TDMHSAS ADAT Program for D.U.I. Offenders; and (c) Upon admission of the service recipient into treatment, the treatment provider shall administer the most current edition of the ASAM PPCCR. The treatment provider shall assess the service recipient using the ASI, and it shall complete admission, continued stay and discharge reviews per ASAM PPCCR.

(3) The treatment provided to a service recipient shall be based on an Individualized Program Plan (Treatment Plan) developed and implemented by the treatment provider and service recipient, which may include an assessment service and/or any of the following treatment services:

(a) Ambulatory Services, which include:

Individual Outpatient (ASAM Level I);
Group Outpatient (ASAM Level I);
Intensive Outpatient (ASAM Level II.1); and 4. Partial Hospitalization (ASAM Level II.5).

(b) Detoxification Services, which include:

Clinically-Managed Detoxification (ASAM Level III-2D); and 2. Medically-Monitored Detoxification (ASAM Level III-7D).

Clinically-Managed Low-Intensity (Halfway House) (ASAM Level III.1);
Clinically-Managed Medium-Intensity (ASAM Level III.3);
Clinically-Managed High-Intensity (ASAM Level III.5); and 4. Medically-Monitored Intensive (ASAM Level III.7).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 40-33-211, 55-10-403, 55-50-504, 68-1-103, 68-24-101, and 68-24-201 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed June 14, 2006; effective August 28, 2006. Rule was transferred from 1200-30- 03 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007). Repeal and new rule filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-06-04-.05 MONITORING SERVICE RECIPIENT COMPLIANCE AND DISCHARGING SERVICE

RECIPIENTS FROM THE TDMHSAS ADAT PROGRAM FOR D.U.I. OFFENDERS.

(1) Each treatment provider shall send the Department, at a minimum, on a monthly basis the “service recipient encounter data” for its service recipients. The service recipient encounter data shall, when appropriate, include notification that a given service recipient has successfully completed his or her Individualized Program Plan (treatment plan).

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 40-33-211, 55-10-403, 55-50-504, 68-1-103, 68-24-101, and 68-24-201 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed June 14, 2006; effective August 28, 2006. Repeal and new rule filed January 4, 2010; effective January 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-06-04-.06 PAYMENT OF TREATMENT PROVIDERS FOR SERVICES RENDERED TO ADAT

PROGRAM SERVICE RECIPIENTS.

(1) The treatment provider’s monthly “service recipient encounter data” required by rule 0940-06- 04-.05 shall include “claim encounter data” which is used to generate an electronic invoice for services rendered by the treatment provider for the applicable month.

(2) In accordance with the terms of the contract between the Department and treatment providers, the Department shall reimburse each treatment provider on a monthly basis using available TDMHSAS ADAT Funds for D.U.I. Offenders based upon the electronic invoice that is generated when the “service recipient encounter data” is received.

History

Authority: T.C.A. §§ 4-4-103, 4-5-202, 4-5-204, 33-1-302, 33-1-305, 40-33-211, 55-10-403, 55-50-504, 68-1-103, 68-24-101, and 68-24-201 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed June 14, 2006; effective August 28, 2006. Rule was transferred from 1200-30- 03 on May 15, 2008, pursuant to Executive Order 44 (February 23, 2007). Repeal and new rule filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-06-04-.07 PAYMENT OF IGNITION INTERLOCK DEVICES

(1) If the court makes a specific finding that it is in the best interest of an individual who meets ADAT Program eligibility criteria, and that it is in the best interest of the public, monies in the TDMHSAS ADAT Fund for D.U.I. Offenders may be used to pay the reasonable cost of leasing, buying, installing, monitoring, and maintaining an ignition interlock device that is ordered for that individual pursuant to T.C.A. § 55-10-412(l), provided that the device does not substitute for treatment for the person.

(2) Application for the use of such funds shall be subject to the review and approval of the Department according to established policies and procedures.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, 40-33-211, 55-10-401, 55-10-412, 68-1-103, 68-24- 101, and 68-24-201 and Executive Order 44 (February 23, 2007).
Administrative History: Original rule filed June 14, 2006; effective August 28, 2006. Repeal and new rule filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.

Tenn. Comp. R. & Regs. 0940-06-04-.08 TDMHSAS ADAT PROBLEM GAMBLING PROGRAM

(1) Under T.C.A. § 40-33-211, a portion of the TDMHSAS ADAT Funds for D.U.I. Offenders shall be used to fund the TDMHSAS ADAT Problem Gambling Program along with any grants, gif ts, or contributions, or other appropriations made to supplement the fund for services.

(2) The TDMHSAS ADAT Problem Gambling Program shall provide prevention, early intervention, assessment or referral, and evaluation services including the following:

(a) Establishing an information and referral hotline to provide public education regarding compulsive gambling and to make treatment referrals;

(b) Coordinating activities, services and gathering data on the prevalence of problems regarding compulsive gambling;

(c) Training personnel in the prevention of gambling disorders and in the screening and assessment of these disorders; and (d) Making assessment services available through local treatment providers.

(3) The TDMHSAS ADAT Problem Gambling Program shall provide treatment services only to the extent that funds exist to do so and still accomplish the goals of the ADAT fund under T.C.A. § 40-33-211.

History

Authority: T.C.A. §§ 4-4-103, 33-1-302, 33-1-305, and 40-33-211.
Administrative History: Original rule filed January 4, 2010; effective April 4, 2010. Administrative corrections made to agency names in December 2022 pursuant to Public Chapter 575 of 2012.